摘要
目的:探讨髋关节置换术并发假体周围骨折的危险因素。方法:检索Pubmed、Embase、Cochrane Library、中国知网、万方数据库,截至2018年11月,并且逆行查找相关文献的参考文献,以求查全。采用Newcastle Ottawa量表对纳入文献的质量进行评估。主要运用Revman 5.3进行原始数据的合并与检验。结果:本次Meta分析共纳入17篇文献,总样本量为90 632例。结果显示:女性(OR=1.62,95%CI:1.44~1.82,P<0.01),翻修(OR=3.78,95%CI:1.88~7.58,P<0.01),术前诊断为类风湿性关节炎(OR=1.60,95%CI:1.07~2.37,P=0.02)的存在,增加了髋关节置换术假体周围骨折的风险。而骨水泥假体固定方式(OR=0.43,95%CI:0.27~0.68,P<0.01),则会减少髋关节置换术假体周围骨折的发生。其他因素,如年龄,术前诊断(股骨头坏死、骨性关节炎、发育性髋关节发育不良、股骨骨折、伴随心脏病)和ASA(美国麻醉医师协会)分级≥3,与髋关节置换术假体周围骨折均无明显相关性。结论:骨科医师应警惕女性、翻修和术前诊断为类风湿性关节炎等危险因素,当出现上述因素时,髋关节置换术中应操作轻柔,术后应密切指导患者功能锻炼,以防假体周围骨折。
Objective:To explore risk factors of the periprosthetic fracture after hip arthroplasty.Methods:Potential studies were searched in databases including Pubmed,Embase,Cochrane Library,CNKI as well as Wanfang Database up to November 2018 and references in related literatures.The methodological quality of literature was estimated by Newcastle Ottawa Scale.Raw data were merged and tested mainly by Revmain 5.3.Results:Seventeen studies in total were appropriate with90 632 patients.The results revealed that it increased the risk of periprosthetic fracture after hip arthroplasty,including female(OR=1.62,95%CI:1.44 to 1.82,P<0.01),revision(OR=3.78,95%CI:1.88 to 7.58,P<0.01),preoperative diagnosis of rheumatoid arthritis(OR=1.60,95%CI:1.07 to 2.37,P=0.02).Conversely,patients involved with cemented prosthesis fixation(OR=0.43,95%CI:0.27 to 0.68,P<0.01)were less likely to suffer periprosthetic fracture after hip arthroplasty.Other factors were not significantly relevant to periprosthetic fracture after hip arthroplasty,including the age,preoperative diagnosis(femoral head necrosis,osteoarthritis,developmental dysplasia of the hip,femoral fracture,concomitant heart diseases)and American Society of Anesthesiologists≥3.Conclusion:Orthopedics doctors should constantly be cantious about the risk factors including female,revision and diagnosis of rheumatoid arthritis.They are supposed to prevent the periprosthetic fracture by gentle operation during hip arthroplasty and monitoring the functional exercise after operations when the above risk factors occur.
作者
鹿战
刘沛东
史俊龙
雷宏伟
杨自权
LU Zhan;LIU Pei-dong;SHI Jun-long;LEI Hong-wei;YANG Zi-quan(Department of Osteoarthritis,the Second Hospital of Shanxi Medical University,Taiyuan 030000,Shanxi,China;不详)
出处
《中国骨伤》
CAS
CSCD
2019年第6期557-563,共7页
China Journal of Orthopaedics and Traumatology
基金
山西省人才专项优秀人才科技创新项目(编号:201705D211022)~~
