AIM To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate.METHODS Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless ...AIM To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate.METHODS Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless and hybrid total hip replacement(THR) were performed. Two independent reviewers evaluated the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate of each implants with a pre-determined form. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Funnel plots were analyzed. RESULTS Twenty-seven studies comprising 5 clinical trials, 9 cohorts, and 13 registers fulfilled the research criteria and analyzed. Compared to cementless THR, cemented THR have pooled RR of 0.47(95%CI: 0.45-0.48), 0.9(0.84-0.95), 1.29(1.06-1.57) and 0.69(0.6-0.79) for revision due to any reason, revision due to aseptic loosening, revision due to infection, and dislocation respectively. Compared to hybrid THR, the pooled RRs of cemented THR were 0.82(0.76-0.89), 2.65(1.14-6.17), 0.98(0.7-1.38), and 0.67(0.57-0.79) respectively. Compared to hybrid THR, cementless THR had RRs of 0.7(0.65-0.75), 0.85(0.49-1.5), 1.47(0.93-2.34) and 1.13(0.98-1.3).CONCLUSION Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival.展开更多
目的评价保髋手术后继发重度骨关节炎的发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者行人工全髋关节置换术(total hip arthroplasty,THA)术后的早中期临床疗效。方法回顾分析2009年9月—2021年3月收治的保髋术后...目的评价保髋手术后继发重度骨关节炎的发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者行人工全髋关节置换术(total hip arthroplasty,THA)术后的早中期临床疗效。方法回顾分析2009年9月—2021年3月收治的保髋术后继发重度骨关节炎并接受THA的25例(31髋)DDH患者临床资料。男1例,女24例;年龄18~65岁,平均43岁。Crowe分型为Ⅰ型8髋,Ⅱ型9髋,Ⅲ型3髋,Ⅳ型11髋。截骨手术距此次THA时间为13~51年,平均31.96年。术前髋关节屈曲活动度(69.31±29.72)°,外展活动度(24.00±14.79)°;Harris评分(45.3±15.5)分。分析患者术后Harris评分、髋关节活动度、并发症、影像学结果和假体生存率。结果两组患者均获随访,随访时间2~132个月,平均51个月。1例股骨柄远端出现假体周围骨折;无髋关节脱位、假体周围感染、神经麻痹或下肢深静脉血栓形成等并发症发生。末次随访时髋关节屈曲活动度为(109.52±11.17)°,外展活动度为(41.25±5.59)°,与术前比较差异有统计学意义(t=8.260,P=0.000;t=6.524,P=0.000)。Harris评分为(91.5±4.1)分,与术前比较差异亦有统计学意义(t=11.696,P=0.000);其中优13例,良12例。影像学评估显示,髋臼旋转中心上移0~18 mm,平均6.35 mm;髋臼外展角28°~49°,平均37.74°;臼杯覆盖率为69.44%~98.33%,平均81.04%。所有股骨柄均中立位固定,未见内翻或外翻;未见假体周围骨溶解、透亮线发生;所有假体固定在位,未见松动及移位。截止随访终点,所有患者均未接受翻修手术,假体生存率为100%。结论对于保髋术后继发重度骨关节炎的DDH患者,THA仍是治疗该类患者的金标准,术后患者可迅速恢复关节功能,生活质量明显改善,假体的早中期生存率令人满意。展开更多
目的探讨自体块状骨移植重建牙槽骨骨量不足后种植修复的临床效果。方法 2010年1月至2016年12月完成的自体块状骨移植结合引导骨再生技术(guided bone regeneration,GBR)重建牙槽骨骨量不足的病例共30例,植入种植体共81颗。按照自体块...目的探讨自体块状骨移植重建牙槽骨骨量不足后种植修复的临床效果。方法 2010年1月至2016年12月完成的自体块状骨移植结合引导骨再生技术(guided bone regeneration,GBR)重建牙槽骨骨量不足的病例共30例,植入种植体共81颗。按照自体块状骨的供区来源分为颌骨组(16例34颗)和髂骨组(14例47颗)两组,通过临床随访及影像学检查,分别计算并比较其种植体存留率。结果 30例自体块状骨移植结合GBR后骨增量明显且愈合良好,术后均无明显供区并发症。同期或延期种植体植入,经平均7.8个月(4~18个月)骨结合期后,除1例种植体因松动拔除,其余29例均完成永久修复。种植体植入后平均随访期为26个月(9~68个月),植入的81颗种植体在随访期内存留率为98.76%。其中颌骨组升支取骨失败1颗,种植体存留率为97.06%;髂骨组失败0颗,种植体存留率为100%,两者统计学上无显著性差异(P>0.05)。结论自体块状骨移植重建牙槽骨骨量不足后种植修复,其种植体存留率,较骨量正常情况下的种植修复无明显差异。颌骨与髂骨两种供区的块状自体骨,其移植重建牙槽骨骨量不足均可取得理想的种植修复临床效果。但颌骨内取骨因避免了第二术区、减少手术时间、术后并发症小等优点,临床上应予以优先选择。展开更多
BACKGROUND The conventional implant approach involves flap elevation,which may result in increased soft tissue and bone loss and postoperative morbidity.The flapless surgical technique,aided by three-dimensional medic...BACKGROUND The conventional implant approach involves flap elevation,which may result in increased soft tissue and bone loss and postoperative morbidity.The flapless surgical technique,aided by three-dimensional medical imaging equipment,is regarded as a possible alternative to the conventional approach to alleviate the above issues.Several studies have been performed regarding the role of flapless implant surgery.However,the results are inconsistent and there is no robust synthesis of long-term evidence to better inform surgeons regarding which type of surgical technique is more beneficial to the long-term prognosis of patients in need of implant insertion.AIM To compare the long-term clinical performance after flapless implant surgery to that after the conventional approach with flap elevation.METHODS PubMed,EMBASE,Cochrane Central Register of Controlled Trials,and grey literature databases were searched from inception to 23 September 2019.Randomised controlled trials (RCTs) and cohort studies comparing the long-term clinical performance after flapless implant surgery to that after the conventional approach over a follow-up of three years or more were induded.Meta-analyses were conducted to estimate the odds ratios (ORs) or mean differences (MDs) and their 95 To confidence intervals (CIs) between the long-term implant survival rate,marginal bone loss,and complication rate of the flapless and conventional groups.Subgroup analyses were carried out to account for the possible effects of the guided or free-hand method during flapless surgery.RESULTS Ten articles,including four RCTs and six cohort studies,satisfied the eligibility criteria and nine of them were inclded in the meta-analysis.There was no significant difference between the long-term implant survival rate [OR=1.30,95%CI (0.37,4.54),P=0.68],marginal bone loss [MD=0.01,95%CI (-0.42,0.44),P=0.97],and complication rate [OR=1.44,95%CI (0.77,2.68),P=0.25] after flapless implant surgery and the conventional approach.Moreover,subgroup analyses revealed that the展开更多
文摘AIM To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate.METHODS Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless and hybrid total hip replacement(THR) were performed. Two independent reviewers evaluated the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate of each implants with a pre-determined form. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Funnel plots were analyzed. RESULTS Twenty-seven studies comprising 5 clinical trials, 9 cohorts, and 13 registers fulfilled the research criteria and analyzed. Compared to cementless THR, cemented THR have pooled RR of 0.47(95%CI: 0.45-0.48), 0.9(0.84-0.95), 1.29(1.06-1.57) and 0.69(0.6-0.79) for revision due to any reason, revision due to aseptic loosening, revision due to infection, and dislocation respectively. Compared to hybrid THR, the pooled RRs of cemented THR were 0.82(0.76-0.89), 2.65(1.14-6.17), 0.98(0.7-1.38), and 0.67(0.57-0.79) respectively. Compared to hybrid THR, cementless THR had RRs of 0.7(0.65-0.75), 0.85(0.49-1.5), 1.47(0.93-2.34) and 1.13(0.98-1.3).CONCLUSION Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival.
文摘目的评价保髋手术后继发重度骨关节炎的发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者行人工全髋关节置换术(total hip arthroplasty,THA)术后的早中期临床疗效。方法回顾分析2009年9月—2021年3月收治的保髋术后继发重度骨关节炎并接受THA的25例(31髋)DDH患者临床资料。男1例,女24例;年龄18~65岁,平均43岁。Crowe分型为Ⅰ型8髋,Ⅱ型9髋,Ⅲ型3髋,Ⅳ型11髋。截骨手术距此次THA时间为13~51年,平均31.96年。术前髋关节屈曲活动度(69.31±29.72)°,外展活动度(24.00±14.79)°;Harris评分(45.3±15.5)分。分析患者术后Harris评分、髋关节活动度、并发症、影像学结果和假体生存率。结果两组患者均获随访,随访时间2~132个月,平均51个月。1例股骨柄远端出现假体周围骨折;无髋关节脱位、假体周围感染、神经麻痹或下肢深静脉血栓形成等并发症发生。末次随访时髋关节屈曲活动度为(109.52±11.17)°,外展活动度为(41.25±5.59)°,与术前比较差异有统计学意义(t=8.260,P=0.000;t=6.524,P=0.000)。Harris评分为(91.5±4.1)分,与术前比较差异亦有统计学意义(t=11.696,P=0.000);其中优13例,良12例。影像学评估显示,髋臼旋转中心上移0~18 mm,平均6.35 mm;髋臼外展角28°~49°,平均37.74°;臼杯覆盖率为69.44%~98.33%,平均81.04%。所有股骨柄均中立位固定,未见内翻或外翻;未见假体周围骨溶解、透亮线发生;所有假体固定在位,未见松动及移位。截止随访终点,所有患者均未接受翻修手术,假体生存率为100%。结论对于保髋术后继发重度骨关节炎的DDH患者,THA仍是治疗该类患者的金标准,术后患者可迅速恢复关节功能,生活质量明显改善,假体的早中期生存率令人满意。
文摘目的探讨自体块状骨移植重建牙槽骨骨量不足后种植修复的临床效果。方法 2010年1月至2016年12月完成的自体块状骨移植结合引导骨再生技术(guided bone regeneration,GBR)重建牙槽骨骨量不足的病例共30例,植入种植体共81颗。按照自体块状骨的供区来源分为颌骨组(16例34颗)和髂骨组(14例47颗)两组,通过临床随访及影像学检查,分别计算并比较其种植体存留率。结果 30例自体块状骨移植结合GBR后骨增量明显且愈合良好,术后均无明显供区并发症。同期或延期种植体植入,经平均7.8个月(4~18个月)骨结合期后,除1例种植体因松动拔除,其余29例均完成永久修复。种植体植入后平均随访期为26个月(9~68个月),植入的81颗种植体在随访期内存留率为98.76%。其中颌骨组升支取骨失败1颗,种植体存留率为97.06%;髂骨组失败0颗,种植体存留率为100%,两者统计学上无显著性差异(P>0.05)。结论自体块状骨移植重建牙槽骨骨量不足后种植修复,其种植体存留率,较骨量正常情况下的种植修复无明显差异。颌骨与髂骨两种供区的块状自体骨,其移植重建牙槽骨骨量不足均可取得理想的种植修复临床效果。但颌骨内取骨因避免了第二术区、减少手术时间、术后并发症小等优点,临床上应予以优先选择。
基金the Graduate Student's Research and Innovation Fund of Sichuan University,No.2018YJSY108the China Postdoctoral Science Foundation Funded Project,No.2018M640931+1 种基金the Science and Technology Key Research and Development Program of Sichuan Province,No.2019YFS0142the National Natural Science Foundation of China,No.81901060.
文摘BACKGROUND The conventional implant approach involves flap elevation,which may result in increased soft tissue and bone loss and postoperative morbidity.The flapless surgical technique,aided by three-dimensional medical imaging equipment,is regarded as a possible alternative to the conventional approach to alleviate the above issues.Several studies have been performed regarding the role of flapless implant surgery.However,the results are inconsistent and there is no robust synthesis of long-term evidence to better inform surgeons regarding which type of surgical technique is more beneficial to the long-term prognosis of patients in need of implant insertion.AIM To compare the long-term clinical performance after flapless implant surgery to that after the conventional approach with flap elevation.METHODS PubMed,EMBASE,Cochrane Central Register of Controlled Trials,and grey literature databases were searched from inception to 23 September 2019.Randomised controlled trials (RCTs) and cohort studies comparing the long-term clinical performance after flapless implant surgery to that after the conventional approach over a follow-up of three years or more were induded.Meta-analyses were conducted to estimate the odds ratios (ORs) or mean differences (MDs) and their 95 To confidence intervals (CIs) between the long-term implant survival rate,marginal bone loss,and complication rate of the flapless and conventional groups.Subgroup analyses were carried out to account for the possible effects of the guided or free-hand method during flapless surgery.RESULTS Ten articles,including four RCTs and six cohort studies,satisfied the eligibility criteria and nine of them were inclded in the meta-analysis.There was no significant difference between the long-term implant survival rate [OR=1.30,95%CI (0.37,4.54),P=0.68],marginal bone loss [MD=0.01,95%CI (-0.42,0.44),P=0.97],and complication rate [OR=1.44,95%CI (0.77,2.68),P=0.25] after flapless implant surgery and the conventional approach.Moreover,subgroup analyses revealed that the
