小切口与传统后外侧入路全髋关节置换术的荟萃分析△

A meta-analysis on mini-incision versus conventional posterolateral approach for total hip arthroplasty

摘要:

［目的］ 系统评价小切口后外侧入路与传统后外侧入路全髋关节置换术 （total hip arthroplasty, THA） 的临床效果。 ［方法］检索 PubMed、Cochrane Library、EMbase、Web of Science 、中国知网（CNKI）、万方数据库，查找所有比较小切口和传统 THA 的随机或非随机对照试验，检索时限为 2003 年 1 月—2021 年 7 月。按纳入排除标进行筛选、资料提取，采用 RevMan 5.3 软件进行荟萃分析。［结果］共纳入 14 篇文献，其中 2 篇随机对照试验，12 篇队列研究。荟萃分析结果显示：小切口组切口长度 （SMD=-3.78，95% CI: -4.97~-2.58，P<0.001）、术中失血量 （SMD=-2.27，95% CI: -3.13~-1.40，P<0.001）、术后引流量 （SMD=-6.90，95% CI: -7.57~-6.23，P<0.001）、并发症的发生 （OR=0.34，95% CI: 0.21~0.56，P<0.001）、外展角 （SMD=- 0.24，95% CI: -0.41~ -0.06，P=0.007）及住院时间（SMD= -1.93，95% CI: -2.33~-1.52，P<0.001）和术后 6 个月髋关节 Harris 评分 （SMD=0.87，95% CI: 0.34~1.40，P=0.001） 均显著优于传统入路组。而两组手术时间 （SMD=0.50，95% CI: -0.20~1.19， P=0.16） 和 VAS 评分 （SMD=-0.51，95% CI: -1.31~0.29，P=0.21） 的差异无统计学意义。［结论］ 本研究表明，小切口后外侧入路 THA 的临床结果优于传统后外侧入路。

Abstract:

[Objective] To compare the clinical outcomes of total hip arthroplasty (THA) through minimal incision posterolateral ap- proach versus conventional posterolateral approach. [Methods] All randomized or non- randomized controlled trials about THA through minimal incision versus conventional posterolateral approaches were searched from PubMed, Cochrane Library, EMbase, Web of Science, CNKI and Wanfang database from January 2003 to July 2021. After screening and data extraction were conducted according to inclusion and exclusion criteria, a meta-analysis was performed using RevMan 5.3 software. [Results] A total of 14 literatures were included, involv- ing 2 randomized controlled trials and 12 cohort studies. As results of the meta-analysis, the minimal incision group proved significantly su- perior to the conventional group in terms of incision length (SMD=- 3.78, 95% CI:-4.97~- 2.58, P＜0.001) , intraoperative blood loss (SMD=-2.27, 95% CI: -3.13~-1.40, P＜0.001) , postoperative drainage (SMD=- 6.90, 95% CI: -7.57~-6.23, P＜0.001) , complications (OR=0.34, 95% CI: 0.21~0.56, P＜0.001) , abducent angles (SMD=-0.24, 95%CI: -0.41~ -0.06, P=0.007) , hospital stay (SMD= -1.93, 95% CI: -2.33~-1.52, P＜0.001) and Harris hip score at 6 months after surgery (SMD=0.87, 95% CI: 0.34~1.40, P=0.001) . However, there were no significant differences between the two groups in terms of operation time (SMD=0.50, 95% CI: -0.20~1.19, P=0.16) and VAS score (SMD=-0.51, 95% CI: -1.31~0.29, P=0.21) . [Conclusion] This study shows that the clinical outcome of THA through minimal incision posterolateral approach is considerably better than that of conventional posterolateral approach.