陈永刚;耿彬;王栓科;夏亚一;汪静;王翠芳;

• 1:兰州大学第二医院骨科研究所

摘要(Abstract)：

[目的]评价微创全髋关节置换术(total hip arthroplasty,THA)的疗效。[方法]电子检索Cochrane图书馆(2010年第8期)、PubMed(2001~2010年8月)、OVID数据库(2001~2010年8月)、万方数据库(2001~2010年8月)、中国期刊全文数据库(2001~2010年8月)、维普中文科技期刊全文数据库(2001~2010年8月),纳入有关人工全髋关节置换术的所有随机对照试验(RCT),评价其方法学质量并提取数据。比较微创全髋关节置换术(minimally invasive surgery to total hip arthroplasty,MIS-THA)和传统THA的切口长度、手术时间、术中出血量、住院时间、并发症及近期疗效。对数据进行异质性检验,用RevMan 5.0软件进行Meta分析。[结果]共纳入12个RCT,1 489例患者。Meta分析结果显示:与传统手术相比,MIS-THA有着术中出血量少(P=0.04)、住院时间短(P=0.000 5)等优点,但其缺陷是手术时间较传统THM略长(P=0.002)。另外,MIS-THA术后总体并发症发生率与传统THA相当[RR=0.90,95%CI(0.62,1.32)P=0.59];MIS-THA术后患者的Harris总评分要高于传统THA(P=0.008)。[结论]MIS-THA的整体近期疗效要优于传统手术,但由于手术开展初期,其手术时伤口暴露时间较长,有可能造成患者体液丢失总量的增多及对手术本身耐受力的下降,故应加强医师手术操作技能的培训及术中对伤口的保护意识。受纳入研究数量及质量限制,上述结论尚需大样本、高质量的RCT进一步证实。

关键词(KeyWords)： 微创;髋关节置换术;疗效;系统评价

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 陈永刚;耿彬;王栓科;夏亚一;汪静;王翠芳;

Email:

DOI:

参考文献(References)：

• [1]Berger RA,Jacobs JJ,Meneghini RM,et al.Rapid rehabilitation and re-covery with minimally invasive total hip arthroplasty[J].Clin Orthop,2004,239-247.
• [2]Goldstein WM,Branson JJ,Berland KA,et al.Minimal-incision totalhip arthroplasty[J].J Bone Joint Surg Am,2003,85-ASuppl 4:33-38.
• [3]陈耀龙,李幼平,杜亮,等.医学研究中证据分级和推荐强度的演进[J].中国循证医学杂志,2008,8:127-133.
• [4]Bal BS,Lowe JA.Muscle damage in minimally invasive total hip arthro-plasty:MRI evidence that it is not significant[J].Instr Course Lect,2008,57:223-229.
• [5]Yoon TR,Park KS,Song EK,et al.New two-incision minimally inva-sive total hip arthroplasty:comparison with the one-incision method[J].J Orthop Sci,2009,14:155-160.
• [6]Goosen JH,Kollen BJ,Castelein RM,et al.Minimally invasive versusclassic procedures in total hip arthroplasty:a double-blind randomizedcontrolled trial[J].Clin Orthop,2010,32:43-48.
• [7]Yang C,Zhu Q,Han Y,et al.Minimally-invasive total hip arthroplastywill improve early postoperative outcomes:a prospective,randomized,controlled trial[J].Ir J Med Sci,2009,179:285-290.
• [8]Laffosse JM,Chiron P,Accadbled F,et al.Learning curve for a modifiedWatson-Jones minimally invasive approach in primary total hip re-placement:analysis of complications and early results versus the stand-ard-incision posterior approach[J].Acta Orthop Belg,2006,72:693-701.
• [9]Glaser D,Dennis DA,Komistek RD,et al.In vivo comparison of hip me-chanics for minimally invasive versus traditional total hip arthroplasty[J].Clin Biomech(Bristol,Avon),2008,23:127-134.
• [10]Szendroi M,Sztrinkai G,Vass R,et al.The impact of minimally invasivetotal hip arthroplasty on the standard procedure[J].Int Orthop,2006,30:167-171.
• [11]Williams SL,Bachison C,Michelson JD,et al.Component position in 2-incision minimally invasive total hip arthroplasty compared to stand-ard total hip arthroplasty[J].J Arthroplasty,2008,23:197-202.
• [12]Bostan B,Sen C,Gunes T,et al.Total hip arthroplasty using the antero-lateral minimally invasive approach[J].Acta Orthop Traumatol Turc,2009,43:464-471.
• [13]Dutka J,Sosin P,Libura M,et al.Total hip arthroplasty through a mini-mally invasive lateral approach-our experience and early results[J].Ortop Traumatol Rehabil,2007,9:39-45.
• [14]Ogonda L,Wilson R,Archbold P,et al.A minimal-incision techniquein total hip arthroplasty does not improve early postoperative outcomes.A prospective,randomized,controlled trial[J].J Bone Joint Surg Am,2005,87:701-710.
• [15]Duwelius PJ.Two-incision minimally invasive total hip arthroplasty:techniques and results to date[J].Instr Course Lect,2006,55:215-222.
• [16]Varela-Egocheaga JR,Suarez-Suarez MA,Fernandez-Villan M,etal.Minimally invasive posterior approach in total hip arthroplasty.Pro-spective randomised trial[J].An Sist Sanit Navar,2010,33:133-143.
• [17]Berry DJ,Berger RA,Callaghan JJ,et al.Minimally invasive total hip ar-throplasty.Development,early results,and a critical analysis[J].J BoneJoint Surg Am,2003,85-A:2235-2246.
• [18]Sculco TP,Jordan LC,Walter WL.Minimally invasive total hip arthro-plasty:the hospital for special surgery experience[J].Orthop ClinNorth Am,2004,35:137-142.
• [19]DiGioia AM3rd,Plakseychuk AY,Levison TJ,et al.Mini-incisiontechnique for total hip arthroplasty with navigation[J].J Arthroplasty,2003,18:123-128.
• [20]唐竞,周一新,周乙雄,等.小切口人工全髋置换假体位置的准确性分析[J].中国矫形外科杂志,2008,6:24-28.