微创小切口在全髋关节置换应用的系统评价

Minimally invasive incision for total hip arthroplasty:a systematic review

[目的]对微创小切口在全髋置换术中的应用进行系统评价。[方法]在Pubmed、Cochrane Library、EMBASE、Science Direct以及CNKI、CBM、中国医学学术会议论文数据库等网站进行检索。文献检索起止时间为2000年1月～2011年1月。再对入选文献的参考文献进行手工检索。系统收集微创小切口进行全髋置换的相关文献,并按临床科研方法的国际通用原则进行阅读和评价。采用Cochrane协作网提供的软件Revman 4.2进行Meta-分析,以获得微创小切口进行全髋置换的疗效及其安全性指标的相关证据。[结果]共检索到236篇原始文献,有6篇符合最终的入选标准,总计随访患者551例。研究显示微创小切口组在手术用时、术中失血量方面少于传统长切口,术后并发症发生率及住院时间无统计学意义。[结论]采用微创小切口在术中失血量、手术用时方面少于传统长切口;术后并发症及住院时间方面,两种切口的差异无统计学意义。因本研究的样本量较小,缺乏足够的证据,尚需更多设计严格的研究以增加证据的强度。

[ Objective ] A systematic review was conducted to assess the application of minimally invasive incision for total hip arthroplasty （THA）. [ Method ] Using PubMed, Cochrane Library, EMBASE, Science Direct, CNKI, CBM and CMAC, we performed a literature search for all the studies published in the English and Chinese languages from January 2000 to January 2011 ,reporting patients undergoing THA with minimally invasive incision. The bibliographic sections of identified papers were manually searched to identify additional papers. The Revman 4.2 provided by the Cochrane Collaboration was used for manage- ment and analysis. Meticulous data extraction and recta-analysis wexe performed according to a preset protocol to gain correlated evidence about THA with minimally invasive incision[ Result] In 236 citations initially identified, 6 eligible papers, which in- cluded 551 patients, met all the final criteria. The combined results of meta-analysis showed that compared with conventional in- cision, minimally invasive incision for total hip arthroplasty could reduce the duration of operation, the amount of intra-operative blood loss, but the rate of complications and the length of stay had no difference. [ Conclusion ] Compared with conventional in- cision, minimally invasive incision for total hip artbroplasty can reduce operation time, and operation blood loss, but the compli- cation rate and the hospital of stay has no difference. However, the trials available for this systematic review are too few and small for reliable estimate of the relative effects of minimally invasive and conventional incision for total hip arthroplasty. Further studies are needed to determine these effects.