微创小切口与传统切口应用于全髋关节置换的Meta分析

Meta analysis on the minimally invasive incision versus conventional incision for total hip arthroplasty

背景:小切口微创人工全髋关节置换的短期效果好,但是有学者认为其术中暴露比传统切口差,置换后易出现假体安置位置差等并发症。目的:系统评价微创小切口与传统切口在人工全髋关节置换中的应用效果。方法:计算机检索PubMED和Ovid等数据库,检索1975/2011有关微创人工全髋关节置换的文献资料,收集小切口微创技术与传统方法比较进行髋关节置换的临床随机对照试验,按Cochrane协作网标准逐个进行质量评价,对符合纳入标准的研究用RevMan5.0软件进行Meta分析。结果与结论:共纳入14个研究,Meta分析结果显示,微创小切口组在术中失血量、总失血量、手术用时方面优于传统长切口组,在术中及置换后并发症方面,两种技术的差异无显著性意义。置换后髋关节功能恢复方面,小切口组置换后近期(1年内)髋关节Harris评分优于传统切口组。提示与传统切口全髋关节置换比较,微创全髋关节置换技术的术中出血量少,手术时间、住院时间和卧床时间均较短。

BACKGROUND： Minimally invasive incision has a good short-term effect on total hip arthroplasty, but some scholars believe that minimally invasive incision has a poor intraoperative exposure than the traditional incision, and has the complications of poor placement of the prosthesis after replacement. OBJECTIVE： To assess the effect of minimally invasive incision versus conventional incision for total hip arthroplasty. METHODS： A computer-based online search of PubMed database and Ovid database was performed for the articles on minimally invasive incision for total hip arthroplasty published from 1975-2011, the randomized controlled trials of minimally invasive incision versus conventional incision for total hip arthroplasty were collected and the quality was individually evaluated by the Cochrane Collaboration standards. The Meta analysis was performed on the articles that met the inclusion criteria by RevMan 5.0 software. RESULTS AND CONCLUSION： A total of 14 related papers were included, Meta analysis indicated that minimally invasive incision for total hip arthroplasty could reduce the duration of operation, the amount of intraoperative blood loss, and the amount of total blood loss when compared with conventional incision, but the rate of complications had no difference. As for the aspect of hip function after total hip arthroplasty, the Harris score of minimally invasive incision was better than that of the conventional incision within one year. The hip function was better in the minimally invasive incision for less blood loss, duration of operation, hospital stay and less on-bed time.