生物型全髋关节置换术后完全负重与部分负重效果的Meta分析

Effect of Early Full Weight Bearing After Uncemented Total Hip Arthroplasty:a Meta-Analysis

目的:比较生物型全髋关节置换术(THA)后完全负重与部分负重的临床效果。方法:计算机检索Pubmed、Embase、Cochrane Library、CNKI、CBM、万方数据库中关于生物型THA术后完全负重与部分负重对比的临床研究。对文献进行筛选、质量评价、数据提取,采用Review Manager5.3软件进行Meta分析。结果:共纳入9项研究,包括430例患者(461侧髋关节)。结果显示:完全负重组与部分负重组术后1年及术后2年术侧髋关节Harris评分无统计学差异[WMD(95%CI)分别为1.61(-0.61,3.84)、0.08(-1.19,1.34)]。完全负重组术后3月内股骨柄下沉量较部分负重组大(WMD=-0.12,95%CI:[-0.22,-0.01]),术后2年及≥2年时股骨柄下沉量无统计学差异[WMD(95%CI)分别为-0.03(-0.31,0.25)、-0.02(-0.37,0.33)]。末次随访时骨长入例数、出现点接合及假体周围透亮线例数均无统计学差异(P>0.05)。结论:基于现有研究,生物型THA术后早期完全负重有利于早期关节功能恢复,且不增加假体松动率。

Objective：To evaluate the efficacy and safety of early full weight bearing after uncemented total hip arhroplasty（THA）.Methods：Electronic databases（Pubmed,Embase,Cochrane Library,CNKI,CBM,Wangfang Data）were used to systematically search for studies investigating the effect of full weight bearing and partial weight bearing after uncemented total hip arhroplasty.The methodological quality of included studies were assessed by the advanced Jadad scale or The Newcastle-Ottawa Scale.A Meta-analysis was performed by using Review Manager 5.3software.Results：Nine articles including a total of 430patients（461THAs）were identified.Metaanalysis showed that,compared with partial weight bearing,full weight bearing group had greater femoral subsidence at 3-month follow-up（WMD=-0.12,95%CI：[-0.22,-0.01]）.Therewere no statistical difference in hip Harris score at 1-year and 2-year follow-up（WMD =1.61,95%CI：[-0.61,3.84];WMD =0.08,95%CI：[-1.19,1.34];respectively）,in femoral subsidence at 2-year follow-up and with follow-up≥2years（WMD =-0.03,95%CI：[-0.31,0.25];WMD=-0.02,95%CI：[-0.37,0.33];respectively）.There were no statistical risk ratio difference in bone ingrowth fixation,spot welds,and radiolucent lines（P〈0.05）.Conclusion：The current evidence shows early full weight bearing could promote the hip joint functional recovery,without jeopardising stability and ingrowth of the implant.