直接前侧与直接外侧入路行全髋关节置换术临床疗效比较的系统评价

Efficacy of total hip arthroplasty by direct anterior and direct lateral approach: a systematic review

目的系统评价直接外侧入路(DLA)与直接前侧入路(DAA)比较行全髋关节置换术(THA)的临床疗效。方法计算机检索CNKI、WanFang Data、VIP、CBM、EMbase、PubMed、The Cochrane Library、ClinicalTrials.gov和PROSPERO数据库或网站,搜集DAA与DLA比较行THA的随机对照试验(RCT),检索时限均从建库到2021年8月6日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入9个RCT。Meta分析结果显示:术后3月,DAA组患者Harris髋关节评分(HHS)高于DLA组[MD=4.83,95%CI(2.09,7.56),P=0.000 5]。此外,DAA组比DLA组的切口长度更短[MD=-2.35,95%CI(-3.90,-0.79),P=0.003]、术中出血量更少[MD=-68.24,95%CI(-119.07,-17.41),P=0.009],且住院时长更短[MD=-0.84,95%CI(-1.54,-0.15),P=0.02]。但两组术后6周HHS、术后1年HHS和手术时长的差异无统计学意义。结论当前证据表明,DAA在术后3月HHS高于DLA,且DAA相比DLA的切口长度更短、术中出血量更少、住院时长更短。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy of total hip arthroplasty by direct anterior approach(DAA) and direct lateral approach(DLA). Methods CNKI, WanFang Data, VIP, CBM, EMbase, PubMed, The Cochrane Library, ClinicalTrials.gov and PROSPERO databases or websites were electronically searched to collect randomized controlled trials(RCTs) of DAA and DLA for THA from inception to August 6 th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 9 RCTs were included. The results of meta-analysis showed that at 3 months post-operation, the Harris hip score(HHS) of the DAA group was higher than the DLA group(MD=4.83, 95%CI2.09 to 7.56, P=0.000 5). Besides, compared with the DLA group, the DAA group showed shorter incision length(MD=-2.35, 95%CI-3.90 to-0.79, P=0.003), less intraoperative bleeding(MD=-68.24, 95%CI-119.07 to-17.41,P=0.009), and shorter hospital stay(MD=-0.84, 95%CI-1.54 to-0.15, P=0.02). However, no significant differences were found between DLA and DAA in operation duration and HHS at 6 weeks after operation. Conclusions Current evidence shows that DAA can provide better HHS at 3 months post-operation, shorter incision length, less intraoperative bleeding,and shorter hospitalization length than DLA. Due to limited quality and quantity of the included studies, more highquality studies are required to verify above conclusions.