中年患者髋关节表面置换与全髋关节置换疗效差异的Meta分析

The difference in curative effect between hip resurfacing and total hip replacement in middle-aged pa-tients:a Meta-analysis

目的通过Meta分析评价髋关节表面置换与全髋关节置换治疗小于60岁中年终末期髋关节疾病患者的临床疗效和安全性。方法检索2010年10月至2020年10月已发表的关于髋关节表面置换与全髋关节置换的临床对照研究。所检索的数据库包括Pubmed、Embase、Cochrane图书馆、万方数据库、中国知网等。中文检索的关键词为表面置换、全髋置换;英文检索的关键词为hip resur-facing,total hip replacement,total hip arthroplasty。提取数据后,采用Review Manager 5.3软件进行数据分析,比较髋关节表面置换与全髋关节置换治疗60岁以下中年患者的疗效差异。结果共检索到相关文献2586篇,并最终纳入20篇相关文献,其中髋关节表面置换3020例,全髋关节置换2407例。Meta分析结果显示,髋关节表面置换的HHS评分[MD=2.49,95%CI(0.66,4.32),P<0.001]和UCLA活动评分[MD=0.64,95%CI(0.11,1.17),P=0.02]高于全髋关节置换,两者差异有统计学意义。而两组的VAS疼痛评分[MD=0.19,95%CI(-0.30,0.69),P=0.44]比较差异无统计学意义。髋关节表面置换的钴离子浓度[MD=-0.72,95%CI(-1.42,-0.02),P=0.04]和铬离子浓度[MD=-0.28,95%CI(-0.39,-0.17),P<0.001]低于全髋关节置换,两者差异有统计学意义。髋关节表面置换的翻修率[OR=0.45,95%CI(0.25,0.80),P=0.007]和并发症发生率[OR=0.35,95%CI(0.12,0.98),P<0.05]低于全髋关节置换,两者差异有统计学意义。髋关节表面置换的手术时间[MD=17.58,95%CI(11.81,23.35),P<0.001]高于全髋关节置换,术中失血量[MD=-41.05,95%CI(-59.87,-22.24),P<0.001]低于全髋关节置换,两者差异有统计学意义。结论对于小于60岁中年终末期髋关节疾病患者,与全髋关节置换相比,髋关节表面置换术后有更好的HHS及UCLA活动评分,减少了术中失血量、血清金属离子浓度、术后翻修率及并发症发生率,提高了患者的生活质量。

Objective Meta-analysis was used to evaluate the clinical efficacy and safety of hip re-surfacing and total hip arthroplasty in the treatment of patients with end-stage hip joint disease less than 60 years old.Methods Retrieve clinical controlled studies on hip resurfacing and total hip arthroplasty that have been published from October 2010 to October 2020.The databases searched include Pubmed,Embase,Cochrane Library,Wanfang Database,CNKI,et al.The keywords searched in Chinese were surface replace-ment and total hip replacement;the keywords searched in English are hip resurfacing,total hip replacement,total hip arthroplasty.After extracting the data,the Review Manager 5.3 software was used for data analysis to compare the effect of hip resurfacing and total hip arthroplasty in the treatment of middle-aged patients un-der 60.Results A total of 20 literatures were finally included,including 3,020 cases of hip resurfacing and 2,407 cases of total hip arthroplasty.Meta-analysis showed that the HHS score of hip resurfacing[MD=2.49,95%CI(0.66,4.32),P<0.001]and UCLA activity score[MD=0.64,95%CI(0.11,1.17),P=0.02]were higher than total hip arthroplasty,and the differences between two group were statistically significant.There were no statistically significant difference in the VAS pain score[MD=0.19,95%CI(-0.30,0.69),P=0.44]be-tween two groups.Cobalt ion concentration of hip resurfacing[MD=-0.72,95%CI(-1.42,-0.02),P=0.04]and chromium ion concentration[MD=-0.28,95%CI(-0.39,-0.17),P<0.001]were lower than total hip ar-throplasty,and the differences between two group were statistically significant.The revision rate of hip re-surfacing[OR=0.45,95%CI(0.25,0.80),P=0.007]and the complication rate[OR=0.35,95%CI(0.12,0.98),P<0.05]were lower than total hip arthroplasty,and the differences between these two group were statistically significant.The operation time of hip resurfacing[MD=17.58,95%CI(11.81,23.35),P<0.001]were higher than total hip arthroplasty,and the intraoperative blood loss[MD=-41.05,95%CI(-59.87,-22.24),P<0.001]were lower than total hip arthroplasty,the difference between two group were statistically significant.Conclu-sion For patients under 60 years old with end-stage hip disease,compared with total hip arthroplasty,hip re-surfacing has better HHS and UCLA activity scores,reducing intraoperative blood loss,serum metal ion con-centration,postoperative the revision rate and complication rate,and improved the quality of life of patients.