AIM To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate.METHODS Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless ...AIM To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate.METHODS Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless and hybrid total hip replacement(THR) were performed. Two independent reviewers evaluated the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate of each implants with a pre-determined form. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Funnel plots were analyzed. RESULTS Twenty-seven studies comprising 5 clinical trials, 9 cohorts, and 13 registers fulfilled the research criteria and analyzed. Compared to cementless THR, cemented THR have pooled RR of 0.47(95%CI: 0.45-0.48), 0.9(0.84-0.95), 1.29(1.06-1.57) and 0.69(0.6-0.79) for revision due to any reason, revision due to aseptic loosening, revision due to infection, and dislocation respectively. Compared to hybrid THR, the pooled RRs of cemented THR were 0.82(0.76-0.89), 2.65(1.14-6.17), 0.98(0.7-1.38), and 0.67(0.57-0.79) respectively. Compared to hybrid THR, cementless THR had RRs of 0.7(0.65-0.75), 0.85(0.49-1.5), 1.47(0.93-2.34) and 1.13(0.98-1.3).CONCLUSION Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival.展开更多
目的 比较骨水泥与非骨水泥型人工全髋关节置换（total hip arthroplasty,THA）治疗肾移植术后股骨头缺血性坏死（osteonecrosis of the femoral head,ONFH）的近期疗效。方法 回顾性分析2005年2月-2012年2月接受初次THA的18例（21髋）...目的 比较骨水泥与非骨水泥型人工全髋关节置换（total hip arthroplasty,THA）治疗肾移植术后股骨头缺血性坏死（osteonecrosis of the femoral head,ONFH）的近期疗效。方法 回顾性分析2005年2月-2012年2月接受初次THA的18例（21髋）肾移植术后ONFH患者临床资料,其中11例（13髋）采用骨水泥型假体置换（骨水泥组）,7例（8髋）采用非骨水泥型假体置换（非骨水泥组）。两组患者性别、年龄、病程、ONFH分期、术前Harris评分及骨密度等一般资料比较,差异均无统计学意义（P〉0.05）。记录两组术后切口及并发症发生情况,采用Harris评分评定髋关节功能,摄X线片观察假体情况。结果 术后患者切口均Ⅰ期愈合。两组患者均获随访,骨水泥组随访时间为6～77个月,平均46个月;非骨水泥组为4～71个月,平均42个月。术后两组各1例（1髋）出现股骨假体感染;骨水泥组1例（1髋）发生髋关节脱位,1例（1髋）发生股骨假体松动,1例（1髋）发生髋臼假体松动。末次随访时,骨水泥组总体并发症发生率为30.7%（4/13）、翻修率为23.1%（3/13）,显著高于非骨水泥组的12.5%（1/8）、0（0/8）（P=0.047,P=0.040）。末次随访时,非骨水泥组Harris评分为（94.1±3.7）分,骨水泥组为（90.0±4.2）分,与术前比较差异均有统计学意义（P〈0.05）;两组间比较,差异无统计学意义（t=1.815,P=0.062）。X线片复查示,两组患者术后假体初始位置均满意;末次随访时,骨水泥组股骨假体骨性固定9髋、纤维固定3髋、松动1髋,髋臼假体1髋松动、其余稳定固定;非骨水泥组股骨假体均骨性固定,髋臼假体均稳定固定。两组均无异位骨化发生。结论 采用非骨水泥型假体行THA治疗肾移植术后ONFH的近期疗效满意,且优于骨水泥型假体,中远期疗效有待进一步观察。展开更多
文摘AIM To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate.METHODS Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless and hybrid total hip replacement(THR) were performed. Two independent reviewers evaluated the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate of each implants with a pre-determined form. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Funnel plots were analyzed. RESULTS Twenty-seven studies comprising 5 clinical trials, 9 cohorts, and 13 registers fulfilled the research criteria and analyzed. Compared to cementless THR, cemented THR have pooled RR of 0.47(95%CI: 0.45-0.48), 0.9(0.84-0.95), 1.29(1.06-1.57) and 0.69(0.6-0.79) for revision due to any reason, revision due to aseptic loosening, revision due to infection, and dislocation respectively. Compared to hybrid THR, the pooled RRs of cemented THR were 0.82(0.76-0.89), 2.65(1.14-6.17), 0.98(0.7-1.38), and 0.67(0.57-0.79) respectively. Compared to hybrid THR, cementless THR had RRs of 0.7(0.65-0.75), 0.85(0.49-1.5), 1.47(0.93-2.34) and 1.13(0.98-1.3).CONCLUSION Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival.
文摘目的 比较骨水泥与非骨水泥型人工全髋关节置换（total hip arthroplasty,THA）治疗肾移植术后股骨头缺血性坏死（osteonecrosis of the femoral head,ONFH）的近期疗效。方法 回顾性分析2005年2月-2012年2月接受初次THA的18例（21髋）肾移植术后ONFH患者临床资料,其中11例（13髋）采用骨水泥型假体置换（骨水泥组）,7例（8髋）采用非骨水泥型假体置换（非骨水泥组）。两组患者性别、年龄、病程、ONFH分期、术前Harris评分及骨密度等一般资料比较,差异均无统计学意义（P〉0.05）。记录两组术后切口及并发症发生情况,采用Harris评分评定髋关节功能,摄X线片观察假体情况。结果 术后患者切口均Ⅰ期愈合。两组患者均获随访,骨水泥组随访时间为6～77个月,平均46个月;非骨水泥组为4～71个月,平均42个月。术后两组各1例（1髋）出现股骨假体感染;骨水泥组1例（1髋）发生髋关节脱位,1例（1髋）发生股骨假体松动,1例（1髋）发生髋臼假体松动。末次随访时,骨水泥组总体并发症发生率为30.7%（4/13）、翻修率为23.1%（3/13）,显著高于非骨水泥组的12.5%（1/8）、0（0/8）（P=0.047,P=0.040）。末次随访时,非骨水泥组Harris评分为（94.1±3.7）分,骨水泥组为（90.0±4.2）分,与术前比较差异均有统计学意义（P〈0.05）;两组间比较,差异无统计学意义（t=1.815,P=0.062）。X线片复查示,两组患者术后假体初始位置均满意;末次随访时,骨水泥组股骨假体骨性固定9髋、纤维固定3髋、松动1髋,髋臼假体1髋松动、其余稳定固定;非骨水泥组股骨假体均骨性固定,髋臼假体均稳定固定。两组均无异位骨化发生。结论 采用非骨水泥型假体行THA治疗肾移植术后ONFH的近期疗效满意,且优于骨水泥型假体,中远期疗效有待进一步观察。
