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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 562 -571. doi: 10.3877/cma.j.issn.1674-134X.2021.05.007

荟萃分析

两种髋关节置换术后髋骨关节炎患者长期生存质量差异
朱瑞逸1, 李好好1, 昌敬惠2,()   
  1. 1. 510515 广州,南方医科大学第二临床医学院
    2. 510515 广州,南方医科大学卫生管理学院
  • 收稿日期:2020-10-15 出版日期:2021-10-01
  • 通信作者: 昌敬惠
  • 基金资助:
    2019年度广东省医学科学技术研究基金(B2019248); 2018年度南方医科大学科研启动计划青年科技人员培育项目(G618369181); 2019年度南方医科大学卫生管理学院国家级课题培育计划项目(2019RFT002); 2020年度南方医科大学大学生创新训练计划项目(X202012121248)

Difference of long-term quality of life in patients with hip osteoarthritis after two types of hip replacement

Ruiyi Zhu1, Haohao Li1, Jinghui Chang2,()   

  1. 1. Second Medical College, Southern Medical University, Guangzhou 510515, China
    2. Health Management College, Southern Medical University, Guangzhou 510515, China
  • Received:2020-10-15 Published:2021-10-01
  • Corresponding author: Jinghui Chang
引用本文:

朱瑞逸, 李好好, 昌敬惠. 两种髋关节置换术后髋骨关节炎患者长期生存质量差异[J/OL]. 中华关节外科杂志(电子版), 2021, 15(05): 562-571.

Ruiyi Zhu, Haohao Li, Jinghui Chang. Difference of long-term quality of life in patients with hip osteoarthritis after two types of hip replacement[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(05): 562-571.

目的

系统评价全髋关节置换术(THA)及表面髋关节置换术(HRA)治疗髋骨关节炎患者术后长期生活质量差异、翻修率及并发症发生率,为临床应用提供意见。

方法

计算机检索PubMed、中国知网、万方数据库,纳入数据库中所有关于表面髋关节置换术和全髋关节置换治疗髋骨关节炎的临床对照研究,检索年限为2000年1月至2020年5月。筛选研究对象为患髋骨关节炎且需行THA或HRA的患者,结局指标涉及术后长期生活质量差异、翻修率及并发症发生率,由两位研究员按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.3软件进行Meta分析。

结果

纳入文献8篇,共纳入患者965例,其中表面髋关节置换组(HRA)522例,全髋关节置换组(THA)443例;Meta分析结果显示HRA组与THA组病人在术后长期疗效的Harris评分[加权均数差(WMD)=1.60,95%置信区间(CI)(0.26,2.94),P=0.02]、髋关节加州大学洛杉矶分校评分[WMD=0.66,95%CI(0.38,0.95),P<0.001]、牛津大学髋关节评分[WMD=2.88,95%CI(0.36,5.40),P=0.03]和术后并发症发生率[RR=0.37,95%CI(0.21,0.65),P=0.0004]差异有统计学意义,HRA组高于THA组;两组在长期翻修率差异无统计学意义[RR=0.64,95%CI(0.36,1.16),P=0.14]。

结论

接受表面髋关节置换术患者在长期生活质量改善上优于接受全髋关节置换术的患者,且翻修率无明显差别,此结论仍需要进一步纳入大量大样本、多中心、高质量的随机对照试验加以论证。

Objective

To systematically evaluate the difference in quality of life and revision rate of patients undergoing total hip replacement and surface hip replacement for osteoarthritis.

Methods

By searching PubMed, Chinese National Knowledge Infrastructure(CNKI) and Wanfang databases, all the clinical controlled studies on superficial hip replacement and total hip replacement for osteoarthritis were included, and the search period was from January 2000 to May 2020. The researches included were those with patients needing THA or HRA for hip osteoarthritis and with outcome measures containing long-term quality-of-life scores, revision rates and complication rates. The two researchers independently screened the literatures, extracted data and evaluated the quality according to the inclusion and exclusion criteria, and then used RevMan 5.3 software for meta-analysis.

Results

A total of 965 patients were included in eight articles, including 522 patients in the hip resurfacing arthroplasty (HRA) group and 443 patients in the total hip replacement (THA) group. Meta-analysis results showed that there was a statistically significant difference between the HRA group and the THA group in the Harris score[weighed mean difference(WMD)=1.60, 95%confidence interval(CI)(0.26, 2.94), P=0.02]、University of California Los Angeles activity-level rating score (UCLA activity score) [MD=0.66, 95%CI(0.38, 0.95), P<0.001]、Oxford hip score [MD=2.88, 95%CI(0.36, 5.40), P=0.03] and postoperative complication rate[RR=0.37, 95%CI(0.21, 0.65), P=0.0004] at long-term function after surgery, and the HRA group was higher than the THA group. There was no significant difference in revision rate and postoperative complication rate between the two groups[RR=0.64, 95%CI (0.36, 1.16), P=0.14].

Conclusions

The patients undergoing hip resurfacing arthroplasty have better long-term quality of life improvement than patients undergoing total hip replacement, and there is no significant difference in revision rate. This conclusion needs to be demonstrated by further including a large sample, multi-center, high-quality randomized controlled trial to demonstrate.

表1 文献基本信息表
图1 文献检索流程图
表2 纳入随机对照试验的偏倚风险评估
表3 纳入队列研究的偏倚风险评估
图2 纳入研究髋关节UCLA(加州大学洛杉矶分校)评分的发表偏倚漏斗图
图3 HRA(表面髋关节置换术)与THA(全髋关节置换术)Harris评分比较
图4 HRA(表面髋关节置换术)与THA(全髋关节置换术)研究髋关节UCLA (加州大学洛杉矶分校)评分比较
图5 HRA(表面髋关节置换术)与THA(全髋关节置换术)OHS评分(牛津大学髋关节评分)比较
图6 HRA(表面髋关节置换术)与THA(全髋关节置换术)翻修率比较
图7 HRA(表面髋关节置换术)与THA(全髋关节置换术)并发症发生率
图8 HRA(表面髋关节置换术)与THA(全髋关节置换术)并发症森林图
图9 术前关节功能森林图
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