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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2021, Vol. 07 ›› Issue (05) : 304 -313. doi: 10.3877/cma.j.issn.2096-0263.2021.05.009

Meta分析

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
牛文杰1, 周新1, 杨彦飞1, 梁浩然1, 宋文杰1, 刘洋1, 王薛丁1, 任智远1, 段王平1,†()   
  1. 1. 030001　太原，山西医科大学第二临床医院，骨与软组织损伤修复山西省重点实验室
  • 收稿日期:2020-10-24 出版日期:2021-10-05
  • 通信作者: 段王平
  • 基金资助:
    山西省重点研发计划项目(201903D421019)

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

Wenjie Niu1, Xin Zhou1, Yanfei Yang1, Haoran Liang1, Wenjie Song1, Yang Liu1, Xueding Wang1, Zhiyuan Ren1, Wangping Duan1,†()   

  1. 1. Department of Osteoarthritis, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2020-10-24 Published:2021-10-05
  • Corresponding author: Wangping Duan
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引用本文：

牛文杰, 周新, 杨彦飞, 梁浩然, 宋文杰, 刘洋, 王薛丁, 任智远, 段王平. 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[J]. 中华老年骨科与康复电子杂志, 2021, 07(05): 304-313.

Wenjie Niu, Xin Zhou, Yanfei Yang, Haoran Liang, Wenjie Song, Yang Liu, Xueding Wang, Zhiyuan Ren, Wangping Duan. The difference in curative effect between hip resurfacing and total hip replacement in middle-aged patients:a Meta-analysis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(05): 304-313.

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 resurfacing，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2 586篇，并最终纳入20篇相关文献，其中髋关节表面置换3 020例，全髋关节置换2 407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。

关键词: 中年, 关节成形术，髋，置换, 假体植入, Meta分析
Objective

Meta-analysis was used to evaluate the clinical efficacy and safety of hip resurfacing 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 replacement 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 under 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] between 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 arthroplasty, and the differences between two group were statistically significant. The revision rate of hip resurfacing [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.

Conclusion

For patients under 60 years old with end-stage hip disease, compared with total hip arthroplasty, hip resurfacing has better HHS and UCLA activity scores, reducing intraoperative blood loss, serum metal ion concentration, postoperative the revision rate and complication rate, and improved the quality of life of patients.

Key words: Middle aged, Arthroplasty, hip, replacement, Prosthesis implantation, Meta-analysis
图1 筛选文献流程图
表1 纳入文献的基本特征
纳入研究 研究类型 国家 样本量（例） 年龄（岁，±s） 性别（例，男/女）
HR THA HR THA HR THA
Slaven[9]2019 回顾性 美国 38 103 49±7.5 46±6.1 20/18 70/33
Laaksonen[10]2019 前瞻性 美国 109 49 57±6.2 60±4.3 77/32 27/22
Bisseling[11]2015 随机对照 荷兰 36 28 57±6.3 56±3.2 19/17 17/11
Hothi[12]2016 回顾性 英国 529 395 51±3.2 55±5.1 未提及
Renner[13]2016 回顾性 美国 77 42 49.3±7.5 53.5±11.8 70/7 33/9
Gerhardt[14]2019 随机对照 荷兰 38 33 54.4±9.5 56.5±7.3 21/17 21/12
Matuszak[15]2018 前瞻性 美国 541 264 55.2±3.1 58.9±3.2 407/134 144/120
Haddad[16]2015 回顾性 美国 40 40 47.8±9.2 48.2±3.2 30/10 29/11
Rueckl[17]2020 前瞻性 美国 40 40 47.6±5.2 48.3±6.1 未提及
Pritchett[18]2020 前瞻性 美国 324 324 48.5±3.2 48.5±6.2 162/162 162/162
Ortiz-Declet[19]2017 前瞻性 美国 42 18 49.1±7.6 53±8.3 42/0 18/0
Halawi[20]2018 前瞻性 美国 442 327 48.2±6.2 46.8±7.4 317/125 161/166
Jonas[21]2019 回顾性 英国 54 54 49.8±6.9 50.4±9.7 未提及
Ford[22]2018 前瞻性 美国 360 360 52±7.5 52±7.5 280/80 280/80
Cushnie[23]2019 回顾性 加拿大 63 63 55±6.7 55±6.7 50/13 50/13
Calkins[24]2019 回顾性 美国 62 62 51.5±8.4 56.6±8.7 38/24 38/24
Fink Barnes[25]2014 前瞻性 美国 89 47 52.7±8.1 57.4±7.2 未提及
Konan[26]2020 随机对照 加拿大 48 56 52±6.2 51.5±7.6 43/5 50/6
Tao[27]2018 随机对照 中国 28 40 43±7.2 47±6.2 19/9 28/12
Costa[28]2018 随机对照 英国 60 62 56.5±6.9 56.7±7 36/24 35/27
纳入研究 BMI（Kg/m2，±s） 随访时间（年，M（QR）） 结局指标
HR THA HR THA
Slaven[9]2019 未提及 10.2（6.8~12.1） ⑤
Laaksonen[10]2019 未提及 8.1（3.4~11.4） 6.6（3.4~10.7） ①③④
Bisseling[11]2015 28±5.1 26.1±3.1 5.0（2.0~6.0） ①②④⑦⑧
Hothi[12]2016 未提及 5.0（0.7~15.0） 4.2（0.6~16.7） ④
Renner[13]2016 未提及 3.3（1.2~5.4） 3.7（1.1~6.0） ②③④
Gerhardt[14]2019 26.1±3.1 28±5.1 5.0（0.25~5.0） ②⑦⑧
Matuszak[15]2018 未提及 6.8（2.0~11.1） 6.2（3.0~10.7） ①②③④
Haddad[16]2015 未提及 12.1（10.0~14.0） ①②
Rueckl[17]2020 27.6±3.3 27.5±3.7 4.7（2.0~7.3） ①②
Pritchett[18]2020 未提及 11.0（7.0~21.0） ①⑤
Ortiz-Declet[19]2017 30±5.5 29.4±4.1 3.0（1.2~7.8） 5.2（3.3~7.3） ①③
Halawi[20]2018 30.3±6.9 30.1±7.7 6.1（0.0~10.3） ⑥
Jonas[21]2019 25.7±7.1 27±8.5 18.0（17.6~19.9） ②⑤
Ford[22]2018 27±3.5 27±3.5 7.2（5.0~10.0） ①②
Cushnie[23]2019 30.9±4.5 30.9±4.5 5.0（4.9~7.0） ①
Calkins[24]2019 28.5±6.1 29.6±6.3 11.0（28~14.2） 6.0（3.2~8.8） ①
Fink Barnes[25]2014 28.6±4.4 30.3±5.3 3.9（2.0~5.0） ⑥⑦
Konan[26]2020 28.3±4.9 28.2±5.4 9.0（8.0~10.0） ②⑤
Tao[27]2018 21.5±9.5 21.8±8.9 7.4（5.0~9.0） ①②⑦⑧
Costa[28]2018 28.4±6.2 28.9±4.8 5.0（1.0~5.0） ⑤⑥
图2 随机对照研究的质量评价结果
表2 非随机对照研究的质量评价结果
纳入研究 病例选择 可比性 暴露因素测量 评分
1 2 3 4 A B C
Slaven[9]2019 *   * * * *   * 8
Laaksonen[10]2019   * * * *   * * 7
Hothi[12]2016 * * * * *   *   7
Renner[13]2016 *   *   * * *   6
Matuszak[15]2018 * *   * * *   * 7
Haddad[16]2015   * * * * * * * 8
Rueckl[17]2020 * * *   * *   * 7
Pritchett[18]2020 * * * * *   * * 8
Ortiz-Declet[19]2017 * *   * * * *   7
Halawi[20]2018 *   * * * * *   7
Jonas[21]2019 * * * * *   * * 8
Ford[22]2018 * *     * * * * 7
Cushnie[23]2019 * *   * * * *   7
Calkins[24]2019   *   * *   * * 6
Fink Barnes[25]2014   * *   * * * * 7
图7 HR与THA术后铬离子浓度比较的森林图
图12 HR与THA术后HHS评分的漏斗图
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