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金属-金属与金属-聚乙烯两种髋关节假体疗效比较的Meta分析 被引量:2

Metal-on-metal versus metal-on-polyethylene prostheses in cementless total hip arthroplasty: a meta-analysis
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摘要 目的系统评价金属-金属与金属-聚乙烯两种髋关节假体的临床疗效。方法计算机检索MEDLINE、EMBASE、Cochrane图书馆、Cochrane协作网肌骨创伤组试验数据库和中国生物医学文献数据库,手工检索相关骨科杂志及会议资料。收集所有比较金属.金属与金属-聚乙烯髋关节假体临床疗效的随机对照试验及半随机对照试验等,评价纳入研究的方法学质量,并使用RewMan4.2.8统计学软件对结果进行Meta分析,比较金属-金属假体与金属-聚乙烯假体髋关节置换术后髋关节Harris评分、髋关节活动范围、假体周围透亮带、脱位及再手术的发生率、血液及尿液中金属离子的浓度。结果共纳入9个研究,其中4篇随机对照试验,5篇临床对照研究。两组患者术后髋关节Harris评分、髋关节活动范围比较差异均无统计学意义(RR=-1.12,95%C1—2.91-0.66,P=0.22;RR=-0.10,95%CI-0.31~0.11,P=0.35)。金属-金属组术后假体周围出现放射透亮带的例数较金属-聚乙烯组少,差异有统计学意义(RR=0.62,95%C10.51~0.76,P〈0.001);术后发生脱位及再次手术的例数较金属-聚乙烯组少,但差异无统计学意义(RR=0.42,95%C10.11~1.57,P=0.20);术后血液中金属离子浓度高于金属-聚乙烯组,差异有统计学意义(RR=2.27,95%C11.56~2.98,P〈0.001);术后尿液中金属离子浓度也较金属-聚乙烯组高,但差异无统计学意义(RR=1.44,95%CI~0.27~3.14,P=0.10)。结论两种髋关节假体术后髋关节功能无明显差异,但金属-金属假体术后假体周围出现放射透亮带的例数较金属-聚乙烯假体少,血液中金属离子浓度较金属,聚乙烯假体高。 Objective To evaluate clinical outcomes of primary cementless total hip arthroplasty with metal-on-metal versus metal-on-polyethylene prostheses. Methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CBM, conference proceedings and reference lists of articles for ran- domised or quasi-randomised controlled trials comparing metal-on-polyethylene (MOP group) with met- al-on-metal (MOM group) in cementless total hip arthroplasty. The Cochrane Collaboration's tool for assessing risk of bias and software RewMan 4.2.8 were used to evaluate methodological quality and to perform a system review. Results Altogether 4 randomised controlled trials and 5 clinical controlled trials were included in this study. Pooled results from all the 9 trials showed no statistical differences between the 2 groups in terms of functional status (Harris hip score) and range of motion ( RR = - 1.12, 95% CI - 2.91 to 0. 66, P = 0.22; RR = - 0. 10, 95% CI- 0. 31 to 0. 11, P = 0.35). However the cases of periprosthetic radiolucency in the MOP group were significantly more than in the MOM group ( RR = 0.62, 95% CI 0. 51 to 0.76, P 〈 0. 001) . Dif- ferences in the rate of postoperative dislocation or surgical revision were not statistically significant between the 2 groups( RR = 0.42, 95% CI 0. 11 to 1.57, P =0. 20), although lower in the MOM group. Serum ion concentrations of cobalt and chromium were significantly higher in the MOM group (RR = 2.27, 95% CI 1.56 to 2.98, P 〈 0. 001 ), but differences in the urine ion concentrations were not statistically significant ( RR = 1, 44, 95% CI -0. 27 to 3. 14, P = 0. 10) . Conclusions MOM implements may lead to higher serum metal ion concentrations and fewer cases of periprosthetic radiolucency than MOP ones. But both prostheses are similar in hip functional outcomes.
出处 《中华创伤骨科杂志》 CAS CSCD 2011年第7期613-619,共7页 Chinese Journal of Orthopaedic Trauma
关键词 关节成形术 置换 假体和植入物 金属 聚乙烯 META分析 Arthroplasty, replacement, hip Prostheses and implants Metals Polyethylene Meta-analysis
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参考文献18

  • 1郭盛君,周一新,张亮,吴坚,吕明,唐竞,张理昂.327例初次人工髋关节置换术失败原因探讨[J].中华外科杂志,2009,47(3):168-171. 被引量:16
  • 2Visuri T, Borg H, Pulkkinen P, et al. A retrospective comparative study of mortality and causes of death among patients with met- al-on-metal and nmtal-on-polyethylene total hip prostheses in primary osteoarthritis after a long-term follow-up. BMC Musculoskeletal Dis- ord, 2010, 11: 78.
  • 3Huo MH, Gilbert NF, Parvizi J, et al, What's new in total hip arthroplasty. J Bone Joint Surg(Am), 2007, 89: /874-1885.
  • 4Jtini P, Altman DG, Egger M. Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ, 2001, 323: 42-46.
  • 5Girard J, Vendittoli PA, Roy AG, et al. Femoral offset restoration and clinical function after total hip arthroplasty and surface replacement of the hip: a randomized study. Rev Chir Orthop Reparatrice Appar Mot, 2008, 94: 376-381.
  • 6Jacobs M, Gorab R, Mattingly D, et al. Three- to six-year results with lhe Uhima metal-on-metal hip articulation for primary total hip arthroplasty. J Arthroplasty, 2004, 19(7 Suppl 2): 48-53.
  • 7Engh CA Jr, Macdonald SJ, Sritulanondha S, et al. 2008 John Charnley award: metal ion levels after metal-on-metal total hip arthroplasty: a randomized trial. Clin Orthop Relat Res, 2009(467): 101-111.
  • 8Dahlstrand H, Stark A, Anissian L, et al. increases in serum con- centrations of cobalt, chromium, nickel, and manganese 2 years after metal-on-metal alloarthroplasty of the hip: a prospective randomized study. J Arthroplasty, 2009, 24: 837-845.
  • 9MacDonald SJ, McCalden RW, Chess DG, et al. Metal-on-metal versus polyethylene in hip arthroplasty: a randomized clinical trial. Clin Orthop Relat Res, 2003(406): 282-296.
  • 10Saito S, Ryu J, Watanabe M, et al. Midterm results of metasul metal-on-metal total hip arthroplasty. J Arthroplasty, 2006, 8: 1105-1110.

二级参考文献29

  • 1王岩,郝立波,周勇刚,李静东,王继芳,唐佩福,黄鹏.人工髋关节置换术后感染的临床经验分析[J].中华外科杂志,2005,43(20):1313-1316. 被引量:37
  • 2Berger RA, Kull LR, Rosenberg AG, et al. Hybrid total hip arthroplasty: 7-to 10-year results. Clin Orthop Relat Res, 1996 (333) : 134-146.
  • 3Callaghan JJ, Tooma GS, Olejniezak JP, et al. Primary hybrid total hip arthroplasty: an interim followup. Clin Orthop Relat Res, 1996 ( 333 ) : 118-125.
  • 4Clohisy JC, Harris WH. Primary hybrid total hip replacement, performed with insertion of the acetabular component without cement and a precoat femoral component with cement: an average ten-year follow-up study. J Bone Joint Surg Am, 1999, 81: 247 -254.
  • 5Eisler T, Svensson O, Tengstrom A, et al. Patient expectation and satisfaction in revision total hip arthroplasty. J Arthroplasty, 2002, 17:457-462.
  • 6Berry D J, Harmsen WS, Cabanela ME, et al. Twenty-five year survivorship of two thousand consecutive primary Charnley total hip replacements: factors affecting survivorship of acetabular and femoral components. J Bone Joint Surg Am, 2002, 84 : 171-177.
  • 7Fumes O, Lie SA, Espehaug B, et al. Hip disease and the prognosis of total hip replacements. A review of 53,698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987-99. J Bone Joint Surg Br, 2001, 83:579-586.
  • 8R~der C, Eggli S, Aebi M, et al. The validity of clinical examination in the diagnosis of loosening of components in total hip arthroplasty. J Bone Joint Surg Br, 2003, 85:37-44.
  • 9DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976 ( 121 ) :20-32.
  • 10Gruen TA, McNeice GM, Amstutz HC. "Modes of failure" of cemented stemtype femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res, 1979 ( 141 ) : 17-27.

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