摘要
目的髋关节置换被视为最为成功的关节置换术,但在骨水泥和非骨水泥型股骨头置换的术式选择上仍存在争议。系统评价骨水泥与非骨水泥股骨头置换在老年患者中的术后感染相关并发症的差异。方法全面检索PubMed、Embase、Cochrane、Ovid、CBM、CNKI、VIP和万方等数据库,检索词包括:hip,hip joint,arthroplasty,hemiarthroplasty,Prosthesis Implantation,cemented,uncemented,aged;髋关节、股骨头置换、骨水泥、非骨水泥和老年人等,检索时间截止至2018年8月,纳入骨水泥与非骨水泥股骨头置换在老年人中术后感染相关并发症的随机对照研究(randomized controlled trial,RCT),对RCT研究采用Cochrane手册针对纳入文献进行的偏倚风险评估,由2位作者独立提取及分析数据,采用Review Manager 5.3软件对所得的数据进行Meta分析。结果共纳入的10篇随机对照试验研究(1325例)。结果显示行骨水泥与非骨水泥股骨头置换的老年患者术后深部感染[RR=1.31,95%CI (0.61,2.75),P=0.49]、浅表伤口感染[RR=1.34,95%CI (0.72,2.51),P=0.35]、泌尿系统感染[RR=1.10,95%CI (0.69,1.74),P=0.70]、肺部感染[RR=0.68,95%CI (0.39,1.16),P=0.16]、上呼吸道感染[RR=0.81,95%CI (0.32,2.04),P=0.66]和胸腔感染[RD=0.00,95%CI (-0.05,0.05),P=0.96]差异均无统计学意义。感染高危因素中仅有手术时间差异有统计学意义[MD=7.00,95%CI (3.24,10.75),P=0.0003],提示行股骨头置换的老年患者,骨水泥组的手术时间长于非骨水泥组。术中出血量[MD=-5.29,95%CI (-46.69,36.10),P=0.80]和住院时间[MD=0.04,95%CI (-0.57,0.66),P=0.89]差异均无统计学意义。结论骨水泥与非骨水泥股骨头置换在老年人中术后感染相关并发症差异无统计学意义,在治疗老年人股骨头置换中骨水泥与非骨水泥术式的选择上,术后感染相关并发症不是考虑的关键因素。
Objective Hip replacement is considered the most successful arthroplasty,but there is a controversy over the choice of surgical procedures for cemented or non-cemented hemiarthroplasty.To evaluate systematically the postoperative infection-related complications of bone cement and non-cement femoral head replacement in elderly patients.Methods PubMed,Cochrane Library,Embase,Ovid,WanFang Data,CBM,VIP and CNKI databases were electronically searched to collect the randomized controlled trials(RCTs)of postoperative infection-related complications between cement and non-cement hemiarthroplasty in elderly patients published up to August 2018.For the RCTs,we used the Cochrane Handbook to assess the methodological quality.Two of the authors independently extracted the articles and predefined data.Statistical analyses were performed using Review Manager 5.3 software.Results A total of 10 studies involving 1325 patients were identified in this analysis(667 cemented and 658 non-cemented).There were no significant differences between the 2 groups regarding deep infection[RR=1.31,95%CI(0.61,2.75),P=0.49],superficial wound infection[RR=1.34,95%CI(0.72,2.51),P=0.35],urinary tract infection[RR=1.10,95%CI(0.69,1.74),P=0.70],pneumonia[RR=0.68,95%CI(0.39,1.16),P=0.16],respiratory infection[RR=0.81,95%CI(0.32,2.04),P=0.66]and chest infection[RD=0.00,95%CI(-0.05,0.05),P=0.96];only operative time difference among the high risk factors of infection was significant(MD=7.00,95%CI(3.24,10.75),P=0.0003)It suggested that the operation time of cement femoral head replacement was longer than that of non-cement group.The other two factors:differences of intraoperative bleeding[MD=-5.29,95%CI(-46.69,36.10),P=0.80]and time of hospitalization[MD=0.04,95%CI(-0.57,0.66),P=0.89]had no significant significance.Conclusions Infection-related postoperative complication is not a determinant factor to consider when selecting a fixation method.
作者
周新
喻雅婷
张中卒
张孝华
ZHOU Xin;YU Ya-ting;ZHANG Zhong-zu;ZHANG Xiao-hua(Department of Orthopedics,Jiangjin Centre Hospital,Chongqing,402260,China)
出处
《中国骨与关节杂志》
CAS
2019年第4期266-274,共9页
Chinese Journal of Bone and Joint
基金
国家自然科学基金(81502329)
作者简介
通讯作者:张孝华,Email:zxhxjz@163.com
