全髋关节置换术经直接前方入路与后方入路临床疗效的Meta分析

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摘要目的通过系统评价及Meta分析评价直接前方入路(direct anterior approach，DAA)和后方入路(posterior approach，PA)对全髋关节置换术(total hip arthroplasty，THA)的临床疗效及安全性。方法检索Pubmed、Embase、Cochrane 图书馆、中国知网和万方等数据库，检索年限均为从建库至2017年10月，无语言限制，全面检索经DAA或PA行全髋关节置换术的临床对比研究，由两名研究员独立筛选及纳入研究，提取数据资料及方法学质量评估，采用Cochrane协助网提供的RevMan5.3软件进行Meta分析。结果纳入前瞻性研究文献10篇，入选患者812例，其中DAA组407例，PA组405例。Meta分析结果显示：DAA组术后早期功能恢复、活动能力、步态优于PA组，DAA组术后视觉模拟疼痛评分低于PA组(P＜0.05)，DAA组发生股外侧皮神经损伤的发生率高于PA组(P＜0.05)，DAA组中髋臼假体在Lewinnek安全区的数量多于PA组(P＜0.05)，DAA组较PA组软组织损伤小。两组在术中骨折、术后脱位、切口并发症、异位骨化、腹股沟区疼痛的发生率比较，差异无统计学意义(P＞0.05)；两组手术时间、住院时间、术中出血量比较，差异无统计学意义(P＞0.05)；两组在髋臼前倾角和外展角比较，差异无统计学意义(P＞0.05)。结论经DAA行THA在术后早期功能的恢复优于PA，术后疼痛轻，但股外侧皮神经损伤的发生率高。

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关键词 ：手术入路, 直接前方入路, 后方入路, 全髋关节置换术

Abstract：Objective To performed a systematic review and meta-analysis to assess the outcome of direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty.Methods Published studies comparing DAA and PA for THA were searched in major databases from the inception of each database until October 2017 without language restriction.Eligible studies were selected according to inclusion and exclution criteria.The data were extracted and the quality of included studies was evaluated by two reviewers.Meta analysis was performed using RevMan 5.3 software.Results A total of 10 prospective comparative studies (7 randomized) with patients treated with DAA (n＝407) or PA (n＝405) were included.The result of Meta-analysis showed that DAA was superior to PA in early postoperative function rehabilitation and acticities and the patients in DAA group had less pain than these in PA after operation.The incidence of lateral femoral cutaneous nerve injury and the percentage of acetabular cups placed within the Lewinnek safe zone were higher in DAA group than PA group.There was no significant difference in the incidence of intraoperative fractures，postoperative dislocation，incision complications，heterotopic ossification and groin pain between the two groups.Neither were the operation time，length of hospital stay，intraoperative blood less or angle of acetabular cup anteversion angle of cup inclination. Conclusion The early recovery of DAA for THA is better than that of PA after operation.Postoperative pain in DAA group is less，but the incidence of lateral femoral cutaneous nerve injury is high.

Key words： surgical approach direct anterior approach posterior approach total hip arthroplast

通讯作者: 张晓岗

作者简介: 彭永刚(1989－ )，男，研究生在读，新疆医科大学第一附属医院关节外科，830000。

引用本文:

彭永刚，任姜栋，张坤，宋星来，苗润清，张晓岗 *. 全髋关节置换术经直接前方入路与后方入路临床疗效的Meta分析[J]. 实用骨科杂志, 2018, 24(6): 510-515.
Peng Yonggang，Ren Jiangdong，Zhang Kun，et al. Direct Anterior Approach Versus Posterior Approach for Total Hip Arthroplasty Meta-analysis. sygkzz, 2018, 24(6): 510-515.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I6/510

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