1st Orthopaedic Department, ATTIKON University General Hospital, University of Athens, School of Medicine, Athens, Greece.
Curr Vasc Pharmacol. 2011 Jan;9(1):24-32. doi: 10.2174/157016111793744751.
We conducted a thorough search of all the English language literature and carried out a meta-analysis in an attempt to reveal potential differences on the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) between one stage bilateral and unilateral total hip replacements, and to provide, if possible, recommendations on thromboembolic prophylaxis. We identified 37 citations eligible for inclusion. A total of 5868 bilateral simultaneous THR patients were identified. Analysis of data was performed with the Mantel-Haenszel method. Meta-analysis of homogeneous data revealed no statistically significant differences in the rates of deep vein thrombosis (p = 0.40) and pulmonary embolism (p = 0.39) when comparing staged with bilateral simultaneous THR procedures as well as the rates of pulmonary embolism when comparing bilateral simultaneous THR with unilateral procedures (p = 0.69). However, deep vein thrombosis rate was in favor of bilateral two-stage compared to unilateral THR (p = 0.00001). Definite recommendations regarding the prevention of thromboembolic events in bilateral simultaneous THR could not be produced as the literature was limited and the data heterogenic. Conclusively, deep vein thrombosis and pulmonary embolism is not increased in bilateral simultaneous THR, provided that appropriate prophylactic measures are taken. More data are needed in order to clarify if additional measures or altered protocols of thromboembolic prophylaxis should be followed.
我们对所有英文文献进行了全面检索，并进行了荟萃分析，试图揭示一期双侧和单侧全髋关节置换术之间深静脉血栓（DVT）和肺栓塞（PE）发生率的潜在差异，并尽可能提供血栓栓塞预防建议。我们确定了 37 项符合纳入标准的引文。共确定了 5868 例双侧同期 THR 患者。采用 Mantel-Haenszel 方法进行数据分析。同质性数据的荟萃分析显示，分期双侧与同期双侧 THR 手术之间深静脉血栓（p=0.40）和肺栓塞（p=0.39）的发生率无统计学差异，双侧同期 THR 与单侧手术之间肺栓塞的发生率也无统计学差异（p=0.69）。然而，深静脉血栓形成率有利于双侧两期手术而非单侧 THR（p=0.00001）。由于文献有限且数据异质性，无法对双侧同期 THR 中血栓栓塞事件的预防提出明确建议。需要更多的数据来阐明是否应该采取额外的措施或改变血栓栓塞预防方案。
