骨盆不连续的手术治疗：系统评价与Meta分析

Surgical Treatment of Pelvic Discontinuity: A Systematic Review and Meta-Analysis.

作者信息

Szczepanski Jason R, Perriman Diana M, Smith Paul N

机构信息

Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia.

School of Medicine, College of Medicine, Biology & Environment, The Australian National University, Acton, Australian Capital Territory, Australia.

出版信息

JBJS Rev. 2019 Sep;7(9):e4. doi: 10.2106/JBJS.RVW.18.00176.

DOI:10.2106/JBJS.RVW.18.00176

PMID:31503100

Abstract

BACKGROUND

Pelvic discontinuity is a rare condition that is treated with a range of implant constructs. However, surgical failure rates are high, and outcome data are inconsistent. It is therefore difficult to gain a clear picture of whether recently developed constructs (antiprotrusio cage [APC], cup-cage, custom triflange, and porous metal) provide better outcomes in terms of mechanical failure and complications in the short to long terms. This study investigated the failure and complication rates associated with cage constructs and porous metal technologies.

METHODS

A systematic review and meta-analysis were performed according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines to evaluate the studies showing pelvic discontinuity in revision total hip arthroplasty. Data retrieved included the intervention performed, length of follow-up, mechanical failure, and other complication rates (dislocation, infection, neurological, loosening, migration). Study quality was assessed with the Methodological Index for Non-Randomized Studies (MINORS) instrument. Pooled mechanical failure and complication rates were calculated using MetaXL 5.3.

RESULTS

None of the included 30 articles (n = 585 hips) were of high quality. The meta-analyses revealed a mechanical failure rate of 14% for all constructs combined. Custom triflange (5%) and cup-cage (7%) had the lowest mechanical failure rates compared with the commonly used APC (25%) and porous metal (12%). The overall other complication rate was 28%, with cup-cage lower at 21% compared with APC (34%) and custom triflange (28%). Long-term evidence investigating both interventions and porous metal technology is limited.

CONCLUSIONS

Mechanical failure rates for cup-cage and custom triflange were lowest. The other complication rate for cup-cage was lower than the pooled average. The study quality was limited, indicating a need for better studies and/or a registry.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

骨盆不连续是一种罕见病症，需采用一系列植入物结构进行治疗。然而，手术失败率较高，且结果数据并不一致。因此，很难清楚了解近期研发的结构（防后突笼[APC]、髋臼杯-笼、定制三翼钢板和多孔金属）在短期至长期的机械性失败和并发症方面是否能带来更好的结果。本研究调查了与笼状结构和多孔金属技术相关的失败率和并发症发生率。

方法

根据流行病学观察性研究的荟萃分析（MOOSE）指南进行系统评价和荟萃分析，以评估翻修全髋关节置换术中显示骨盆不连续的研究。检索到的数据包括所实施的干预措施、随访时间、机械性失败以及其他并发症发生率（脱位、感染、神经损伤、松动、移位）。使用非随机研究的方法学指数（MINORS）工具评估研究质量。使用MetaXL 5.3计算合并的机械性失败率和并发症发生率。

结果

纳入的30篇文章（n = 585髋）均非高质量研究。荟萃分析显示，所有结构合并的机械性失败率为14%。与常用的APC（25%）和多孔金属（12%）相比，定制三翼钢板（5%）和髋臼杯-笼（7%）的机械性失败率最低。总体其他并发症发生率为28%，髋臼杯-笼为21%，低于APC（34%）和定制三翼钢板（28%）。关于干预措施和多孔金属技术的长期证据有限。