直接前入路与 SuperPATH 入路和传统入路在全髋关节置换术中的比较：一项随机对照试验的网络荟萃分析。
Direct anterior approach vs. SuperPATH vs. conventional approaches in total hip replacement: A network meta-analysis of randomized controlled trials.
机构信息
Department of Emergency Medicine, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany.
Faculty of Medicine, Department of Statistics, University of Salamanca, Calle Espejo 2, 37007 Salamanca, Spain.
出版信息
Orthop Traumatol Surg Res. 2021 Dec;107(8):103058. doi: 10.1016/j.otsr.2021.103058. Epub 2021 Sep 15.
BACKGROUND
Two minimally invasive approaches showed some advantages in outcomes compared to conventional approaches (CAs) - the direct anterior approach (DAA) and the supercapsular percutaneously assisted approach in THA (SuperPATH). To the best of our knowledge, these three approaches have never been ranked in a network meta-analysis (NMA) before. Therefore, we conducted a systematic review and NMA of randomized controlled trials comparing short-term outcomes of DAA, SuperPATH and CAs in total hip joint arthroplasty (THA), using CAs as common comparator.
METHODS
A systematic literature search up to February 2021 was performed to identify randomized controlled trials (RCTs) comparing DAA with CAs and SuperPATH with CAs in THA. We measured surgical, functional and radiological outcomes. A NMA, using frequentist methods was performed to assess treatment effects between DAA, SuperPATH and CAs. Information was borrowed from the above-mentioned RCTs, using the CA group as a common comparator.
RESULTS
A total of 24 RCTs involving 2,074 patients met the inclusion criteria, six trials with a level I evidence, 18 trials with level II evidence. SuperPATH reduced operation time (fixed effects model: MD=8.1, 95% CI: 5.7 to 10.4), incision length (fixed effects model: MD=2.7, 95%CI: 2.5 to 2.9; random effects model: MD=4.1, 95%CI: 0.6 to 7.6), intraoperative blood loss (fixed effects model: MD=157, 95%CI: 139.2 to 174.2; random effects model: MD=129, 95%CI: 11.5 to 245.7) and early pain intensity (VAS 1 day postoperatively with a fixed effects model: MD=0.8, 95%CI: 0.4 to 1.2) compared to DAA. The two approaches did not differ in functional outcome and in acetabular cup inclination positioning.
CONCLUSIONS
Our overall findings suggest that short-term outcomes of THA through SuperPATH were superior to DAA and CAs and that short-term outcomes of THA through DAA were superior to CAs.
LEVEL OF EVIDENCE
II; systematic review with level I studies and level II studies.
背景
与传统入路（CA）相比，两种微创入路（直接前入路 [DAA] 和经皮SuperPATH 髋关节置换术 [SuperPATH]）在结果方面显示出一些优势。据我们所知，这三种方法以前从未在网络荟萃分析（NMA）中进行过排名。因此，我们进行了一项系统评价和 NMA，比较了 DAA、SuperPATH 和 CA 在全髋关节置换术中的短期结果，以 CA 作为共同比较。
方法
系统检索至 2021 年 2 月，以确定比较 DAA 与 CA 和 SuperPATH 与 CA 在全髋关节置换术中的随机对照试验（RCT）。我们测量了手术、功能和影像学结果。使用频率论方法进行 NMA，以评估 DAA、SuperPATH 和 CA 之间的治疗效果。使用 CA 组作为共同比较，从上述 RCT 中获取信息。
结果
共有 24 项 RCT 符合纳入标准，涉及 2074 例患者，其中 6 项为 I 级证据，18 项为 II 级证据。SuperPATH 缩短了手术时间（固定效应模型：MD=8.1，95%CI：5.7 至 10.4）、切口长度（固定效应模型：MD=2.7，95%CI：2.5 至 2.9；随机效应模型：MD=4.1，95%CI：0.6 至 7.6）、术中失血量（固定效应模型：MD=157，95%CI：139.2 至 174.2；随机效应模型：MD=129，95%CI：11.5 至 245.7）和早期疼痛强度（术后第 1 天 VAS：MD=0.8，95%CI：0.4 至 1.2）与 DAA 相比。两种方法在功能结果和髋臼杯倾斜定位方面没有差异。
结论
我们的总体发现表明，SuperPATH 行全髋关节置换术的短期结果优于 DAA 和 CA，而 DAA 行全髋关节置换术的短期结果优于 CA。
证据水平
II；包括 I 级研究和 II 级研究的系统评价。
Zotero 插件