Kobayashi Naomi, Kamono Emi, Kameda Kensuke, Yukizawa Yohei, Takagawa Shu, Honda Hideki, Inaba Yutaka
Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, Japan.
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
Arch Orthop Trauma Surg. 2023 Mar;143(3):1689-1697. doi: 10.1007/s00402-022-04444-y. Epub 2022 May 6.
Although several surgical approaches, with or without capsular repair, can be used during total hip arthroplasty (THA), there is no clear evidence that capsular repair provides a clinical advantage post-surgery, regardless of surgical approach. This systematic review and meta-analysis evaluated whether capsular repair using various surgical approaches provides a clinical advantage over capsular resection post-THA.
This study was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 checklist for systematic reviews and meta-analyses. Multiple comprehensive literature searches were performed. Results were summarized qualitatively as meta-analysis of pooled odds ratios, and the standardized mean difference, with 95% confidence intervals for each group: capsular repair or capsular resection. A P value < 0.05 was considered statistically significant. Each study was evaluated for the risk of bias. Publication bias was also assessed.
A total of 12 studies were included after screening and eligibility assessment. The odds ratio for hip dislocation after capsular repair was 0.14 (P < 0.00001). The standard mean difference of the Harris Hip Score (HHS) after capsular repair was 1.11 (P = 0.02). There were no significant differences between groups with respect to operation time (P = 0.79) and blood loss (P = 0.42).
The current meta-analysis suggests that capsular repair leads to lower dislocation rates and a better HHS after THA.
尽管在全髋关节置换术（THA）中可以采用多种手术方法，包括有无关节囊修复，但尚无明确证据表明关节囊修复在术后能带来临床优势，无论采用何种手术方法。本系统评价和荟萃分析评估了采用不同手术方法进行关节囊修复在THA后是否比关节囊切除具有临床优势。
本研究按照系统评价和荟萃分析的首选报告项目（PRISMA）2020系统评价和荟萃分析清单进行。进行了多次全面的文献检索。结果以合并比值比的荟萃分析和标准化均数差进行定性总结，每组（关节囊修复或关节囊切除）的95%置信区间。P值<0.05被认为具有统计学意义。对每项研究进行偏倚风险评估。还评估了发表偏倚。
经过筛选和纳入标准评估，共纳入12项研究。关节囊修复后髋关节脱位的比值比为0.14（P<0.00001）。关节囊修复后Harris髋关节评分（HHS）的标准化均数差为1.11（P=0.02）。两组在手术时间（P=0.79）和失血量（P=0.42）方面无显著差异。
当前的荟萃分析表明，关节囊修复可降低THA后的脱位率，并改善HHS。
