直接前侧入路与后侧或外侧入路在全髋关节置换术中的比较：系统评价和荟萃分析。
Comparing direct anterior approach versus posterior approach or lateral approach in total hip arthroplasty: a systematic review and meta-analysis.
机构信息
Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia.
Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia.
出版信息
Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2773-2792. doi: 10.1007/s00590-023-03528-8. Epub 2023 Apr 3.
BACKGROUND
There are several approaches to THA, and each has their respective advantages and disadvantages. Previous meta-analysis included non-randomised studies that introduce further heterogeneity and bias to the evidence presented. This meta-analysis aims to present level I evidence by comparing functional outcomes, peri-operative parameters and complications of direct anterior approach (DAA) versus posterior approach (PA) or lateral approach (LA) in THA.
PATIENTS AND METHODS
A comprehensive multi-database search (PubMed, OVID Medline, EMBASE) was conducted from date of database inception to 1st December 2020. Data from randomised controlled trials comparing outcomes of DAA versus PA or LA in THA were extracted and analysed.
RESULTS
Twenty-four studies comprising 2010 patients were included in this meta-analysis. DAA has a longer operative time (MD = 17.38 min, 95%CI: 12.28, 22.47 min, P < 0.001) but a shorter length of stay compared to PA (MD = - 0.33 days, 95%CI: - 0.55, - 0.11 days, P = 0.003). There was no difference in operative time or length of stay when comparing DAA versus LA. DAA also had significantly better HHS than PA at 6 weeks (MD = 8.00, 95%CI: 5.85, 10.15, P < 0.001) and LA at 12 weeks (MD = 2.23, 95%CI: 0.31, 4.15, P = 0.02). There was no significant difference in risk of neurapraxia for DAA versus LA or in risk of dislocations, periprosthetic fractures or VTE between DAA and PA or DAA and LA.
CONCLUSION
The DAA has better early functional outcomes with shorter mean length of stay but was associated with a longer operative time than PA. There was no difference in risk of dislocations, neurapraxias, periprosthetic fractures or VTE between approaches. Based on our results, choice of THA approach should ultimately be guided by surgeon experience, surgeon preference and patient factors.
LEVEL OF EVIDENCE I
Meta-analysis of randomised controlled trials.
背景
全髋关节置换术（THA）有几种方法，每种方法都有各自的优缺点。先前的荟萃分析包括非随机研究，这给所呈现的证据引入了更多的异质性和偏倚。本荟萃分析旨在通过比较直接前侧入路（DAA）与后侧入路（PA）或外侧入路（LA）在 THA 中的功能结果、围手术期参数和并发症，提供 I 级证据。
患者和方法
从数据库建立日期到 2020 年 12 月 1 日，进行了全面的多数据库搜索（PubMed、OVID Medline、EMBASE）。提取并分析了比较 DAA 与 PA 或 LA 在 THA 中结果的随机对照试验的数据。
结果
这项荟萃分析纳入了 24 项研究，共 2010 名患者。与 PA 相比，DAA 的手术时间更长（MD=17.38 分钟，95%CI：12.28，22.47 分钟，P<0.001），但住院时间更短（MD=-0.33 天，95%CI：-0.55，-0.11 天，P=0.003）。与 LA 相比，DAA 与 PA 在手术时间或住院时间方面没有差异。DAA 在 6 周（MD=8.00，95%CI：5.85，10.15，P<0.001）和 12 周（MD=2.23，95%CI：0.31，4.15，P=0.02）时的 HHS 也显著优于 PA。DAA 与 LA 相比，神经损伤的风险无显著差异，与 PA 或 LA 相比，脱位、假体周围骨折或 VTE 的风险也无显著差异。
结论
DAA 具有更好的早期功能结果，平均住院时间更短，但手术时间长于 PA。在脱位、神经损伤、假体周围骨折或 VTE 风险方面，不同入路之间没有差异。基于我们的结果，THA 方法的选择最终应取决于外科医生的经验、偏好和患者因素。
证据等级 I：随机对照试验的荟萃分析。
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