微创与传统入路全髋关节置换术功能结局及并发症发生率的危险因素与预测因素：41项随机对照试验的系统评价与Meta回归分析

Risk Factors and Predictors for Functional Outcome and Complication Rate in Total Hip Arthroplasty through Minimally Invasive and Conventional Approaches: A Systematic Review and Meta-Regression Analysis of 41 Randomized Controlled Trials.

作者信息

Ramadanov Nikolai, Ostojic Marko, Lazaru Philip, Liu Kuiliang, Hable Robert, Marinova-Kichikova Polina, Dimitrov Dobromir, Becker Roland

机构信息

Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, 14770 Brandenburg an der Havel, Germany.

Department of Orthopedics, University Hospital Mostar, 88000 Mostar, Bosnia and Herzegovina.

出版信息

J Clin Med. 2023 Sep 11;12(18):5895. doi: 10.3390/jcm12185895.

OBJECTIVE

To investigate and identify risk factors and predictors for the difference in functional outcome and complications between total hip arthroplasty (THA) through minimally invasive and conventional approaches, using a meta-regression analysis of randomized controlled trials (RCTs).

METHODS

A systematic review of the literature up to 31 July 2022 was performed. A meta-regression was conducted based on a random effects meta-analysis using the Hartung-Knapp-Sidik-Jonkman method.

RESULTS

A total of 41 RCTs with 3607 patients were found. The following predictors of HHS ≥ 6 months postoperatively were identified: patient age (predictor estimate = 0.14; < 0.01), avascular necrosis of the femoral head (predictor estimate = -0.03; = 0.04); incision length (predictor estimate = -0.82; < 0.01). The following predictors of complication rate were identified: osteoarthritis (predictor estimate = 0.02; = 0.02); femoral neck fracture (predictor estimate = -0.02; = 0.02); SuperPATH (predictor estimate = -1.72; < 0.01).

CONCLUSIONS

Patient age, avascular necrosis of the femoral head, and incision length were identified as predictors of the effect size of the HHS ≥ 6 months postoperatively; and osteoarthritis, femoral neck fracture, and SuperPATH as predictors of the effect size of the complication rate. Based on these findings, we recommend that more frequent use of minimally invasive THA in elderly patients should be considered.

LEVEL OF EVIDENCE I

a systematic review of all relevant randomized controlled trials. Registered in PROSPERO on 10 August 2022 (CRD42022350287).

目的

通过对随机对照试验（RCT）进行Meta回归分析，调查并确定全髋关节置换术（THA）采用微创和传统入路时功能结局和并发症差异的风险因素及预测指标。

方法

对截至2022年7月31日的文献进行系统综述。采用Hartung-Knapp-Sidik-Jonkman方法，基于随机效应Meta分析进行Meta回归。

结果

共纳入41项RCT，涉及3607例患者。确定了术后≥6个月Harris髋关节评分（HHS）的以下预测指标：患者年龄（预测指标估计值=0.14；P<0.01）、股骨头缺血性坏死（预测指标估计值=-0.03；P=0.04）；切口长度（预测指标估计值=-0.82；P<0.01）。确定了并发症发生率的以下预测指标：骨关节炎（预测指标估计值=0.02；P=0.02）；股骨颈骨折（预测指标估计值=-0.02；P=0.02）；SuperPATH入路（预测指标估计值=-1.72；P<0.01）。