直接前方入路（DSA）在全髋关节置换术中的疗效和安全性：系统评价和荟萃分析。

The efficacy and safety of direct superior approach (DSA) for total hip arthroplasty: a systematic review and meta-analysis.

机构信息

The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China.

Orthopedics IV, Gansu Provincial Hospital, No. 204 Donggang West Road, Chengguan District, Lanzhou, China.

出版信息

J Orthop Surg Res. 2023 Oct 10;18(1):764. doi: 10.1186/s13018-023-04233-2.

OBJECTIVE

To systematically evaluate the clinical safety and efficacy of the direct superior approach and the conventional surgical approach.

DATE SOURCES

From PubMed, Embase, the Cochrane Library, and China Knowledge Network up to January 30, 2023.

MAIN RESULTS

A total of 7 case series involving 4306 patients undergoing total hip arthroplasty were included, including 679 patients with direct superior approach. All outcome measures: Oxford Hip Score [MD = 0.30, 95% CI (- 0.87, 1.47), P = 0.62], Hip Harris Score [MD = - 0.18, 95% CI (- 0.86, 0.49), P = 0.59], intraoperative blood loss [MD = - 54.14, 95% CI (- 102.75,-5.52), P = 0.03], transfusion rate [MD = 0.49, 95% CI (0.29, 0.83), P = 0.008], Limb Length Differences [MD = - 0.21, 95% CI (0.02, 0.39), P = 0.03], Length of Stay [MD = - 0.61, 95% CI (- 0.69, - 0.52), P < 0.00001].

CONCLUSIONS

The DSA was superior to conventional access in terms of incision length, bleeding, postoperative transfusion rate, and early postoperative HHS. In addition, our study found that because the DSA has less tissue damage, it has the potential advantages of accelerating patient recovery after surgery, shortening hospitalization time, and reducing patient economic pressure, which can significantly improve patient quality of life and satisfaction.

目的

系统评价直接前路和传统手术入路的临床安全性和疗效。

资料来源

检索 PubMed、Embase、Cochrane 图书馆和中国知网，检索时间截至 2023 年 1 月 30 日。

主要结果

共纳入 7 项病例系列研究，共计 4306 例接受全髋关节置换术的患者，其中 679 例采用直接前路入路。所有结局指标：牛津髋关节评分[MD＝0.30，95％CI（-0.87，1.47），P＝0.62]、髋关节 Harris 评分[MD＝-0.18，95％CI（-0.86，0.49），P＝0.59]、术中失血量[MD＝-54.14，95％CI（-102.75，-5.52），P＝0.03]、输血率[MD＝0.49，95％CI（0.29，0.83），P＝0.008]、肢体长度差异[MD＝-0.21，95％CI（0.02，0.39），P＝0.03]、住院时间[MD＝-0.61，95％CI（-0.69，-0.52），P＜0.00001]。