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颗粒状同种异体骨在髋关节翻修术中治疗髋臼大缺损的应用:一项系统评价和荟萃分析

Use of morselized bone allograft in revision hip arthroplasty for massive acetabular defect: A systematic review and meta-analysis.

作者信息

Cimatti Pietro, Del Piccolo Nicolandrea, Dallari Benedetta, Mazzotta Alessandro, Dallari Dante

机构信息

Reconstructive Orthopaedic Surgery Innovative Techniques-Musculoskeletal Tissue Bank IRCCS Istituto Ortopedico Rizzoli Bologna Italy.

Department of Surgical Sciences and Innovative Technologies University of Bologna-Alma Mater Studiorum Bologna Italy.

出版信息

J Exp Orthop. 2024 Dec 4;11(4):e70091. doi: 10.1002/jeo2.70091. eCollection 2024 Oct.

Abstract

PURPOSE

Many treatment options are available for the revision of large acetabular defects. Debate continues as to which technique is most effective. This meta-analysis aimed to determine the rates of failure of acetabular bone defects Paprosky type III or American Academy of Orthopaedic types III-IV treated with morselized allograft in association with cemented cup or cementless cup or reinforcement devices.

METHODS

The US National Library of Medicine (PubMed/MEDLINE), EMBASE and the Cochrane Database of Systematic Reviews were queried for publications from January 1980 to 1 April 2024 utilizing keywords pertinent to total hip arthroplasty (THA), acetabular impaction bone grafting and revision THA. The main outcome measure was the 9-year implant failure rate.

RESULTS

Thirty-nine articles were eligible for inclusion in the current study. We found 41 treatment approaches that we grouped into three different treatment options: 1 = morselized allograft and cemented cup (10 studies); 2 =morselized allograft and cementless cup (nine studies); 3 = morselized allograft and device (22 studies). The overall implant failure rate was 2.1% (95% confidence interval [CI], 1.6%-2.8%) at a mean of 9.2 years. There was no significant difference in failure rates between different treatment options (1.6% [95% CI, 0.9%-2.6%]) for morselized allograft and cemented cup; 2.1% (95% CI, 1.4%-3.2%) for morselized allograft and cementless cup; 2.5% (95% CI, 1.7%-3.7%) for morselized allograft and device) between the three different types of treatment (heterogeneity between groups  = 0.351).It was determined that the number one cause of failure was aseptic loosening (80.5%), followed by infection (13.1%) and dislocation (6.4%). THA with reinforcement devices has a higher incidence of infection (3.6 vs. 0.7%,  = 0.001) and dislocation (1.4 vs. 0.6%,  = 0.010) than THA with a cemented cup.

CONCLUSIONS

The use of morselized allograft in hip revision of large acetabular defects has low implant failure rates, independently of the associated type of implant. Reinforcement devices increase the risk of re-revision for infection and dislocation.

LEVEL OF EVIDENCE

Level III.

摘要

目的

对于大型髋臼缺损的翻修有多种治疗选择。关于哪种技术最有效,争论仍在继续。这项荟萃分析旨在确定采用颗粒状同种异体骨联合骨水泥杯或非骨水泥杯或加强装置治疗的Paprosky III型髋臼骨缺损或美国矫形外科学会III - IV型髋臼骨缺损的失败率。

方法

利用与全髋关节置换术(THA)、髋臼打压植骨和翻修THA相关的关键词,查询美国国立医学图书馆(PubMed/MEDLINE)、EMBASE和Cochrane系统评价数据库1980年1月至2024年4月1日期间的出版物。主要结局指标是9年植入物失败率。

结果

39篇文章符合纳入本研究的条件。我们发现41种治疗方法,将其分为三种不同的治疗选择:1 = 颗粒状同种异体骨和骨水泥杯(10项研究);2 = 颗粒状同种异体骨和非骨水泥杯(9项研究);3 = 颗粒状同种异体骨和装置(22项研究)。平均9.2年时,总体植入物失败率为2.1%(95%置信区间[CI],1.6% - 2.8%)。不同治疗选择之间的失败率无显著差异(颗粒状同种异体骨和骨水泥杯为1.6%[95%CI,0.9% - 2.6%];颗粒状同种异体骨和非骨水泥杯为2.1%[95%CI,1.4% - 3.2%];颗粒状同种异体骨和装置为2.5%[95%CI,1.7% - 3.7%]),三种不同类型的治疗之间(组间异质性 = 0.351)。确定失败的首要原因是无菌性松动(80.5%),其次是感染(13.1%)和脱位(6.4%)。与骨水泥杯的THA相比,使用加强装置的THA感染发生率更高(3.6%对0.7%,P = 0.001),脱位发生率更高(1.4%对0.6%,P = 0.010)。

结论

在大型髋臼缺损的髋关节翻修中使用颗粒状同种异体骨,植入物失败率较低,与相关植入物类型无关。加强装置增加了因感染和脱位而再次翻修的风险。

证据级别

III级。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d858/11615971/4ce31fedfc87/JEO2-11-e70091-g005.jpg

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