人工髖關節置換術股骨柄固定方式的安全性系統評價_《中國循證醫學雜志》

作者：

馬杰科 ¹ , 裴福興 ¹ , 李幼平 ² , 熊鷹 ² , 魏欣 ³

1. 四川大學華西醫院骨科,成都,6100412. 四川大學華西醫院循證醫學與臨床流行病學中心3. 中國協和醫科大學,北京,100005;

關鍵詞：

人工髖關節置換骨水泥非骨水泥系統評價

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目的　應用Cochrane系統評價的方法,評價人工髖關節置換術中兩種股骨柄固定方式的效果差異,以期為臨床選擇股骨柄固定方式提供依據.
方法　計算機檢索中國生物醫學文摘數據庫(1979～2004.12)、MEDLINE(1966～2005.2)、EMBASE(1984～2004)和Cochrane圖書館(2004年第4期),手工檢索 lt;中華骨科雜志 gt;、 lt;骨與關節損傷雜志 gt;和 lt;中華創傷骨科雜志 gt;,均從創刊檢索至2005年2月,收集所有相關隨機對照試驗,并利用RevMan 4.2對納入試驗進行Meta分析.
結果　共納入符合標準的RCT 9個,合計1 075例髖關節(髖例數).合并后分析發現,第1代和第2代骨水泥技術固定組栓塞發生率明顯高于非骨水泥固定組[OR 0.02,95%CI (0,0.11),P＜0.000 01],而第3代骨水泥技術固定組栓塞發生率與非骨水泥固定組無統計學差異 [OR 0.80, 95%CI (0.36,1.78), P=0.58];骨水泥組股骨柄下降率 [OR 12.20, 95%CI (3.58,41.54), P＜0.000 1] 和皮質增生現象發生率 [OR 69.97, 95%CI (27.88,175.57), P＜0.000 01],明顯低于非骨水泥組.
結論　第1代和第2代骨水泥技術固定組的栓塞現象發生率高于非骨水泥固定組,而第3代骨水泥技術固定組與非骨水泥固定組比較沒有明顯差異;骨水泥組的股骨柄下降和皮質增生現象發生率低于非骨水泥組,但在術后大腿痛、股骨柄假體翻修以及異位骨化發生率等術后并發癥等問題仍然有待進一步研究.

引用本文： 馬杰科,裴福興,李幼平,熊鷹,魏欣. 人工髖關節置換術股骨柄固定方式的安全性系統評價. 中國循證醫學雜志, 2005, 05(4): 296-302. doi: 復制

1.	Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers Handbook 4.2.1 [updated December 2003] [M/CD]. Section 6. In: The Cochrane Library. The Cochrane Collaboration. Oxford: 2004, issue 1.
2.	Anders W, Elisabeth O, Gabriella A, Ian G. Total hip arthroplasty: a comparison between cemented and Press-fit noncemented fixation[J]. J Arthroplasty, 1991; 6(1): 19-29.
3.	Andreas L, Robert B, Cecil R, David F, Peter T, Cindy W. Comparison of Total Hip Arthroplasty performed with and without cement: a randomized trial[J]. J Bone Joint Surg Am, 2002; 84-A(10): 1 823-1 828.
4.	Astor R, Magne R, Kjell B, Merete B. Femoral remodeling after arthroplasty of the hip: TPospective randomized 5-year comparison of 120 cemented/uncemented cases of arthrosis[J]. Acta Orthop Scand, 1993; 64(4): 411-416.
5.	Christie J, Burnett R, Potts HR, Pell ACH. Echocardiography of transatrial embolism during cem and uncemented hemiarthroplasty of the hip[J]. J Bone Joint Surg Br, 1994; 76(3): 409-412.
6.	Godsiff SP, Emery RJ, Heywood MB, Thomas TL. Cemented versus uncemented femoral components in the ring hip TPosthesis[J]. J Bone Joint Surg Br, 1992; 74(6): 822-824.
7.	Johan K, Henrik M, Finnur S, Peter H. Micromotion of femoral stem in total hip arthroplasty: A randomized study of cemented, hydroxapatite-coated and porous-coated stems with roentgen sterophotogrammetri analysis[J]. Journ of Bone Joint Surg, 1994; 76(11): 1 692-1 705.
8.	Pitto RP, Koessler M, Joern WK. Comparison of fixation of the femoral component without cement and fixation with use of a bone-vacuum cementing technique for the prevention of fat embolism during THA[J]. J Bone Joint Surg Am, 1999; 81(6): 831-843.
9.	Rorabeck CH, Robert BB, Mulliken BD, Naresh N, Andereas L, Peter T, David F. The Nicloas Andry Award: Comparative results of cemented and cementless total hip arthroplasty[J]. Clinical Orthopaedics and Related Research, 1996; 325: 330-344.
10.	Young HK, S-W O, J-S K. Prevalence of fat embolism following bilateral simultaneous and unilateral THA performed with or without cement. A prospective randomized clinical study[J]. J Bone Joint Surg Am, 2002; 84-A(8): 1 372-1 379.
11.	Orsini EC, Byrick RJ, Mullen JB, Kay JC, Waddell JP.Cardiopulmonary function and pulmonary microemboli during arthroplasty using cemented or noncemented components. The role of intramedullary pressure[J]. J bone Joint Surg Am, 1987; 69: 822-832.
12.	Ries MD, Lynch F, Rauscher LA, Richman J, Mick C, Gomez M. Pulmonary function during and after total hip replacement. Findings in patients who have insertion of a femoral component with or without cement[J]. J Bone Joint Surg Am, 1993; 75(4): 581-587.
13.	Inadome T, Wall MC, Smith CL, Whiteside LA. Femoral intramedullary pressure during in vitro cemented and cementless total hip arthroplasty[J]. Orthop Trans, 1998-99; 22: 154-155.
14.	Hagio K, Sugano N, Masaki T, Takashi N, Hideki Y, Takahiro O. Embolic events during total hip arthroplasty: An echocardiographic study[J]. Journal of Arthroplasty, 2003; 18(2): 186-192.
15.	Weber BG. Pressurized cement fixation in total hip arthroplasty[J]. Clin Orthop Relat Res, 1988; 232: 87-95.
16.	Pitto RP, Koessler M, Draenert K. Prophylaxis of fat and bone marrow embolism in cemented total hip arthroplasty[J]. Clin Orthop, 1998; 355: 23-34.
17.	McGee MA, Howie DW, Neale SD, Haynes DR, Pearcy MJ. The role of polyethylene wear in joint replacement failure[J]. Proc Inst Mech Eng, 1997; 211(1): 65-72.
18.	Sylvain GM, Kassab S, Coutts R, Santore R. Early failure of a roughened surface, precoated femoral component in total hip arthroplasty[J]. J Arthroplasty, 2001; 16(2): 141-148.
19.	Mulliken BD, Nayak N, Bourne RB, Rorabeck CH, Bullas R. Early radiographic results comparing cemented and cementless THA[J]. J Arthroplasty, 1996; 11(1): 24-33.
20.	Karrholm J, Frech W, Snorrason F, Nilsson KG. Increased metal release from cemented femoral components. Evaluation of 19 hip TPotheses followed with stereoradiography[J]. Trans Orthop Res Soc, 1993; 18: 507.
21.	Mjoberg B, Selvic G, Hansson L, Rosenqvist R, Onnerfalt R. Mechanical loosening of total hip protheses: A radiographic and roentgen stereophotogrammetric study[J]. J Bone Joint Surg Br, 1986; 68-B(5): 770-774.
22.	Harris W H. Will stress-shielding limit the longevity of cemented femoral components of THR[J]? Clin Orthop, 1992; 274: 120-123.
23.	Huiskes R. The various stress patterns of Press-fit, ingrown, and cemented femoral stems[J]. Clin Orthop, 1990; 261: 27-38.
24.	Lintner F, Zweymuller K, Bohm G, Brand G. Reactions of surrounding tissue to the cementless hip implant Ti-6Al-4V after an implantation period of several years. Autopsy study in three cases[J]. Arch Orthop Trauma Surg, 1988; 107(6): 357-363.

1. Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers Handbook 4.2.1 [updated December 2003] [M/CD]. Section 6. In: The Cochrane Library. The Cochrane Collaboration. Oxford: 2004, issue 1.
2. Anders W, Elisabeth O, Gabriella A, Ian G. Total hip arthroplasty: a comparison between cemented and Press-fit noncemented fixation[J]. J Arthroplasty, 1991; 6(1): 19-29.
3. Andreas L, Robert B, Cecil R, David F, Peter T, Cindy W. Comparison of Total Hip Arthroplasty performed with and without cement: a randomized trial[J]. J Bone Joint Surg Am, 2002; 84-A(10): 1 823-1 828.
4. Astor R, Magne R, Kjell B, Merete B. Femoral remodeling after arthroplasty of the hip: TPospective randomized 5-year comparison of 120 cemented/uncemented cases of arthrosis[J]. Acta Orthop Scand, 1993; 64(4): 411-416.
5. Christie J, Burnett R, Potts HR, Pell ACH. Echocardiography of transatrial embolism during cem and uncemented hemiarthroplasty of the hip[J]. J Bone Joint Surg Br, 1994; 76(3): 409-412.
6. Godsiff SP, Emery RJ, Heywood MB, Thomas TL. Cemented versus uncemented femoral components in the ring hip TPosthesis[J]. J Bone Joint Surg Br, 1992; 74(6): 822-824.
7. Johan K, Henrik M, Finnur S, Peter H. Micromotion of femoral stem in total hip arthroplasty: A randomized study of cemented, hydroxapatite-coated and porous-coated stems with roentgen sterophotogrammetri analysis[J]. Journ of Bone Joint Surg, 1994; 76(11): 1 692-1 705.
8. Pitto RP, Koessler M, Joern WK. Comparison of fixation of the femoral component without cement and fixation with use of a bone-vacuum cementing technique for the prevention of fat embolism during THA[J]. J Bone Joint Surg Am, 1999; 81(6): 831-843.
9. Rorabeck CH, Robert BB, Mulliken BD, Naresh N, Andereas L, Peter T, David F. The Nicloas Andry Award: Comparative results of cemented and cementless total hip arthroplasty[J]. Clinical Orthopaedics and Related Research, 1996; 325: 330-344.
10. Young HK, S-W O, J-S K. Prevalence of fat embolism following bilateral simultaneous and unilateral THA performed with or without cement. A prospective randomized clinical study[J]. J Bone Joint Surg Am, 2002; 84-A(8): 1 372-1 379.
11. Orsini EC, Byrick RJ, Mullen JB, Kay JC, Waddell JP.Cardiopulmonary function and pulmonary microemboli during arthroplasty using cemented or noncemented components. The role of intramedullary pressure[J]. J bone Joint Surg Am, 1987; 69: 822-832.
12. Ries MD, Lynch F, Rauscher LA, Richman J, Mick C, Gomez M. Pulmonary function during and after total hip replacement. Findings in patients who have insertion of a femoral component with or without cement[J]. J Bone Joint Surg Am, 1993; 75(4): 581-587.
13. Inadome T, Wall MC, Smith CL, Whiteside LA. Femoral intramedullary pressure during in vitro cemented and cementless total hip arthroplasty[J]. Orthop Trans, 1998-99; 22: 154-155.
14. Hagio K, Sugano N, Masaki T, Takashi N, Hideki Y, Takahiro O. Embolic events during total hip arthroplasty: An echocardiographic study[J]. Journal of Arthroplasty, 2003; 18(2): 186-192.
15. Weber BG. Pressurized cement fixation in total hip arthroplasty[J]. Clin Orthop Relat Res, 1988; 232: 87-95.
16. Pitto RP, Koessler M, Draenert K. Prophylaxis of fat and bone marrow embolism in cemented total hip arthroplasty[J]. Clin Orthop, 1998; 355: 23-34.
17. McGee MA, Howie DW, Neale SD, Haynes DR, Pearcy MJ. The role of polyethylene wear in joint replacement failure[J]. Proc Inst Mech Eng, 1997; 211(1): 65-72.
18. Sylvain GM, Kassab S, Coutts R, Santore R. Early failure of a roughened surface, precoated femoral component in total hip arthroplasty[J]. J Arthroplasty, 2001; 16(2): 141-148.
19. Mulliken BD, Nayak N, Bourne RB, Rorabeck CH, Bullas R. Early radiographic results comparing cemented and cementless THA[J]. J Arthroplasty, 1996; 11(1): 24-33.
20. Karrholm J, Frech W, Snorrason F, Nilsson KG. Increased metal release from cemented femoral components. Evaluation of 19 hip TPotheses followed with stereoradiography[J]. Trans Orthop Res Soc, 1993; 18: 507.
21. Mjoberg B, Selvic G, Hansson L, Rosenqvist R, Onnerfalt R. Mechanical loosening of total hip protheses: A radiographic and roentgen stereophotogrammetric study[J]. J Bone Joint Surg Br, 1986; 68-B(5): 770-774.
22. Harris W H. Will stress-shielding limit the longevity of cemented femoral components of THR[J]? Clin Orthop, 1992; 274: 120-123.
23. Huiskes R. The various stress patterns of Press-fit, ingrown, and cemented femoral stems[J]. Clin Orthop, 1990; 261: 27-38.
24. Lintner F, Zweymuller K, Bohm G, Brand G. Reactions of surrounding tissue to the cementless hip implant Ti-6Al-4V after an implantation period of several years. Autopsy study in three cases[J]. Arch Orthop Trauma Surg, 1988; 107(6): 357-363.

《中國循證醫學雜志》

人工髖關節置換術股骨柄固定方式的安全性系統評價

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《中國循證醫學雜志》

人工髖關節置換術股骨柄固定方式的安全性系統評價

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