卢　巍　谭　为　李建平　蒋振东　杨　琳.遵义医学院珠海校区解剖学教研室，广东珠海　5904；.南方医科大学第三附属医院儿童骨科，广东广州　50630

全髋关节置换术中伴或不伴转子下短缩截骨疗效的Meta分析

卢巍1谭为2李建平1蒋振东1杨琳1
1.遵义医学院珠海校区解剖学教研室，广东珠海519041；2.南方医科大学第三附属医院儿童骨科，广东广州510630

目的比较不同手术方法全髋关节置换术后髋关节功能评分及并发症，探讨截骨与不截骨全髋关节置换术的疗效。方法以全髋关节置换术、髋关节发育不良、截骨为检索词并制定检索策略，检索PubMed、Embase、CNKI、The Cochrane Library（2016年第1期）、Wan Fang Data和VIP数据库，时限为1996年1月～2016年1月间，筛选评价文献，提取相关研究数据，采用RevMan 5.3软件进行Meta分析。结果 纳入5个研究，共计260例患者。全髋关节置换术后截骨组与未截骨组Harris评分差异无统计学意义（Z=1.81，P=0.07），截骨组术后并发症发生率低于未截骨组，差异有统计学意义（Z=2.10，P=0.04）。结论 全髋关节置换术治疗髋关节发育不良可显著改善患者关节功能，恢复患肢长度，但术前需严格评估患者关节状况，选择是否行转子下短缩截骨术。

髋关节；全髋关节置换术；截骨；Meta分析

[Abstract]Objective To compare the hip joint function sores and complications after different surgical methods of total hip arthroplasty(THA),and to discuss the efficacy of THA with or without osteotomy.Methods THA,developmental dysplasia of hip(DDH),and osteotomy were selected as search terms,formulating search strategy and searching PubMed, Embase,CNKI,the Cochrane Library,Wan Fang Data and VIP database.The time limit was set from January 1996 to January 2016.The literature was screened and study data was extracted.Meta-analysis was conducted by RevMan 5.3 software.Results Five studies were enrolled,including 260 patients.There was no difference in Harris scores between patients with and without osteotomy after THA(Z=1.81,P=0.07).The incidence rate of complications was significantly lower in patients with osteotomy than in those without osteotomy,the difference was statistically significant(Z=2.10,P= 0.04).Conclusion Treatment of DDH after THA can significantly improve the joint function of patients and regain the length of affected limb,but the condition of affected joint should be evaluated carefully before operation to determine whether to conduct ubtrochanteric shortening osteotomy.

[Key words]Hip joint;Total hip arthroplasty;Osteotomy;Meta-analysis

髋关节发育不良（DDH）病患的髋臼发育不良和股骨头脱位在疾病进程中可并发骨性关节炎[1]，严重影响髋关节功能及患者生活质量。由于高位脱位，髋关节正常的解剖结构发生改变，治疗可采用多种方案，较为有效的是人工全髋关节置换术（totalhip arthroplasty，THA）[2]。髋关节发育不良因软组织解剖异常，将髋臼重建存在复位困难，且复位过程中过度牵拉神经及血管引起相关并发症，现行转子下短缩截骨术可降低此类并发症发病率[3]，但同时面临手术时间及失血量升高等问题。……