克罗伊Ⅳ型髋关节发育不良患者全髋关节置换术的中长期疗效和并发症：系统回顾和元分析。

IF 3.4 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty Pub Date : 2025-02-01 DOI:10.1016/j.arth.2024.08.026

Mohammad Poursalehian MD , Ali Hassanzadeh MD , Seyyed Hossein Shafiei MD , S.M. Javad Mortazavi MD

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引用次数: 0

摘要

背景：成年期严重的髋关节发育不良（DDH）通常需要进行全髋关节置换术（THA）。本研究旨在评估克罗伊Ⅳ型DDH病例的全髋关节置换术中长期疗效：方法：在PubMed、EMBASE、Web of Science和Scopus上搜索了平均随访时间超过100个月的Crowe IV型DDH成人患者THA治疗的观察性研究和系列病例。最初共找到 3,710 条记录，最终分析纳入了 24 项研究。这些研究使用美国国立卫生研究院（NIH）质量评估工具进行了质量评估。分析了各种结果，包括翻修率、腿长差异（LLD）、哈里斯髋关节评分（HHS）以及假体周围关节感染（PJI）、脱位和神经损伤等并发症。统计分析采用随机效应模型，在异质性较高的情况下采用敏感性分析和元回归：纳入的研究对1024个髋关节进行了评估，平均随访时间为11年，结果显示THA术后HHS有所改善，LLD有所降低。但也存在一些值得注意的问题，包括10.7%的术中骨折率、1.8%的PJI率和5.8%的脱位率。分别有9.1%和8%的病例出现骨溶解和无菌性松动翻修。11.1%的患者发生了异位骨化（HO）。4.2%的病例出现神经损伤。通过使用元回归，发现了一些导致观察到的异质性的因素：结论：Crowe IV型DDH患者的全髋关节置换术面临着显著的挑战，但可以大大改善患者报告的长期疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Mid- to Long-Term Outcomes and Complications of Total Hip Arthroplasty in Patients Who Have Crowe IV Developmental Dysplasia of the Hip: A Systematic Review and Meta-Analysis

Background

Severe forms of developmental dysplasia of the hip (DDH) in adulthood often lead to total hip arthroplasty (THA). This study aimed to evaluate the mid-term to long-term outcomes of THA in Crowe type IV DDH cases, which represent a technically challenging and complex patient group.

Methods

PubMed, EMBASE, Web of Science, and Scopus were searched for observational studies and case series with over 100 months of mean follow-up on adult patients who had Crowe type IV DDH treated with THA. A total of 3,710 records were initially identified, leading to the inclusion of 24 studies in the final analysis. These studies were subjected to quality assessment using the National Institutes of Health Quality Assessment tool. Various outcomes including revision rates, leg-length discrepancy, Harris Hip Score, and complications like periprosthetic joint infections, dislocations, and nerve injuries were analyzed. A random effects model was employed for statistical analysis, with sensitivity analysis and metaregression applied in cases of high heterogeneity.

Results

The included studies assessed 1,024 hips with a mean follow-up of 11 years, revealing improvements in Harris Hip Score and reductions in leg length discrepancy post-THA. However, notable challenges were noted, including a 10.7% rate of intraoperative fractures, a 1.8% periprosthetic joint infection rate, and a 5.8% dislocation rate. Osteolysis and aseptic loosening revisions were observed in 9.1 and 8% of cases, respectively. Heterotopic ossification occurred in 11.1% of patients. Nerve injury was reported in 4.2% of cases. With the use of metaregression, some factors for observed heterogeneity were identified.

Conclusions

Total hip arthroplasty (THA) in Crowe type IV DDH patients presents notable challenges, but can lead to substantial long-term improvements in patient-reported outcomes.

Level of Evidence

IV.

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来源期刊

Journal of Arthroplasty 医学-整形外科

CiteScore

7.00

自引率

20.00%

发文量

734

审稿时长

48 days

期刊介绍： The Journal of Arthroplasty brings together the clinical and scientific foundations for joint replacement. This peer-reviewed journal publishes original research and manuscripts of the highest quality from all areas relating to joint replacement or the treatment of its complications, including those dealing with clinical series and experience, prosthetic design, biomechanics, biomaterials, metallurgy, biologic response to arthroplasty materials in vivo and in vitro.