全髋关节置换术联合粗隆下截骨术治疗严重的髋关节发育不良：一项系统回顾和荟萃分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-04-01 DOI:10.1016/j.jor.2025.03.027

Tomonori Shigemura, Yohei Yamamoto, Yasuaki Murata

{"title":"全髋关节置换术联合粗隆下截骨术治疗严重的髋关节发育不良：一项系统回顾和荟萃分析","authors":"Tomonori Shigemura, Yohei Yamamoto, Yasuaki Murata","doi":"10.1016/j.jor.2025.03.027","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is technically difficult because of the anatomical features of dysplasia, such as a hypoplastic and shallow acetabulum, narrow femoral canal, and soft tissue contractures. Subtrochanteric osteotomy (STO) is effective technique to reduce the risk of sciatic nerve palsy while placing the acetabular cup in an anatomical position during THA for severe DDH. Few studies have compared THA performed without STO to THA performed with STO. We performed a systematic literature review and single-arm meta-analysis to integrate the results of studies regarding THA with STO for severe DDH.</div></div><div><h3>Patients and methods</h3><div>A systematic literature review was conducted using relevant original studies from various databases. Pooling of data was performed using RevMan software. A <em>p</em>-value of <0.05 was considered significant. The results are expressed as incidences with 95 % confidence intervals (CIs) for dichotomous data and means with 95 % CI for continuous data. Statistical heterogeneity was assessed based on <em>I</em><sup>2</sup> using the standard χ<sup>2</sup> test. When <em>I</em><sup>2</sup> > 50 %, significant heterogeneity was assumed, and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity.</div></div><div><h3>Results</h3><div>Twelve studies were included in this meta-analysis. The pooled incidence of sciatic nerve palsy, delayed union or nonunion, dislocation, intraoperative femoral fracture, and infection were 2.44 % (95 % CI: 0.86–4.01), 2.74 % (95 % CI: 1.11–4.37), 2.92 % (95 % CI: 1.63–4.20), 2.19 % (95 % CI: 0.95–3.42), and 3.11 % (95 % CI: 0.10–6.12), respectively. Pooling of the data also showed a mean Harris Hip Score (HHS) of 88.33 (95 % CI: 84.95–91.70).</div></div><div><h3>Discussion</h3><div>Although THA with STO for severe DDH is a challenging surgical procedure, this meta-analysis showed that the results of THA with STO for severe DDH are favourable.</div><div><strong><em>Level of evidence:</em></strong> Ⅳ (systematic review and meta-analysis).</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"62 ","pages":"Pages 197-206"},"PeriodicalIF":1.5000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Total hip arthroplasty with subtrochanteric osteotomy for severe developmental dysplasia of the hip: A systematic review and meta-analysis\",\"authors\":\"Tomonori Shigemura, Yohei Yamamoto, Yasuaki Murata\",\"doi\":\"10.1016/j.jor.2025.03.027\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is technically difficult because of the anatomical features of dysplasia, such as a hypoplastic and shallow acetabulum, narrow femoral canal, and soft tissue contractures. Subtrochanteric osteotomy (STO) is effective technique to reduce the risk of sciatic nerve palsy while placing the acetabular cup in an anatomical position during THA for severe DDH. Few studies have compared THA performed without STO to THA performed with STO. We performed a systematic literature review and single-arm meta-analysis to integrate the results of studies regarding THA with STO for severe DDH.</div></div><div><h3>Patients and methods</h3><div>A systematic literature review was conducted using relevant original studies from various databases. Pooling of data was performed using RevMan software. A <em>p</em>-value of <0.05 was considered significant. The results are expressed as incidences with 95 % confidence intervals (CIs) for dichotomous data and means with 95 % CI for continuous data. Statistical heterogeneity was assessed based on <em>I</em><sup>2</sup> using the standard χ<sup>2</sup> test. When <em>I</em><sup>2</sup> > 50 %, significant heterogeneity was assumed, and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity.</div></div><div><h3>Results</h3><div>Twelve studies were included in this meta-analysis. The pooled incidence of sciatic nerve palsy, delayed union or nonunion, dislocation, intraoperative femoral fracture, and infection were 2.44 % (95 % CI: 0.86–4.01), 2.74 % (95 % CI: 1.11–4.37), 2.92 % (95 % CI: 1.63–4.20), 2.19 % (95 % CI: 0.95–3.42), and 3.11 % (95 % CI: 0.10–6.12), respectively. Pooling of the data also showed a mean Harris Hip Score (HHS) of 88.33 (95 % CI: 84.95–91.70).</div></div><div><h3>Discussion</h3><div>Although THA with STO for severe DDH is a challenging surgical procedure, this meta-analysis showed that the results of THA with STO for severe DDH are favourable.</div><div><strong><em>Level of evidence:</em></strong> Ⅳ (systematic review and meta-analysis).</div></div>\",\"PeriodicalId\":16633,\"journal\":{\"name\":\"Journal of orthopaedics\",\"volume\":\"62 \",\"pages\":\"Pages 197-206\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of orthopaedics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0972978X25000923\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of orthopaedics","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0972978X25000923","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

摘要

背景：由于发育不良的解剖学特征，如髋臼发育不良和浅、股管狭窄和软组织挛缩，全髋关节置换术（THA）治疗严重发育不良的髋关节（DDH）在技术上是困难的。股骨粗隆下截骨术（STO）是一种有效的技术，可以降低坐骨神经麻痹的风险，同时将髋臼杯放置在一个解剖位置。很少有研究比较无STO和STO的THA。我们进行了系统的文献综述和单臂荟萃分析，以整合THA与STO治疗严重DDH的研究结果。患者与方法采用不同数据库的相关原始研究进行系统文献综述。使用RevMan软件进行数据汇总。p值为0.05被认为是显著的。结果表示为二分类数据95%置信区间（CI）的发生率，连续数据95%置信区间的平均值。采用标准χ2检验，以I2为基础评估统计异质性。当I2 >；假设异质性为50%，采用随机效应模型进行meta分析。在没有显著异质性的情况下，采用固定效应模型。结果本meta分析共纳入12项研究。坐骨神经麻痹、延迟愈合或不愈合、脱位、术中股骨骨折和感染的总发生率分别为2.44% （95% CI: 0.86-4.01）、2.74% （95% CI: 1.11-4.37）、2.92% （95% CI: 1.63-4.20）、2.19% （95% CI: 0.95-3.42）和3.11% （95% CI: 0.10-6.12）。汇总数据还显示Harris髋关节评分（HHS）平均为88.33 （95% CI: 84.95-91.70）。尽管THA联合STO治疗严重DDH是一项具有挑战性的手术，但本荟萃分析显示THA联合STO治疗严重DDH的结果是有利的。证据水平：Ⅳ（系统评价和荟萃分析）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Total hip arthroplasty with subtrochanteric osteotomy for severe developmental dysplasia of the hip: A systematic review and meta-analysis

Background

Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is technically difficult because of the anatomical features of dysplasia, such as a hypoplastic and shallow acetabulum, narrow femoral canal, and soft tissue contractures. Subtrochanteric osteotomy (STO) is effective technique to reduce the risk of sciatic nerve palsy while placing the acetabular cup in an anatomical position during THA for severe DDH. Few studies have compared THA performed without STO to THA performed with STO. We performed a systematic literature review and single-arm meta-analysis to integrate the results of studies regarding THA with STO for severe DDH.

Patients and methods

A systematic literature review was conducted using relevant original studies from various databases. Pooling of data was performed using RevMan software. A p-value of <0.05 was considered significant. The results are expressed as incidences with 95 % confidence intervals (CIs) for dichotomous data and means with 95 % CI for continuous data. Statistical heterogeneity was assessed based on I² using the standard χ² test. When I² > 50 %, significant heterogeneity was assumed, and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity.

Results

Twelve studies were included in this meta-analysis. The pooled incidence of sciatic nerve palsy, delayed union or nonunion, dislocation, intraoperative femoral fracture, and infection were 2.44 % (95 % CI: 0.86–4.01), 2.74 % (95 % CI: 1.11–4.37), 2.92 % (95 % CI: 1.63–4.20), 2.19 % (95 % CI: 0.95–3.42), and 3.11 % (95 % CI: 0.10–6.12), respectively. Pooling of the data also showed a mean Harris Hip Score (HHS) of 88.33 (95 % CI: 84.95–91.70).

Discussion

Although THA with STO for severe DDH is a challenging surgical procedure, this meta-analysis showed that the results of THA with STO for severe DDH are favourable.

Level of evidence: Ⅳ (systematic review and meta-analysis).

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.