全髋关节置换后交联聚乙烯和传统聚乙烯髋臼内衬磨损与骨溶解比较的系统评价

摘要

BACKGROUND: Aseptic loosening occurs after long-term total hip replacement, which directly affects the service life and prospective efficacy of artificial joints. The particles produced by artificial joint wear lead to the surrounding bone dissolved, further cause loosening, among which, polyethylene particles because of acetabular liner wear stand out. OBJECTIVE: To systematically assess the acetabular liner wear, loosening and osteolysis caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty. METHODS: A computer-based research of Medline, EMbase, CBM, CNKI, CqVip, WanFang databases before December 2015 and Cochrane (3rd issue, 2011) was performed in accordance with the retrieval strategy made by Cochrane collaboration. A manual retrieval of related bone journals and conference papers was conducted. Eleven randomized controlled trials about the wear caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty were enrolled based on inclusion criteria, followed by a Meta-analysis using RevMan 5.0 software. RESULTS AND CONCLUSION: (1) Eleven randomized controlled trials involving 952 patients were included. (2) Meta-analysis showed that the acetabular liner wear rate of cross-linked polyethylene was significantly lower than that of conventional polyethylene at 5 years postoperatively [MD=-0.07, CI(-0.09, -0.05), I2=93%, P < 0.00001]; the large heterogeneity was decreased [MD=-0.06, 95%CI (-0.07, -0.04), I2=39%, P < 0.00001] after three research removed through sensitivity analysis. (3) The osteolysis rate in the cross-linked polyethylene group was significantly lower than that in the conventional polyethylene group [RR=0.39, 95%CI (0.27, 0.57), I2=0%, P < 0.00001]. (4) These results suggest that the cross-linked polyethylene liners exhibit reduced radiological wear and osteolysis, but the mean follow-up of 5 years (1.8 to 8.0) cannot meet the long-term requirements. Therefore, multi-central, large sample size and high-quality randomized controlled trials are needed to testify the efficacy and safety of cross-linked polyethylene.BACKGROUND: Aseptic loosening occurs after long-term total hip replacement, which directly affects the service life and prospective efficacy of artificial joints. The particles produced by artificial joint wear lead to the surrounding bone dissolved, further cause loosening, among which, polyethylene particles because of acetabular liner wear stand out. OBJECTIVE: To systematically assess the acetabular liner wear, loosening and osteolysis caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty. METHODS: A computer-based research of Medline, EMbase, CBM, CNKI, CqVip, WanFang databases before December 2015 and Cochrane (3rd issue, 2011) was performed in accordance with the retrieval strategy made by Cochrane collaboration. A manual retrieval of related bone journals and conference papers was conducted. Eleven randomized controlled trials about the wear caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty were enrolled based on inclusion criteria, followed by a Meta-analysis using RevMan 5.0 software. RESULTS AND CONCLUSION: (1) Eleven randomized controlled trials involving 952 patients were included. (2) Meta-analysis showed that the acetabular liner wear rate of cross-linked polyethylene was significantly lower than that of conventional polyethylene at 5 years postoperatively [MD=-0.07, CI(-0.09, -0.05), I2=93%, P < 0.00001]; the large heterogeneity was decreased [MD=-0.06, 95%CI (-0.07, -0.04), I2=39%, P < 0.00001] after three research removed through sensitivity analysis. (3) The osteolysis rate in the cross-linked polyethylene group was significantly lower than that in the conventional polyethylene group [RR=0.39, 95%CI (0.27, 0.57), I2=0%, P < 0.00001]. (4) These results suggest that the cross-linked polyethylene liners exhibit reduced radiological wear and osteolysis, but the mean follow-up of 5 years (1.8 to 8.0) cannot meet the long-term requirements. Therefore, multi-central, large sample size and high-quality randomized controlled trials are needed to testify the efficacy and safety of cross-linked polyethylene.%背景:全髋关节置换后远期出现的关节无菌性松动直接影响人工关节使用寿命和患者满意度.导致松动的原因在于人工关节磨损产生的颗粒诱导假体周围骨溶解所致,而髋臼内衬磨损产生的聚乙烯颗粒是主要因素.目的:系统评价全髋关节置换后交联聚乙烯和普通聚乙烯髋臼内衬磨损和骨溶解松动情况的差异.方法:按照Cochrane协作网制订的检索策略进行检索,计算机检索截止至2015年12月Medline、EMbase、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库、万方数据库及Cochrane图书馆(2011年第3期).手工检索相关的中外骨科杂志和学术会议论文汇编.纳入交联聚乙烯和普通聚乙烯内衬全髋关节置换后聚乙烯磨损情况的随机对照试验11篇,对符合纳入标准的研究用RevMan 5.0软件进行Meta分析.结果与结论:①纳入随机对照试验11篇,共952例患者;②Meta分析结果显示,术后平均5年交联聚乙烯髋臼内衬线性磨损率显著低于传统聚乙烯髋臼[MD=-0.07,CI(-0.09,-0.05),I2=93%,P<0.00001],由于异质性很大(I2=93%),行敏感性分析,去掉3个研究后异质性下降[MD=-0.06,95%CI(-0.07,-0.04),I2=39%,P<0.00001];③术后平均5年骨溶解松动Meta分析显示,交联聚乙烯内衬组的骨溶解松动率显著低于普通聚乙烯内衬组[RR=0.39,95%CI(0.27,0.57),I2=0%,P<0.00001];④结果提示,全髋关节置换交联聚乙烯内衬髋臼较普通聚乙烯更耐磨,近期磨损率更低,磨损碎少,引起骨溶解松动的概率越低.但由于搜集的随机对照试验研究平均随访时间5年(1.8-8.0年),长期随访结果不得而知.鉴于纳入研究在方法学方面的局限性,尚需开展多中心、大样本、高质量的随机对照试验进一步论证交联聚乙烯的疗效和安全性.