循证医学：金属对高交联聚乙烯全髋关节置换术后骨溶解与无菌性松动
Incidence of Osteolysis and Aseptic Loosening Following Metal-on-Highly Cross-Linked Polyethylene Hip Arthroplasty : A Systematic Review of Studies with Up to 15-Year Follow-up
金属对高交联聚乙烯全髋关节置换术后骨溶解与
无菌性松动的发生率：最高15年随访的系统性综述
译者：张蔷
Background: This study compared the incidence of osteolysis, aseptic loosening, and revision following use of highly cross-linked polyethylene (HXLPE) or conventional polyethylene (CPE) at medium to long-term (>5 to 15 years) follow-up in primary total hip arthroplasty (THA). Incidences were quantified and compared with regard to age and method of implant fixation.
背景：本篇文章比较了应用高交联聚乙烯（HXLPE）或传统聚乙烯（CPE）初次全髋关节置换术（THA）后中期至长期（5至15年）随访中骨溶解、无菌性松动和翻修的发生率。
Methods: Using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, 12 randomized controlled trials and 18 cohort studies were investigated for evidence-based outcomes following HXPLE and CPE use in 2,539 hips over a 5 to 15-year follow-up.
方法：使用PRISMA（相关的系统性综述与荟萃分析）指南，我们共入组了12篇随机对照试验和18项队列研究，在5-15年的随访时间中共2539例应用HXPLE和CPE的全髋病例。
Results: Lower rates of osteolysis, aseptic loosening, and implant revision were reported following use of HXLPE liners. Osteolysis was reduced from 25.4% with CPE to 4.05% with HXLPE in young patients, and from 29.7% to 6.6% in the older patient cohort. Similarities in osteolysis rates were observed when cemented (24.9% for CPE and 6.5% for HXLPE) and uncemented components (32.8% for CPE and 7.1% for HXLPE) were compared. No clear advantage in the type of HXLPE used was observed.
结果：使用高交联聚乙烯内衬（HXLPE）组的骨溶解、无菌性松动和假体翻修发生率均更低。年轻病人的骨溶解发生率从CPE组的25.4%降低至HXLPE组的4.05%，而老年病人的骨溶解发生率从CPE组的29.7%降低至HXLPE组的6.6%。根据应用骨水泥假体还是生物假体进行亚组分析后，我们发现结果相似：骨水泥组CPE的骨溶解发生率为24.9%而HXLPE的骨溶解发生率为6.5%，生物组CPE的发生率为32.8%而HXLPE的发生率7.1%。但是并没有发现众多不同的类型中某一种特定类型的高交联内衬优于其他类型。
Conclusions: Over a follow-up period of up to 15 years, when compared with CPE, use of HXLPE liners reduced the incidence of osteolysis, aseptic loosening, and implant revision, regardless of the fixation method and including in younger and potentially more active patients.
结论：在5-15年的随访后，我们发现：与传统内衬相比，高交联聚乙烯内衬的应用可以降低骨溶解、无菌性松动和假体翻修的发生率，而这一结果并不会因固定方式和患者年龄而改变。
文献出处：Prock-Gibbs H, Pumilia CA, Meckmongkol T, Lovejoy J, Mumith A, Coathup M. Incidence of Osteolysis and Aseptic Loosening Following Metal-on-Highly Cross-Linked Polyethylene Hip Arthroplasty: A Systematic Review of Studies with Up to 15-Year Follow-up. J Bone Joint Surg Am. 2021 Jan 7;Publish Ahead of Print. doi: 10.2106/JBJS.20.01086. Epub ahead of print. PMID: 33411465.