Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip: A PRISMA-compliant meta-analysis of observational studies.
Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip: A PRISMA-compliant meta-analysis of observational studies.
复制标题
髋关节发育不良中切开或闭合复位与股骨头缺血性坏死之间的关系符合 PRISMA 标准的观察性研究荟萃分析
DOI：
10.1097/md.0000000000004276
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发表时间：
2016-07
期刊：
影响因子：
1.6
通讯作者：
Li LY
中科院分区：
文献类型：
--
作者：
Wang YJ;Yang F;Wu QJ;Pan SN;Li LY
文本中有补充数字内容
髋关节治疗后股骨头的血管性坏死的风险与某些作者的方法相关。
在2015年5月的PubMed，Embase和Cochrane图书馆中识别出的研究，重点是闭合或开放式的髋关节发育障碍，以<3岁的患者进行年龄匹配的患者我们使用随机效应模型从单个研究中汇总了几率（ORS）和95％置信区间（95％CI），并评估了异质性和发布偏见。
该分析包括九个回顾性研究。 = 69.6％， p = 0.003）在开放式和闭合的还原之间也有一个重要的关联，其合并或0.30（95％CI = 0.15-0.60）和中等的异质性（I2 = 46.4％，P = 0.133）。
荟萃分析的发现表明，与封闭式治疗相比，开放式减少是AVN发展的危险因素。
Supplemental Digital Content is available in the text The risk of avascular necrosis of the femoral head (AVN) after treatment of developmental dysplasia of the hip is associated with the method of reduction. Some authors have suggested that open reduction is a risk factor for AVN; however, this is controversial. To our knowledge, a quantitative comparison of the incidence of AVN between closed and open reduction has not been conducted. Published studies were identified by searching PubMed, EMBASE, and the Cochrane Library up to May, 2015, focusing on the incidence of AVN after closed or open reduction for developmental dysplasia of the hip in children aged <3 years. Patients were age-matched who were treated by either closed or open reduction, but without pelvic or femoral osteotomy. Two authors independently assessed eligibility and abstracted data. Discrepancies were discussed and resolved by consensus. We pooled the odds ratios (ORs) and 95% confidence intervals (95%CIs) from individual studies using a random-effects model and evaluated heterogeneity and publication bias. Nine retrospective studies were included in this analysis. The pooled OR for comparing open reduction with closed reduction for all grades of AVN was 2.26 (95%CI = 1.21–4.22), with moderate heterogeneity (I2 = 44.7%, P = 0.107). The pooled OR for grades II to IV AVN was 2.46 (95%CI = 0.93–6.51), with high heterogeneity (I2 = 69.6%, P = 0.003). A significant association was also found for the further surgery between open and closed reduction, with a pooled OR of 0.30 (95%CI = 0.15–0.60) and moderate heterogeneity (I2 = 46.4%, P = 0.133). No evidence of publication bias or significant heterogeneity between subgroups was detected by meta-regression analyses. Findings from this meta-analysis suggest that open reduction is a risk factor for the development of AVN compared with closed treatment. Future studies are warranted to investigate how open reduction combined with pelvis and/or femoral osteotomy affects the incidence of AVN.