Evidence-Based And Clinical Study On The Use Of Collum Femoris Preserving In Total Hip Arthroplasty

Objective1.To conduct evidence-based research on the effectiveness and safety of the prosthesis using the femoral neck(CFP)in total hip replacement(THA),and use Cochrane system evaluation to obtain evidence-based medical evidence of the efficacy and safety of the use of CFP in THA,providing a reference for clinical treatment.2.Through clinical case study,the clinical efficacy of CFP prosthesis THA and its difference from that of traditional nonCFP prosthesis THA were preliminarily evaluated to provide reliable reference data for clinical use.Methods1.Systematic ReviewIn this study,the clinical control of the use of CFP prosthesis in THA operation was investigated by computer search of the electronic literature database in Chinese and English(CBM,CNKI,Vip,Wanfang,Pubmed,EMBASE,The Cochrane Library).It provides evidence of evidence-based medicine for clinical application of CFP prosthesis in THA.2.Clinical StudyBased on EMR,retrospective clinical study of the use of CFP prosthesis in THA operation was carried out,and compared with non-CFP prosthesis,the efficacy,safety and correlation between CFP prosthesis and non-CFP prosthesis were evaluated.Results1.Systematic ReviewA total of 4 clinical controlled studies,including 302 patients,were not able to carry out Meta analysis but descriptive system evaluation because of the low number of studies and sample sizes and the large differences in outcome evaluation indicators.Three studies compared the effectiveness oftwo methods in improving Harris scores,two of which found that the use of CFP prosthesis THA was significantly better than that of non-CFP prosthesis THA,and one study found no significant difference in the improvement of Harris scores.Two studies compared the efficacy of two surgical methods in improving joint mobility,one showed that the use of CFP prosthesis THA was significantly better than that of non-CFP prosthesis THA,and the other suggested that there was no significant difference between the two methods in improving joint mobility.One study showed that around 1 year after operation with CFP prosthesis THA,bone loss was significantly lower than in the non-CFP prosthesis THA.One study found that the operation group using CFP prosthesis THA was superior to the non-CFP prosthesis THA group in improving VAS scores for 1 year after surgery.Two studies concluded that there were no adverse prosthesis events such as loosening and sinking in 1 year after THA.Two studies compared the difference in the time of operation and the amount of bleeding in operation.The results showed no significant difference in the time of operation and the amount of bleeding in operation.One study found that the cumulative amount of bleeding in the surgical group using CFP prosthesis THA was higher than in the nonCFP prosthesis THA group.One study described the adverse events in the non-CFP prosthesis THA group after operation,which resulted in unequal length of lower limbs and postoperative dislocation of joints.The complications have been dealt with accordingly.2.Clinical Study(1)There was no significant difference between the two groups(P>0.05)in age,Harris score before operation and bone density around 1 week after operation.(2)The difference between Harris scores before and after operation in treatment group was statistically significant(P < 0.05).The difference between Harris scores before and after operation in control group was statistically significant(P<0.05).(3)There was significant difference of Harris scores between two groups after 1 year operation(P<0.05).(4)There was no significant difference in bone mineral density in the ROI3 area between the 1 weeks and 1 years after operation in the treatment group(P>0.05),and the difference in other areas was statistically significant(P<0.05).The difference of bone mineral density around ROI 1 and ROI 7 in the control group 1 weeks after operation and 1 years after operation was statistically significant(P<0.05).(5)The bone mineral density of the two groups in 1 years after operation was compared.The bone mineral density of the treatment group in ROI 1,ROI3,ROI 6 and ROI 7 area had statistically significant difference compared with the control group(P<0.05).(6)There were no adverse events of prosthesis such as loosening,sinking and breaking in the X-Ray imaging evaluation in both groups.(7)In terms of safety,there were no complications such as hip prosthesis loosening,fracture,periprosthesis fracture,periprosthesis infection and deep venous thrombosis of lower limbs in both groups.Conclusion1.Systematic evaluation showed that THA had definite curative effect in improving patients ’function and pain,but it was not possible to determine exactly which operation method was the best.There was no tendency of prosthesis loosening and sinking during 1 year after operation.The use of CFP prosthesis THA may have some advantages in improving patient Harris score,reducing VAS score and loss of bone around prosthesis.Due to the limitation of this system,the above conclusions need more high quality clinical research to increase the strength and credibility of the evidence.2.Clinical studies have confirmed that the use of CFP prosthesis THA and non-CFP prosthesis THA have better clinical efficacy in improving patient function and pain.There is no significant difference in safety between the two methods within 1 year after operation,but the use of CFP prosthesis THA has a greater advantage in improving Harris score and reducing bone loss at the proximal end of femur.