非骨水泥全髋关节置换术中的自动撞击：系统综述和荟萃分析

摘要(中文译文)

术中假体周围股骨骨折（IPFs）是全髋关节置换术（THA）的严重并发症，通常归因于手术技术。手动敲击可提供触觉反馈，但会因术者疲劳和经验而有所差异。自动敲击系统能够提供一致的能量输出，可能提高安全性和效率。本研究旨在通过系统综述和荟萃分析，比较初次非骨水泥型THA中自动敲击与手动敲击之间IPF风险和手术时间的差异。我们对比较自动敲击与手动敲击技术的初次非骨水泥型THA研究进行了系统综述和随机效应荟萃分析。结局指标包括IPFs和手术时间。计算IPF风险的合并比值比（ORs），并采用均数差及95% CI分析两种技术之间平均手术时间的差异。共有五项研究提供了比较数据（n = 2,607例THA）。荟萃分析纳入三项研究（n = 2,377），其中自动组1,408髋（14例IPFs），手动组969髋（3例IPFs）。两种技术之间IPF风险无显著差异（合并OR 1.29；95% CI 0.52至3.21；p = 0.59）。三项研究报告了手术时间。合并均数差提示自动敲击的手术时间较短（-1.34分钟；95% CI -15.60至12.92；p = 0.72）。在初次非骨水泥型THA中，与手动技术相比，自动敲击与较低的IPF风险或手术时间无关。骨折风险和效率可能反而取决于股骨假体与股骨的兼容性以及假体尺寸选择。需要进一步开展纳入多样化股骨假体设计和自动敲击系统的随机研究，并进行正式的经济学评价。

Abstract

Intraoperative periprosthetic femoral fractures (IPFs) are a serious complication of total hip arthroplasty (THA), typically attributed to surgical technique. Manual impaction provides tactile feedback but varies with surgeon fatigue and experience. Automated impaction systems offer consistent energy delivery, potentially improving safety and efficiency. This study aimed, through a systematic review and meta-analysis, to compare the risk of IPF and operating times between automated and manual impaction during primary uncemented THA. We performed a systematic review and random-effects meta-analysis of primary uncemented THA studies comparing automated and manual impaction techniques. Outcomes included IPFs and operating time. Pooled odds ratios (ORs) were calculated for IPF risk, and differences in mean operating time between techniques were analyzed using mean differences with 95% CIs. Comparative data were available from five studies (n = 2,607 THAs). Meta-analysis included three studies (n = 2,377), with 1,408 hips in the automated group (14 IPFs) and 969 hips in the manual group (three IPFs). There was no significant difference in IPF risk between techniques (pooled OR 1.29; 95% CI 0.52 to 3.21; p = 0.59). Operating time was reported in three studies. The pooled mean difference suggested a shorter operating time with automated impaction (-1.34 minutes; 95% CI -15.60 to 12.92; p = 0.72). Automated impaction was not associated with a lower risk of IPF or operating time compared with manual techniques in primary uncemented THA. Fracture risk and efficiency may instead depend on femoral component-femur compatibility and implant sizing. Further randomized studies incorporating diverse femoral component designs and automated impaction systems, alongside formal economic evaluation, are required.

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