髌骨置换在全膝关节置换中的系统评价
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摘要
目的：系统评价人工全膝关节置换术(Total knee arthroplasty,TKA)髌骨置换的疗效,为进一步的临床研究及医疗实践提供参考。
材料与方法：根据严格制定的纳入和排除标准,按照事先制定的检索策略,计算机检索Cochrane图书馆临床对照试验资料库(2011年第1期),EMBASE (1978～2011.1),MEDLINE(1950～2011.1), CBM, CNKI和VIP(1989～2011.1)。使用Cochrane协作网提供的软件Revman 5.0.25进行Meta分析,各试验组间的异质性检验采用卡方检验,若无异质性(p>0.05),则采用固定效应模型分析,若有异质性(p≤0.05),则分析异质性的来源,根据实际情况采用随机效应模型、亚组分析,或不作Meta分析只作描述性分析,若所收集的研究数据不能或不适合进行Meta分析,则只进行描述性分析。
结果：14个随机对照试验共纳入1788例膝,其中886例膝关节置换同时行髌骨置换,902例未行髌骨置换。Meta分析结果显示,髌骨置换组术后5至7.5年内发生膝前痛的风险低,加权后RR=0.19,95% CI(0.11,0.31),但5年前和7.5年后二者无明显统计学差异；髌骨置换组与非髌骨置换组术后5年内发生再手术的风险无明显统计学差异,但5年以上髌骨置换组发生再手术的风险低,加权后RR=0.49,95% CI(0.33,0.75)；膝关节KSS评分不论是亚组分析还是总体分析,均无统计学差异。总体meta分析结果,KSS评分加权均数差值(WMD)为0.26,95%CI(-1.39,1.90)；患者满意度不论是亚组meta分析还是总体meta分析,均无统计学差异。总体meta分析结果,患者满意度加权后RR=1.01,95%CI(0.97,1.05)。
结论：全膝关节置换术中髌骨置换比髌骨不置换总体疗效要好。
Objective To evaluate the efficacy of patellar replacement of total knee replacement (Total knee arthroplasty, TKA) systematically, to provide references for further clinical research and medical practice.
Materials and methods:In accordance with strict inclusion and exclusion criteria and the pre-developed search strategy, the following databases and journals were searched for relavant articles:the databases of the Cochrane UpperGastro-intestinal and Pancreatic Group specialised register, Cochrane Central Register of Controlled Trials(Phase 1 of 2011), MEDLINE(1950～2011.1), PubMed (1950-2011.1), EMBASE (1980～2011.1), CBM, CNKI and VIP (1989～2011.1). Meta analysis uses the Revman 5.0.25 software provided by Cochrane collaboration. The heterogeneity of pilot test among researches is used by the chi-square test. The fixed-effect model analysis was adopted in case of absence of heterogeneity(p>0.05), otherwise the sources of heterogeneity were analyzed,and random effect model was adopted in accordance with the actual situation, even use sub-group analysis or abandon Meta-analysis, instead of descriptive analysis only. If the research data collected is impossible or inappropriate to carry out Meta analysis, descriptive analysis only.
Results 1788 knees were included in the 14 published trials,including 886 knees in the resurfaced group and 902 in the nonresurfaced group. The result of meta-analys is indicated that the risk of postoperative anterior knee pain was lower in patellar resurfacing group than in patellar nonresurfacing group between 5 years and 7.5 years, The combined RR was 0.19,95% CI (0.11,0.31);But the difference did not exist within 5 years or after?.5 years.The risk of reoperation had no significant difference in patellar resurfacing group and patellar nonresurfacing group within 5 years.But 5 years later, the risk of reoperation was lower in patellar resurfacing group than in patellar nonresurfacing group.The combined RR was 0.49,95% CI (0.33,0.75); Whether using sub-group analysis or using general analysis, there was no difference in the mean postoperative knee scores WMD for the results of general analysis was 0.26,95% CI (-1.39,1.90); Whether using sub-group analysis or using general analysis,there was no difference in patient satisfaction too.The combined RR for results of general analysis was 0.26,95% CI(-1.39,1.90).
Conclusion The efficacy of resurfacing the patella in total knee arthroplasty is better than nonresurfacing the patella in total knee arthroplasty in the mass.
材料与方法：根据严格制定的纳入和排除标准,按照事先制定的检索策略,计算机检索Cochrane图书馆临床对照试验资料库(2011年第1期),EMBASE (1978～2011.1),MEDLINE(1950～2011.1), CBM, CNKI和VIP(1989～2011.1)。使用Cochrane协作网提供的软件Revman 5.0.25进行Meta分析,各试验组间的异质性检验采用卡方检验,若无异质性(p>0.05),则采用固定效应模型分析,若有异质性(p≤0.05),则分析异质性的来源,根据实际情况采用随机效应模型、亚组分析,或不作Meta分析只作描述性分析,若所收集的研究数据不能或不适合进行Meta分析,则只进行描述性分析。
结果：14个随机对照试验共纳入1788例膝,其中886例膝关节置换同时行髌骨置换,902例未行髌骨置换。Meta分析结果显示,髌骨置换组术后5至7.5年内发生膝前痛的风险低,加权后RR=0.19,95% CI(0.11,0.31),但5年前和7.5年后二者无明显统计学差异；髌骨置换组与非髌骨置换组术后5年内发生再手术的风险无明显统计学差异,但5年以上髌骨置换组发生再手术的风险低,加权后RR=0.49,95% CI(0.33,0.75)；膝关节KSS评分不论是亚组分析还是总体分析,均无统计学差异。总体meta分析结果,KSS评分加权均数差值(WMD)为0.26,95%CI(-1.39,1.90)；患者满意度不论是亚组meta分析还是总体meta分析,均无统计学差异。总体meta分析结果,患者满意度加权后RR=1.01,95%CI(0.97,1.05)。
结论：全膝关节置换术中髌骨置换比髌骨不置换总体疗效要好。
Objective To evaluate the efficacy of patellar replacement of total knee replacement (Total knee arthroplasty, TKA) systematically, to provide references for further clinical research and medical practice.
Materials and methods:In accordance with strict inclusion and exclusion criteria and the pre-developed search strategy, the following databases and journals were searched for relavant articles:the databases of the Cochrane UpperGastro-intestinal and Pancreatic Group specialised register, Cochrane Central Register of Controlled Trials(Phase 1 of 2011), MEDLINE(1950～2011.1), PubMed (1950-2011.1), EMBASE (1980～2011.1), CBM, CNKI and VIP (1989～2011.1). Meta analysis uses the Revman 5.0.25 software provided by Cochrane collaboration. The heterogeneity of pilot test among researches is used by the chi-square test. The fixed-effect model analysis was adopted in case of absence of heterogeneity(p>0.05), otherwise the sources of heterogeneity were analyzed,and random effect model was adopted in accordance with the actual situation, even use sub-group analysis or abandon Meta-analysis, instead of descriptive analysis only. If the research data collected is impossible or inappropriate to carry out Meta analysis, descriptive analysis only.
Results 1788 knees were included in the 14 published trials,including 886 knees in the resurfaced group and 902 in the nonresurfaced group. The result of meta-analys is indicated that the risk of postoperative anterior knee pain was lower in patellar resurfacing group than in patellar nonresurfacing group between 5 years and 7.5 years, The combined RR was 0.19,95% CI (0.11,0.31);But the difference did not exist within 5 years or after?.5 years.The risk of reoperation had no significant difference in patellar resurfacing group and patellar nonresurfacing group within 5 years.But 5 years later, the risk of reoperation was lower in patellar resurfacing group than in patellar nonresurfacing group.The combined RR was 0.49,95% CI (0.33,0.75); Whether using sub-group analysis or using general analysis, there was no difference in the mean postoperative knee scores WMD for the results of general analysis was 0.26,95% CI (-1.39,1.90); Whether using sub-group analysis or using general analysis,there was no difference in patient satisfaction too.The combined RR for results of general analysis was 0.26,95% CI(-1.39,1.90).
Conclusion The efficacy of resurfacing the patella in total knee arthroplasty is better than nonresurfacing the patella in total knee arthroplasty in the mass.
引文
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