单髁关节置换术与全膝关节置换术比较治疗单间室骨关节炎疗效的Meta分析  

Effects of Unicompartmental Keen Arthroplasty versus Total Keen Arthroplasty for Unicompartmental Osteoarthritis: A Meta-analysis

作　　者：徐彬[1] 裴福兴[1] 马俊[1] 谢锦伟[1] 谢小伟[1] 姚欢[1] 岳辰[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国循证医学杂志》2015年第6期652-658,共7页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价单髁关节置换术(UKA)与全膝关节置换术(TKA)治疗单间室骨关节炎的疗效。方法计算机检索Pub Med、MEDLINE(Ovid)、Pro Quest、EBSCO、The Cochrane Library(2014年10期)、EMbase、CNKI、VIP、CBM和Wan Fang Data数据库,搜集UKA与TKA比较治疗单间室骨关节炎的相关随机对照试验(RCT)和队列研究,检索时限均从建库至2014年11月。由2位评价员按纳入与排除标准独立筛选文献、提取资料并评价质量后,采用Rev Man 5.2软件进行Meta分析。结果纳入6个RCT,6个队列研究,共940例研究对象(以膝数计)。Meta分析结果显示,与TKA组相比,UKA组术后屈膝90°所需时间更短[RCT:P<0.05;队列研究:SMD=–1.70,95%CI(–2.07,–1.34),P<0.000 01],膝关节活动度更好[队列研究:SMD=0.59,95%CI(0.41,0.78),P=0],DVT发生率更低[RCT:RR=0.31,95%CI(0.12,0.82),P=0.02],但翻修率更高[RCT:RR=7.59,95%CI(1.76,32.85),P=0.007]。UKA组与TKA组膝关节评分差异无统计学意义[RCT:P=0.626;队列研究:MD=1.78,95%CI(–0.09,3.65),P=0.06]。结论当前证据显示,与TKA相比,UKA术后恢复更快更好,术后DVT发生率更低,但翻修率更高。两种术式中远期膝关节评分相当。受纳入研究数量和质量所限,上述结论尚需开展更多高质量研究予以验证。Objective To systematically review the effects of unicompartmental keen arthroplasty（UKA） and total keen arthroplasty（TKA） in patients with unicompartmental osteoarthritis of the keen. Methods We electronically searched PubMed, MEDLINE（Ovid）, Pro Quest, EBSCO, The Cochrane Library（Issue 10, 2014）, EMbase, CNKI, VIP, CBM and Wan Fang Data from inception to November 2014, to collect randomized controlled trials（RCTs） and cohort studies of UKA versus TKA for patients with unicompartmental osteoarthritis of the keen. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using Rev Man 5.2 software. Results A total of 6 RCTs and 6 cohort studies involving 940 keens were included. The results of meta-analysis indicated that patients underwent UKA enjoyed a quicker rehabilitation to achieve a flexion of 90°（RCT： P〈0.05; cohort study： SMD= –1.70, 95%CI –2.07 to –1.34, P0.000 01）, had better range of motion（cohort study： SMD=0.59, 95%CI 0.41 to 0.78, P=0）, and were less likely to get DVT（RCT： RR=0.31, 95%CI 0.12 to 0.82, P=0.02）, but the patients underwent UKA were more likely to have a revision（RCT： RR=7.59, 95%CI 1.76 to 32.85, P=0.007）. The keen scores of the UKA group were similar to the TKA group（RCT： P=0.626; cohort study： MD=1.78, 95%CI –0.09 to 3.65, P=0.06）. Conclusion Current evidence shows that, compared with patients underwent TKA, patients underwent UKA have a quicker rehabilitation and fewer rates of DVT, and are more likely to have a revision. The medium to long-term follow up result of keen scores in both groups was equivalent. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

关 键 词：单髁关节置换术 全膝关节置换术 单间室骨关节炎 META分析 随机对照试验 队列研究 

分 类 号：R687.4[医药卫生—骨科学]