髓内与髓外定位胫骨截骨对全膝关节置换术后胫骨假体力线影响的Meta分析  

Comparison of effects on tibial prosthetic alignment using intramedullary versus extramedullary alignment for tibia osteotomy in total knee arthroplasty: meta-analysis

作　　者：张志伟[1] 高耀祖[1] 郭丽[1] 李鹏翠[1] 卫小春[1] 

机构地区：[1]国家临床重点专科山西医科大学第二医院骨科骨与软组织损伤修复山西省重点实验室,太原030001

出　　处：《中华关节外科杂志（电子版）》2016年第2期65-70,共6页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：国家自然科学基金(31271033;81572098);山西省青年科技研究基金(2014021039-1);2015年山西省研究生教育创新基金(2015SY32);山西医科大学第二医院博士基金(20140406)

摘　　要：目的用Meta分析方法系统评价髓内与髓外定位胫骨截骨对全膝关节置换术后胫骨假体力线的影响。方法按照Cochrane系统评价的方法,检索PUBMED、EMBASE、中文学术期刊全文数据库（CNKI）和万方医学网等数据库,全面检索关于髓内与髓外定位胫骨截骨的随机病例对照的相关文献,检索年限为1990年1月到2015年10月。按照文献为随机对照研究（RCT）、研究对象为经下肢全长立位片显示胫骨均适合做髓内或髓外定位法截骨的患者等作为纳入标准,以不符合以上纳入标准、由于手术或/和其他原因导致术后假体力线受影响等作为排除标准,严格进行文献筛选并提取数据,用Review Manager 5.0软件对数据进行Meta分析。结果最终共纳入9篇随机对照试验（Jadad评分均在3-5分之间）。Meta分析结果显示,应用两种定位法胫骨截骨对术后胫骨力线的影响在术后冠状位胫骨假体角度（TCA）[MD=0.30,95%CI（-0.51,1.11）,P=0.47]、术后冠状位股胫角（FTA）[MD=0.14,95%CI（-0.48,0.77）,P=0.69]、术后冠状位FTA内外翻（7±5）°以内患者数量[MD=1.70,95%CI（0.66,4.38）,P=0.27]以及脂肪栓塞的发生情况方面的差别无统计学意义,尚不能认为两种定位法胫骨截骨在改善术后冠状位TCA、冠状位FTA、冠状位FTA内外翻（7±5）°以内患者数量以及脂肪栓塞的发生情况方面哪种更具优势;而在术后冠状位TCA内外翻2°或3°以内患者数量{内外翻2°：[RR=1.15,95%CI（1.01,1.31）,P=0.03];内外翻3°：[RR=1.12,95%CI（1.01,1.25）,P=0.03]}方面的差别有统计学意义,可认为髓内定位法胫骨截骨术后TCA内外翻2°或3°以内患者数量均高于髓外定位法胫骨截骨。结论本研究发现,对于经下肢全长立位片显示胫骨均适合做髓内或髓外定位法截骨的患者,与髓外定位法胫骨截骨比较,使用髓内定位法截骨的优点是可提高术后冠状位TCA达到理想90°的机率又不会增加�Objective To compare the prosthetic alignments of intramedullary and extramedullary alignment for tibia osteotomy in total knee arthroplasty（ TKA） by meta-analysis. Methods The randomized controlled trials of comparison of intramedullary and extramedullary tibial alignment in TKA were searched in PUBMED,EMBASE,CNKI and Chinainfo etc. from January 1990 to October 2015,according the methods provided by Cochrane. Data were extracted according to the inclusion criteria,such as randomized controlled trials（ RCT）,and exclusion criteria,i. e. component angles were influnced by other surgical operations ect. The extracted data were analyzed by Review Manager 5. 0. Results Nine randomized controlled trials（ Jadad score： 3- 5） were eligible for meta-analysis. There was no statistically significant difference in the tibial component angle（ TCA） [MD = 0. 30,95% CI（- 0. 51,1. 11）,P =0. 47],the femorotibial angle（ FTA） [MD = 0. 14,95% CI（- 0. 48,0. 77）,P = 0. 69],the number of the patient with correct FTA within（ 7 ± 5） °[MD = 1. 70,95% CI（ 0. 66,4. 38）,P = 0. 27 ] and the number of the patient with fat embolisms after TKA between the two alignment methods. However,the differences in the numbers of the patients with coronal TCA within 2°or 3°between the two methods{ within 2°： [RR = 1. 15,95% CI（ 1. 01,1. 31）,P = 0. 03]; within 3°： [RR = 1. 12,95% CI（ 1. 01,1. 25）,P = 0. 03]} were significant. Conclusion This meta-analysis indicates that using intramedullary alignment in TKA can increase the number of the patient with coronal TCA within 2°or 3°,but will not increase the number of the patient with fat embolisms after TKA,which may improve the survivorship of the TKA.

关 键 词：胫骨 关节成形术 置换 膝 META分析 

分 类 号：R687.4[医药卫生—骨科学]