全膝关节置换过程中切除或保留髌下脂肪垫的Meta分析  

Total knee arthroplasty with and without preservation of the infrapatellar fat pad: a meta-analysis

作　　者：揭珂 邓鹏 曾建春[2] 冯文俊[2] 曾会粮 吴克亮 曾意荣[2] Jie Ke;Deng Peng;Zeng Jian-chun;Feng Wen-jun;Zeng Hui-liang;Wu Ke-liang;Zeng Yi-rong(Guangzhou University of Chinese Medicin;First Affiliated Hospital of Guangzhou University of Chinese Medicin)

机构地区：[1]广州中医药大学,广东省广州市510405 [2]广州中医药大学第一附属医院,广东省广州市510405

出　　处：《中国组织工程研究》2018年第23期3759-3765,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:在全膝置换过程中,为避免遮挡手术视野、影响假体安装,大部分手术医师会将髌下脂肪垫切除,但临床中切除或保留髌下脂肪垫仍然备受争议。目的:系统评价全膝关节置换过程中切除或保留髌下脂肪垫的有效性和安全性。方法:计算机检索万方数字化期刊全文数据库、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库及Cochrane Library、Pubmed、EMbase。检索各数据库建库日起至2017年8月符合纳入标准的临床对照试验,然后对纳入的研究进行数据提取和质量评价,使用Revman 5.3软件进行Meta分析。结果与结论:(1)共12个临床文献纳入系统评价,共1 478例膝;(2)Meta结果显示,髌下脂肪垫切除组的髌韧带缩短长度在随访12-18个月、28-38个月时比髌下脂肪垫保留组更大[MD=2.90,95%CI(2.21,3.58),P<0.000 01;MD=2.65,95%CI(1.96,3.35),P<0.000 01],但随访一至两个月、6个月时差异无显著性意义(P>0.05);(3)同时2组间膝前痛、美国膝关节协会评分、美国特种外科医院膝关节评分、Insall-Salvati指数在各随访时间段内比较差异均无显著性意义(P>0.05);(4)结果提示,全膝关节置换过程中应尽可能保留髌下脂肪垫及减少对其损伤,尤其是"密集血管区",以更好地预防低位髌骨。BACKGROUND： During total knee arthroplasty, the infrapatellar fat pad is usually resected to enhance surgical exposure and install the prosthesis easily. However, it is still controversial whether the infrapatellar fat pad is removed or retained in the clinic. OBJECTIVE： To systematically assess the effectiveness and safety of the excision and preservation of infrapatellar fat pad during total knee arthroplasty. METHODS： Wanfang Data, CNKI, CBM, VIP, Cochrane Library, Pubmed and EMbase were researched for the clinical controlled trials from the database establishment to August 2017 according to inclusion and exclusion criteria. The included data were extracted and quality was evaluated. Meta-analysis was performed by using Rev Man 5.3 software. RESULTS AND CONCLUSION：（1） Totally 12 clinical controlled trials with 1 478 knees were included.（2） Meta-analysis results showed that infrapatellar fat pad excision could significantly increase shortening of the patellar tendon, compared with the infrapatellar fat pad preservation at the follow-up period of 12 to 18 months and 28 to 38 months postoperatively [MD=2.90, 95%CI（2.21, 3.58）, P 〈 0.000 01; MD=2.65, 95%CI（1.96, 3.35）, P 〈 0.000 01]. However, the difference of shortening of the patellar tendon between two groups within 1 to 2 months and 6 months postoperatively was not statistically significant（P 〉 0.05）.（3） Anterior knee pain, American knee society knee score, hospital for special surgery knee score and Insall-Salvati ratio were not significantly different between the two groups（P 〉 0.05）.（4） Infrapatellar fat pad, especially the dense vascular position, should be preserved as much as possible and protected from injury during total knee arthroplasty.

关 键 词：关节成形术 置换 膝 循证医学 组织工程 保留髌下脂肪垫 切除髌下脂肪垫 骨科植入物 人工假体 全膝关节置换 膝前痛 KSS评分 HSS评分 Insall-Salvati指数 髌韧带缩短长度 META分析 

分 类 号：R318[医药卫生—生物医学工程]