单髁置换失败翻修为全膝关节置换与初次全膝关节置换术后结果比较的Meta分析  

Does total knee arthroplasty converted from unicompartmental knee arthroplasty have similar efficacy to primary total knee arthroplasty?

作　　者：王勇卓 张民[1] 谭亚运[1] 王晋豫[1] 马技[1] Wang Yongzhuo;Zhang Min;Tan Yayun;Wang Jinyu;Ma Ji(Laboratory of Orthopedics Department,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院骨科实验室,太原030001

出　　处：《中华临床医师杂志（电子版）》2017年第17期2167-2172,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：山西省卫生计生委科研计划项目(2015039)

摘　　要：目的使用Meta分析方法系统评价在治疗膝关节骨性关节炎方面单髁置换术(UKA)失败后翻修所行的全膝关节置换术(TKA)与初次治疗行全膝关节置换术相关方面的异同。方法通过计算机检索Pub Med、Springer、EMbase、Ovid、万方数据库、中国知网、维普医学网等数据库,收集2010年1月至2016年12月所有关于单髁置换术失败后翻修所行TKA与初次治疗行TKA对比的随机对照研究与非随机对照研究,并运用Rev Man 5.2软件行Meta分析。结果共纳入6项回顾性队列研究,NOS评分均为7分,共596例,其中UKA失败后翻修而来的TKA病例238例,初次治疗行TKA者358例。分析显示:单髁置换失败后翻修而来的TKA比初次行TKA再翻修率高(RR=3.30,95%CI:1.09~10.06,P=0.04),而在术后膝关节评分(MD=-4.92,95%CI:-4.36~14.19,P=0.30)、术后关节活动度(MD=-5.58,95%CI:-12.62~1.45,P=0.12)、术后感染发生率(MD=0.55,95%CI:0.17~1.77,P=0.32)及术中失血量(MD=96.03,95%CI:-155.27~347.32,P=0.45)方面差异却无统计学意义。结论单髁置换后翻修而来的TKA短期内可取得与初次行TKA相似的手术效果,但再翻修率较高;长期结果分析需要进一步的研究。Objective To perform a meta-analysis to compare the efficacy between total knee arthroplasty(TKA)converted from unicompartmental knee arthroplasty(UKA)and primary TKA.Methods Randomized controlled trails and non-randomized controlled trails comparing TKA converted from UKA with primary TKA were searched in Wanfang Data,CNKI,VIP,PubMed,Springer,EMbase,and Ovid from 2010 to now.RevMan 5.2 software was used to conduct this meta-analysis.Results Six retrospective studies[mean Newcastle-Ottawa scale(NOS)score:7]were eligible for this meta-analysis.There were 238 patients in the revision group,and 358 patients in the primary TKA group.The meta-analysis showed that the revision group had significantly higher re-revision rate than primary TKA(RR=3.30,95%CI:1.09~10.06,P=0.04),but there was no difference in the knee function score[MD=-4.92,95%CI(-4.36,14.19),P=0.30],range of motion(MD=-5.58,95%CI:-12.62~1.45,P=0.12),infection rate(MD=0.55,95%CI:0.17~1.77,P=0.32),or blood loss(MD=96.03,95%CI:-155.27~347.32,P=0.45)between the two groups.Conclusion TKA converted from UKA can achieve the same effect as primary TKA in the short term,but is associated with a higher re-revision rate.

关 键 词：单髁置换术 翻修 初次全膝关节置换 META分析 

分 类 号：R687.4[医药卫生—骨科学]