内轴型和后稳定型全膝关节置换假体的应用优势比较的Meta分析  

Medial pivot versus posterior stabilized prostheses for total knee arthroplasty:a meta-analysis

作　　者：谷明西 朱雨农 田丰德[1] 安宁[1] 王常成 郭林[1] Gu Mingxi;Zhu Yunong;Tian Fengde;An Ning;Wang Changcheng;Guo Lin(Second Department of Orthopedics,Zhongshan Hospital of Dalian University,Dalian 116001,Liaoning Province,China)

机构地区：[1]大连大学附属中山医院骨二科,辽宁省大连市116001

出　　处：《中国组织工程研究》2021年第33期5395-5403,共9页Chinese Journal of Tissue Engineering Research

摘　　要：目的:内轴型假体与后稳定型假体在全膝关节置换后临床疗效方面仍存在争议。文章旨在通过Meta分析比较两组假体置换后主要临床结局指标的差异。方法:检索PubMed、Medline、Cochrane Library和中国知网数据库有关内轴型假体和后稳定型假体用于全膝关节置换疗效对比的临床对照研究。检索时限为各数据库建库日期至2020年9月。由2名研究人员独立检索文献和提取数据,随机对照试验的质量评价采用Cochrane协作网的随机对照试验偏倚风险评估工具,非随机临床对照试验使用NOS量表进行质量评估,采用RevMan 5.3软件进行统计分析。结果:最终纳入18项临床对照研究,共计纳入全膝关节置换患膝3025个。Meta分析结果显示,相比于全膝关节置换时选用后稳定假体,采用内轴型假体在膝关节KSS评分方面获改善更大(MD=0.81,95%CI:0.36-1.86,P=0.02);放射学结果显示,两组假体之间,内轴型假体的股骨冠倾角α更符合最佳解剖角度(MD=-0.80,95%CI:-1.49至-0.11,P=0.02);内轴型假体在置换后总体并发症的发生率更低(MD=-0.56,95%CI:0.34-0.97,P=0.03),而在置换后活动范围、膝关节功能KSFS评分、牛津OKS评分、特种外科医院HSS评分、骨关节炎WOMAC指数、人工关节被遗忘FJS指数及翻修率等方面均无显著差异。结论:相较于选用后稳定设计,采用内轴型设计的假体在全膝关节置换后膝关节KSS评分方面的改善更大,总体并发症的发生率更低,具有更佳的矢状稳定性,更符合生理功能解剖。此次Meta分析基于有限的数据,仍存在一定的局限性,还需要更多更高质量的研究验证结果。OBJECTIVE:Medial pivot and posterior stabilized prostheses are still controversial in terms of clinical outcomes after total knee arthroplasty.The aim of this study was to compare the differences in the main clinical outcome measures after surgery between the two groups of prostheses using meta-analysis.METHODS:PubMed,Medline,Cochrane Library,and China National Knowledge Infrastructure were searched for studies comparing the efficacy of medial pivot prosthesis and posterior stabilized prosthesis for total knee arthroplasty.The search period was from the date of database establishment to September 2020.Two researchers independently searched the literature and extracted the data.The quality of randomized controlled trials was evaluated using the Cochrane Collaboration's tool for assessing the risk of bias of randomized controlled trials.The quality of non-randomized controlled clinical trials was assessed using the NOS scale.RevMan 5.3 software was used for statistical analysis.RESULTS:Finally,18 controlled clinical trials were included,totally 3025 knees for total knee arthroplasty.Meta-analysis results showed that compared with the selection of posterior stable prosthesis in total knee arthroplasty,the use of medial pivot prosthesis improved the Knee Society Score(MD=0.81,95%CI:0.36−1.86,P=0.02).Radiographic results showed that the femoral crown inclination angleαof the medial pivot prosthesis was more in line with the optimal anatomical angle between the two groups of prostheses(MD=−0.80,95%CI:−1.49 to−0.11,P=0.02).Medial pivot prosthesis had a lower incidence of overall postoperative complications(MD=−0.56,95%CI:0.34−0.97,P=0.03),while there were no significant differences in the postoperative range of motion,Knee Society Functional score,Oxford Knee scores,Hospital for Special Surgery knee Score,Western Ontario and McMaster Universities Osteoarthritis Index,Forgotten Joint Score,and revision rate.CONCLUSION:Compared with the selection of posterior stable prosthesis,the improvement of KSS score aft

关 键 词：关节 膝 膝关节 假体 关节置换 全膝关节置换 内轴型假体 后稳定型假体 META分析 

分 类 号：R459.9[医药卫生—治疗学] R363[医药卫生—临床医学]