滑膜切除术后联合放疗治疗膝关节色素沉着绒毛结节性滑膜炎疗效的meta分析  

Effect of synoviectomy combined with postoperative radiotherapy on pigmented villonodular synovitis in knee:A meta-analysis

作　　者：赖启忠 林天烨 杨鹏 熊冰朗 邹启昭 蔡开沈 李子祺[2] 何伟[2] 张庆文[2] LAI Qi-zhong;LIN Tian-ye;YANG Peng;XIONG Bing-lang;ZOU Qi-zhao;CAI Kai-shen;LI Zi-qi;HE Wei;ZHANG Qing-wen(The First Clinical College of Guangzhou University of Chinese Medicine,Guangzhou 510080,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510080,China)

机构地区：[1]广州中医药大学第一临床医学院 [2]广州中医药大学第一附属医院,广东广州510080

出　　处：《海南医学院学报》2022年第4期284-293,共10页Journal of Hainan Medical University

基　　金：国家自然科学基金面上项目(81873327);国家自然科学基金青年项目(81904226)。

摘　　要：目的:本文评价了滑膜切除术后联合放疗相较于单纯滑膜切除治疗膝关节色素沉着绒毛结节性滑膜炎的疗效。方法:检索SinoMed、中国知网、万方、维普、PubMed、Embase、Cochrane Library及Web of Science数据库建库至2020年10月的相关文献,筛选滑膜切除术后联合放疗的相关文献,符合纳排标准的文献根据其研究类型选择相应的评价方法进行质量评价,采用RevMan 5.3软件行meta分析。主要结局指标为复发情况;次要结局指标为并发症、膝关节功能优良率、膝关节活动度、膝关节Lysholm评分及IKDC评分等。结果:共纳入11篇文献,研究对象510例,联合组280例,对照组230例。Meta分析结果显示:(1)联合组的复发率明显低于对照组[OR=0.33,95%CI(0.20,0.55),P<0.0001]。(2)联合组并发症明显高于对照组[OR=2.70,95%CI(1.16,6.31),P=0.02]。(3)优良率方面,联合组明显优于对照组[OR=2.86,95%CI(1.23,6.64),P=0.01],也有可能是各个研究评价优良的标准不一样导致的结果。(4)膝关节活动度MD=2.96,95%CI(-0.54,6.47),P=0.10;Lysholm评分MD=3.22,95%CI(-0.51,6.96),P=0.09;IKDC评分MD=2.88,95%CI(-1.07,6.82),P=0.15。在膝关节活动度、Lysholm评分及IKDC评分方面,两组未见显著差异。结论:膝关节色素沉着绒毛结节性滑膜炎行滑膜切除术后联合放疗可以降低复发率,但与单纯手术相比存在较高的并发症。上述结论尚需更多高质量的临床研究长期随访进行验证。Objective:To evaluate the efficacy of synovectomy combined with postoperative radiotherapy in the treatment of pigmented villonodular synovitis compared with only synovectomy in knee.Methods:The related references were searched from SinoMed,CNKI,Wanfang,VIP,PubMed,Embase,Cochrane Library and Web of Science from date of databases establishment to October 2020,and the studies of synovectomy combined with postoperative radiotherapy were screened.According to the type of research,the corresponding evaluation methods were selected for quality evaluation of the literature.RevMan 5.3 software was used for meta-analysis.The primary outcome was recurrence,while the secondary outcomes included complications,excellent and good rate of function of knee,range of motion of knee,Lysholm score,and IKDC score of knee etcetera.Results:A total of 11 articles were included in meta-analysis,with 510 cases,280 in the combined group and 230 in the control group.The results of meta-analysis showed that:(1)The recurrence rate in the combination group was significantly lower than that in the control group,[OR=0.33,95%CI(0.20,0.55),P<0.0001];(2)The complications in the combined group were higher than that in the control group[OR=2.70,95%CI(1.16,6.31),P=0.02];(3)The excellent and good rate of the combined group was significantly better than that of the control group[OR=2.86,95%CI(1.23,6.64),P=0.01],and it also may be the result of different evaluation criteria of each study;(4)There was no significant difference range of motion[MD=2.96,95%CI(-0.54,6.47),P=0.10],Lysholm score[MD=3.22,95%CI(-0.51,6.96),P=0.09],or IKDC score[MD=2.88,95%CI(-1.07,6.82),P=0.15]in knee between the two groups.Conclusion:The meta-analysis shows that synovectomy combined with radiotherapy can reduce the recurrence rate of pigmented villonodular synovitis in knee,but compared with only operation,there are higher complications.However,the above conclusions need to be verified by long-term follow-up of more high-quality clinical studies.

关 键 词：色素沉着绒毛结节性滑膜炎 膝关节 关节镜 开放性手术 滑膜切除 放疗 META分析 

分 类 号：R687.4[医药卫生—骨科学]