间隙平衡技术与测量截骨技术在全膝人工关节置换术应用的Meta分析  

Gap balancing vs measured resection technique for total knee arthroplasty:a Meta-analysis

作　　者：杨溯 王月鹏 韩鹏飞 Yang Su;Wang Yuepeng;Han Pengfei(Department of Graduate,Changzhi Medical College,Shanxi 046000,China;Department of Orthopedics,Peace Hospital Affiliated to Changzhi Medical College,Shanxi 046000,China)

机构地区：[1]长治医学院研究生处,046000 [2]长治医学院附属和平医院骨科,046000

出　　处：《中国药物与临床》2022年第7期603-613,共11页Chinese Remedies & Clinics

基　　金：长治医学院2020年博士启动基金(BS2020004)。

摘　　要：目的 比较间隙平衡技术(GB)与测量截骨技术(MR)在全膝人工关节置换术(TKA)后功能评分及影像结果的差异。方法 检索国内外2009年3月至2021年3月发表的随机对照研究和回顾性病例对照研究。检索的数据库包括Embase、PubMed、中国知网、万方数据库、维普数据库等。依据检索策略,共检索到相关文献3 387篇,最终纳入23篇,其中英文文献16篇,中文文献7篇。采集原始数据后,使用Review Manager 5.3软件进行数据分析。结果 在治疗中、重度膝关节骨关节炎时,采用MR行TKA后膝关节功能(FS)评分随访6个月[95%CI(3.81,6.70),P<0.001]、随访1年[95%CI(0.60,3.61),P=0.006]均优于GB,MR术后FS及美国膝关节学会(KSS)评分优于GB[95%CI(0.32,2.89),P=0.01]。但采用GB行TKA术后下肢力线与小腿解剖轴夹角[95%CI(-2.01,-0.46),P=0.002]、机械轴夹角[95%CI(-0.65,-0.13),P=0.003]、关节间隙[95%CI(-0.37,-0.04),P=0.01]均优于MR,差异均有统计学意义。余结局指标2组差异均无统计学意义。结论 在行TKA术时,MR短期(≤2年)功能评分优于GB,但是这种优势会随时间增加而降低。采用GB的影像结果较优于MR。MR与GB都是安全可靠的治疗选择。Objective To compare the differences in functional scores and imaging after total knee arthroplasty(TKA) with gap balancing(GB) vs measured resection(MR) technique.Methods Randomized controlled studies and retrospective case reviews published in China or worldwide between March 2009 and March2021 were search in Embase,PubMed,CNKI,Wanfang and VIP databases.According to our search strategy,a total of 3 387 relevant papers were retrieved.Twenty-three studies were finally included,with 16 published in English and 7 in Chinese.After data extraction,Review Manager 5.3 was used for data analysis.Results For moderate to severe knee osteoarthritis,MR led to better FS scoresduring follow up at 6 months [95%CI(3.81,6.70),P<0.01] and 1 year [95%CI(0.60,3.61),P=0.006] after TKA,compared with GB.The post-TKA FS and KSS scores were more favorable with MR than with GB technique [95%CI(0.32,2.89),P=0.01].However,GB technique resulted in more favorable angle between the lower limb force line and the anatomical axis [95%CI(-2.01,-0.46),P=0.002] or the mechanical axis [95%CI(-0.65,-0.13),P=0.003] of the leg,and joint space [95% CI(-0.37,-0.04),P =0.01] after TKA,compared to MR technique,with statistical differences.There were no significant differences in the remaining outcome measures between the two groups.Conclusion MR technique is more favorable than GB in terms of short-term (≤2 years) functional scores after TKA,although such advantage fades out with time.On the other hand,GB results in better outcomes on imaging compared with MR technique.Either MR or GB techniquesis safe and reliable as a treatment option.

关 键 词：关节成形术 置换 膝 骨关节炎 膝 间隙平衡 截骨术 META分析 

分 类 号：R687.4[医药卫生—骨科学]