Quadriceps-Sparing入路与传统入路全膝关节置换术临床疗效的Meta分析

目的 系统评价（QS）入路全膝关节置换（TKA）与传统入路临床疗效的差异,为临床提供参考.方法 检索Cochrane图书馆、PubMed、EMbase、CNKI、万方数据库、维普资讯数据库等中英文数据库,检索截止日期为2013年2月.由两名评价员独立筛查文献、提取资料和方法学质量评估,采用Rev Man 5.2.0 软件进行Meta分析,并绘制漏斗图评定有无发表偏倚.结果 一共纳入11篇临床随机对照试验文献（8篇英文文献,3篇中文文献）,共分析813膝,其中QS入路407膝,传统入路406膝.Meta分析结果显示：与传统TKA相比,QS入路术后负重下地行走时间、直腿抬高时间、VAS评分、屈膝度数、引流量及切口长度等方面更有优势,在KSS功能评分、屈膝90°时间、术中出血量、总出血量、假体位置（下肢力线、α角、β角、γ角及δ角）及并发症发生率等方面均无统计学差异,而在手术时间、止血带时间等方面并无优势.结论 对于经验丰富且已走出学习曲线的关节外科医生,选择QS入路会使患者术中创伤小,术后疼痛轻,下地锻炼时间早,功能恢复快,引流量少,而假体位置及并发症发生率较传统TKA无统计学差异.上述结果尚需更多高质量随机对照试验来进一步验证.

Meta-analysis of quadriceps-sparing approach versus conventional approach in total knee arthroplasty

Objective To compare the clinical efficacy of the quadriceps-sparing （QS） approach with conventional approach in total knee arthroplasty （TKA）. Methods The data bases including Coehrane Library, PubMed, EMBASE, CNKI, VIP and Wan Fang were searched for collecting randomized controlled trials （RCTs） comparing the QS approach with the conventional approach in TKA. The study selection, assessment, data collection and analysis were undertaken by two authors independently. The data analysis was performed with Review Manager 5.2.0, and the publication bias was evaluated by a funnel plot. Results 11 RCTs were included （8 English and 3 Chinese studies） with 813 knees comparing the QS-TKAs （n = 407） with the conventional TKAs （n = 406 ）. The results suggested that the QS approach had advantages in ambulation, straight leg raising, knee flexion, VAS score, drainage and incision length. Except suffering longer surgical time and tourniquet time in the QS approach, there was no difference in KSS score, the 90° knee flexion time, intraoperative blood loss, total blood loss, radiological measurements, and complications between the two groups. Conclusion For the experienced orthopedic surgeons who went out the learning curve, the Qs approach may provide better outcomes and faster recovery than the conventional approach without bad component measurement and complications. However, more high-quality RCTs are required for further investigation.