骨水泥与非骨水泥固定在初次全膝关节置换术中的应用:系统评价和meta分析

背景:全膝关节置换术(TKA)治疗终末期膝关节疾病的效果已被公认。目前TKA中假体-骨的固定形式主要有骨水泥固定和非骨水泥固定两种;前者应用广泛,但理想的假体固定方法仍存在争议。目的:通过meta分析评价骨水泥或非骨水泥固定在初次TKA中的优缺点,探讨其不同的适应证并提出TKA的最佳固定方式。方法:通过检索策略检索PubMed、The Cochrane Library、EMbase、CNKI、VIP、CBM和万方数据库,收集所有TKA术中骨水泥和非骨水泥固定的报道,采用RevMan 5.1软件进行meta分析。结果:最终纳入17项研究,并对其报道的结局指标进行合并分析。其中9项研究报道了TKA术后5年内的膝关节假体生存率,发现骨水泥固定组与非骨水泥固定组间生存率有显著统计学差异(RR=1.02,95%CI:1.00~1.05,P=0.02),但5年后的膝关节假体生存率无统计学差异(RR=1.01,95%CI:0.97~1.04,P=0.75)。术后假体相关并发症,骨水泥与非骨水泥固定组间无显著统计学差异(RR=0.97,95%CI:0.75~1.27,P=0.84)。影像学指标:术后两组间胫骨组件位置在冠状位及矢状位上偏移度数存在统计学差异,其他指标无统计学意义。结论:非骨水泥固定TKA植入组件发生偏转的概率相对较高,但非骨水泥固定TKA在假体中期生存率和临床疗效方面与骨水泥固定结果相似。为了更全面、准确地评价骨水泥固定与非骨水泥固定的长期生存率、安全性、临床及放射学指标,还需进一步研究。

Comparison of cemented versus cementless fixation in total knee arthroplasty:a systematic review and meta-analysis

Background: The clinical application and therapeutic effect of total knee arthroplasty(TKA) in the terminal disease of the knee has been recognized worldwide. The prosthesis-bone fixation forms in TKA mainly include bone cemented fixation and cementless fixation, and the former is most widely used. However, the ideal fixation method is still controversial. Objective: To compare cemented fixation with cementless fixation in TKA using meta-analysis, and to explore the optimal fixation. Methods: PubMed, The Cochrane Library, EMbase, CNKI, VIP, CBM, and WanFang Data databases were searched by search strategy to collect reports on cemented and cementless fixation in TKA using RevMan. 5.1 software for meta-analysis.Results: Seventeen systematic reviews and pooled analyses were included in this study. Nine studies compared knee joint survival at ≤5 years follow-up after replacement and a statistically significant difference was identified between cemented and cementless groups(RR=1.02, 95%CI: 1.00-1.05, P=0.02). There was no statistical heterogeneity in knee survival more than 5-year between cemented and cementless fixation groups(RR=1.01, 95%CI: 0.97-1.04, P=0.75). There were no significant differences in postoperative prosthesis-related complications between cemented and cementless groups(RR=0.97, 95%CI: 0.75-1.27, P=0.84). There were statistical differences in the imaging index between the two groups. The difference in the position of the tibia and the sagittal position between the two groups was not statistically significant. Conclusions: The implant components of the cementless group have relatively high rotation rates, but the survival rate and clinical efficacy of the two groups are similar. The use of cementless fixation is also an acceptable surgical procedure for primary TKA. To more comprehensively and accurately evaluate the long-term survival rate, safety, clinical and radiological indicators of bone cement solid and uncemented cement, further research is needed.