全膝关节置换中髌骨置换效果的系统评价

背景：在进行全膝关节置换时是否行髌骨置换一直存在争议。目的：系统评价人工全膝关节置换过程中行髌骨置换的疗效,为进一步的临床研究及医疗实践提供参考。方法：根据严格制定的纳入和排除标准,按照事先制定的检索策略,计算机检索Cochrane图书馆临床对照试验资料库,EMBASE,MEDLINE,中国生物医学文献数据库,中国期刊全文数据库和维普中文期刊数据库。 使用Cochrane协作网提供的软件Revman 5.0.25进行Meta分析。结果与结论：14个随机对照试验共纳入1 788例膝,其中886例膝关节置换同时行髌骨置换,902例未行髌骨置换。Meta分析结果显示,髌骨置换组置换后5~7.5年内发生膝前痛的风险低,加权后RR=0.19,95%CI (0.11,0.31),但5年前和7.5年后二者差异无显著性意义;髌骨置换组与非髌骨置换组置换后5年内发生再手术的风险差异均无显著性意义,但5年以上髌骨置换组发生再手术的风险低,加权后RR=0.49,95%CI (0.33,0.75);膝关节KSS评分不论是亚组分析还是总体分析,差异均无显著性意义。总体Meta分析结果,KSS评分加权均数差值(WMD)为0.26,95%CI(-1.39, 1.90);患者满意度不论是亚组Meta分析还是总体Meta分析,差异均无显著性意义。总体Meta分析结果,患者满意度加权后RR=1.01,95%CI(0.97,1.05)。结果显示全膝关节置换中髌骨置换比髌骨不置换总体疗效要好。

Systematic evaluation of patellar replacement in total knee arthroplasty

BACKGROUND:Whether patellar displacement is performed during total knee replacement or not has been controversial.OBJECTIVE:To evaluate the efficacy of patellar replacement during total knee arthroplasty systematically, and to provide references for further clinical research and medical practice.METHODS: Inaccordance with strict inclusion and exclusion criteria and the pre-developed search strategy, the following databases and journals were searched for relavant articles: Cochrane Central Register of Controlled Trials, MEDLINE-, PubMed-, EMBASE-, CBM, CNKI and VIP. Meta analysis used the Revman 5.0.25 software provided by Cochrane collaboration. RESULTS AND CONCLUSION:1788 knees were included in the 14 published trials, including 886 knees in the patellar resurfacing group and 902 in the patellar nonresurfacing group. The result of the meta-analysis indicated that the risk of postoperative anterior knee pain was lower in patellar resurfacing group than in patellar nonresurfacing group between 5 years and 7.5 years. The combined RR was 0.19, 95%CI (0.11, 0.31). But the difference did not exist within 5 years or after 7.5 years. The risk of reoperation had no significant difference between the patellar resurfacing group and patellar nonresurfacing group within 5 years. But 5 years later, the risk of reoperation was lower in the patellar resurfacing group than in the patellar nonresurfacing group. The combined RR was 0.49, 95%CI (0.33, 0.75). Whatever using sub-group analysis or using general analysis, there was no difference in the mean postoperative knee scores. Weighted mean difference for the results of the general analysis was 0.26, 95%CI (-1.39, 1.90). Whatever using sub-group analysis or using general analysis, there was no difference in patient satisfaction. The combined RR for patient satisfaction was 1.01, 95%CI (0.97, 1.05). The efficacy of resurfacing the patella in total knee arthroplasty is better than nonresurfacing the patella in total knee arthroplasty.