单髁置换术与全膝置换术治疗膝骨关节炎疗效的Meta分析

目的系统评价单髁置换术(UKA)与全膝关节置换术(TKA)治疗膝骨关节炎的临床疗效。 方法计算机检索Cochrane Library、Pubmed、Web of science、中国知识总库(CNKI)、万方数据学术论文总库、中国生物医学文献服务系统、公开发表的单髁置换术与全膝置换术治疗膝骨关节炎的临床研究。由2名研究者按照纳排标准进行文献筛选并提取相关资料,纳入标准为选取随机对照试验(RCT)或非随机对照试验(no-RCT)的文献,患者首次行全膝关节置换术或单髁置换术,观察比较膝关节KSS评分、屈曲膝关节达90°所需时间、关节活动度、疼痛度等结局指标。同时,排除重复发表、无法得到原始相关数据、无法获取全文、以及质量等级较低的文献。用RevMan 5.3.3软件进行数据处理,计量资料采用均数差(MD)为合并统计量,计数资料选择相对危险度(RR)为合并统计量,所有效应量以95%可信区间(CI)表示。通过卡方检验判断研究间异质性,若P≥0.05,I²≤50%,采用固定效应模型;反之分析其异质性来源,若无临床异质性,则采用随机效应模型。若不能进行数据的合并,则进行描述性分析。 结果共纳入7个随机对照试验(RCT)及13个非随机对照试验(no-RCT)。Meta分析结果显示：关节活动度在2、3、6、12、48个月的时间点测量,结果显示两组间在2个月时无异质性[MD＝7.31,95%CI(－0.99,15.61),P＝0.08],而在中、远期时存在异质性[MD＝5.90,95% CI(1.07,10.74),P＝0.02]。屈曲90°所需时间方面单髁组[RCT: MD＝－3.36,95% CI(－6.22,－0.50),P＝0.02;no-RCT: MD＝－2.94,95% CI(－3.51,－2.37),P＝0.02]相对于全膝置换组更短。与全膝置换组相比,单髁置换术在术后膝关节KSS评分早中期疗效相当,但在远期疗效方面有着明显的优势。在术中出血量[RCT: MD＝－176.99,95% CI(－205.36,－148.62),P <0.01;no-RCT: MD ＝－139.08,95% CI(－150.94,－127.22),P <0.01]及术中引流量[MD＝－77.33,95% CI(－88.18,－66.48),P<0.01]方面比全膝置换组有着明显的优势。在手术时间方面[no-RCT: MD＝－0.43,95% CI(－7.27,－6.40),P＝0.90]两组间异质性不明显。 结论单髁置换术在术后膝关节活动度、屈曲90°所需时间、术后膝关节KSS评分、术中出血量、术中引流量方面存在明显优势,在手术时间方面无统计学差异,但是上述研究纳入的高质量文献较少,尚需要更多高质量、大样本的临床试验进一步验证。

Meta analysis of efficacy of monondylar replacement and total knee replacement in treatment of knee osteoarthritis

ObjectiveTo systematically evaluate the clinical efficacy of single condylar replacement (unicompartmental kenn arthroplasty, UKA) and total knee replacement (total knee arthroplasty, TKA) in the treatment of knee osteoarthritis. MethodsCochrane Library, Pubmed, Web of science, China national knowledge infrastructure (CNKI), Wanfang database, Chinese biomedical literature service system, published clinical studies on the treatment of knee osteoarthritis by single condyle replacement and total knee replacement were searched by computer. Two researchers screened the literature and extracted the relevant data according to the naught criteria. The inclusion criteria were randomized controlled trials (RCT) or non-randomized controlled trials (no-RCT). The patients underwent total knee arthroplasty or unicondylar replacement for the first time. The KSS score of knee joint, the time required for flexion of knee joint to reach 90 degrees, joint mobility, pain and other outcome indicators were observed and compared.Duplicate publications, original relevant data could not be obtained, full texts could not be obtained, and low-quality literature were excluded. RevMan 5.3.3 software was used for data processing: measurement data using mean differences (MD) for combined statistics, counting information using relative risk (RR) for combined statistics, all the effects data were described by 95% confidence interval (CI). Two researchers extracted data and determined heterogeneity between studies: if P ≥0.05, I²≤50%, using fixed effect model (fixed effects model); if no clinical heterogeneity, the random effects model would be adopted. If data could not be combined, descriptive analysis was performed. ResultsA total of seven RCTS and 13 no-RCTS were included. Meta analysis results showed that the joint activity was measared in two, three, six, 12, 48 months. According to the results, between the two groups after two months [MD=7.31, 95% CI (0.99, 15.61), P=0.08] there was no heterogeneity, and in the mid-and long term, [MD=5.90, 95% CI(1.07, 10.74), P=0.02] there was heterogeneity. The monocondylar group [RCT: MD=-3.36, 95% CI(-6.22, -0.50), P=0.02, no-RCT: MD=-2.94, 95% CI)(-3.51, -2.37), P=0.02] was shorter than the total knee replacement group in the time for 90° flexion.Compared with the total knee replacement group, monocondylar replacement had the same efficacy in the early and middle stage of the postoperative KSS score of the knee joint, but had obvious advantages in the long-term efficacy.Intraoperative blood loss [RCT: MD=-176.99, 95% CI(-205.36, -148.62), P <0.01, no-RCT: MD =-139.08, 95% CI(-150.94, -127.22), P <0.01]and intraoperative drainage[MD=-77.33, 95% CI(-88.18, -66.48), P<0.01]had significant advantages over the total knee replacement group. In terms of operation time [no-RCT: MD=-0.43, 95% CI(-7.27, -6.40), P=0.90], no significant heterogeneity was found between the two groups. ConclusionSingle condyle replacement shows no abvious advantage in the time needed for postoperative knee joint mobility, buckling 90 degrees, knee KSS score after operation, intraoperative blood loss, intraoperative led traffic obvious advantages, heterogeneity in terms of operation time, but more high quality, further clinical trials of large sample verification is still needed.