人工膝关节置换中髌骨置换效果的Meta分析

背景：全膝关节置换是否进行髌骨置换一直存有争议。 目的：比较人工膝关节置换中未行髌骨置换与行髌骨置换后的临床疗效，分析目前关于髌骨置换研究所存在的问题及需要改进的策略。 方法：检索PubMed、Medline、Elsevier、Embase、OVID、ProQuest、Springer、BlackWell、JohnWiley、中国生物医学数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)中2011-11-15前发表的膝关节置换术中髌骨置换与非髌骨置换的随机对照研究。相同样本的多篇文献选择其随访时间最长者。采用国际Cochrane协作组提供的Revman 5.0软件对人工膝关节置换后再手术率、术后膝前痛发生率和功能评分进行统计学分析。 结果与结论：共纳入随机对照试验研究18篇，共7 075例患者(置换组3 463例和非置换组3 612例)。Meta分析结果显示膝前痛的发生率在髌骨置换组和非髌骨置换组间差异无显著性意义(RR=0.150，95%CI：0.129-0.185，P > 0.05)；但与非髌骨置换组比较，髌骨置换组术后5年以上再手术率降低(RR=0.135，95%CI：0.118-0.166，P < 0.05)；两组的膝关节功能评分差异无显著性意义(WMD=-0.144，95%CI：-1.122-2.109，P > 0.05)。提示人工膝关节置换中行或不行髌骨置换疗效相当，应鼓励更多使用国家关节置换登记系统数据为全膝关节置换中是否植入特定髌骨假体提供依据。

Meta-analysis of the outcomes of patella resurfacing in total knee arthroplasty

BACKGROUND:There is controversy on whether the patellar resurfacing should be performed during total knee arthroplasty. OBJECTIVE:To compare the outcomes of total knee arthroplasty with or without patellar resurfacing, and to analyze the problems and the strategies that need to be improved of patellar resurfacing. METHODS:The PubMed database, Medline database, Elsevier database, Embase database, OVID database, ProQuest database, Springer database, BlackWell database, JohnWiley database, CBM database, CNKI database and VIP database were used to search the randomized controlled trials on total knee arthroplasty with or without patellar resurfacing that published before 2011-11-15. For the articles of the same sample, we selected those with the longest follow-up. The reoperation rates, incidence of anterior knee pain and functional scores were analyzed by the Revman 5.0 software provided by the International Cochrane Collaboration Group. RESULTS AND CONCLUSION:A total of 18 randomized controlled trials of 7 075 patients were selected (3 463 in the resurfacing group and 3 612 in the non-resurfacing group). Meta-analysis showed that there was no significant difference of the incidence of anterior knee pain between resurfacing group and non-resurfacing group (RR=0.150, 95%CI: 0.129-0.185, P > 0.05). Compared with non-resurfacing group, the reoperation rates more than 5 years in the resurfacing group was decreased (RR=0.135, 95%CI:0.118-0.166, P < 0.05). There was no significant difference of the functional scores between two groups (WMD=-0.144, 95%CI: -1.122-2.109, P > 0.05). It indicates that there is no significant difference in the outcome of total knee arthroplasty with or without patellar resurfacing, so more usage of national registry joint replacement data should be encouraged to provide the basis for the identification of whether the patellar resurfacing should be performed during total knee arthroplasty.