中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (36): 5897-5904.doi: 10.12307/2021.360

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    

后稳定型与后交叉韧带保留型膝关节假体在全膝关节置换中的疗效：系统综述和Meta分析

万大地1，2，段祥瑞1，2，范鑫超1，3，袁  野1，3，黄  腾1，潘迪康2，刘静艳2，李西成1   

  1. 1河北省人民医院骨科，河北省石家庄市   050051；2华北理工大学研究生院，河北省唐山市   063210；3河北北方学院，河北省张家口市   075000
  • 收稿日期:2021-03-22 修回日期:2021-03-24 接受日期:2021-04-12 出版日期:2021-12-28 发布日期:2021-09-18
  • 通讯作者: 李西成，博士，主任医师，河北省人民医院骨科，河北省石家庄市 050051
  • 作者简介:万大地，男，1993年生，湖北省荆州市人，汉族，华北理工大学在读硕士。

Efficacy of posterior cruciate ligament retaining versus posterior stabilized prostheses in total knee arthroplasty: a systematic review and a meta-analysis

Wan Dadi1,2, Duan Xiangrui1,2, Fan Xinchao1,3, Yuan Ye1,3, Huang Teng1, Pan Dikang2, Liu Jingyan2, Li Xicheng1   

  1. 1Department of Orthopedics, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China; 2Graduate School of North China University of Science and Technology, Tangshan 063210, Hebei Province, China; 3Hebei North University, Zhangjiakou 075000, Hebei Province, China
  • Received:2021-03-22 Revised:2021-03-24 Accepted:2021-04-12 Online:2021-12-28 Published:2021-09-18
  • Contact: Li Xicheng, MD, Chief physician, Department of Orthopedics, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
  • About author:Wan Dadi, Master candidate, Department of Orthopedics, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China; Graduate School of North China University of Science and Technology, Tangshan 063210, Hebei Province, China

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摘要：


文题释义：

CR假体：即posterior cruciate ligament retaining，应用CR假体进行全膝关节置换时保留了后交叉韧带，假体限制程度小，但是后髁截骨要求高，容易出现股骨髁反常前移。
PS假体：即posterior stabilized，为后稳定型假体，应用PS假体进行全膝关节置换时切除了后交叉韧带。

目的：临床上医生在进行全膝关节置换时常用到后稳定型(posterior stabilized，PS)与后交叉韧带保留型(posterior cruciate ligament retaining，CR)膝关节假体，而哪一种假体更具有优势还不能完全确定。文章探讨CR假体与PS假体应用于全膝关节置换的安全性和有效性。
方法：在Cochrane library、PubMed、Web of Science、EMbase、中国知网、万方、维普、CBM数据库检索CR假体与PS假体应用于全膝关节置换的临床研究。使用Cochrane偏倚风险评估工具对随机对照试验的偏倚风险进行评估，对回顾性队列研究的文献质量评价参考纽卡斯尔-渥太华量表评估，使用RevMan 5.3软件进行Meta数据分析。
结果：共纳入11篇文献，包括7项随机对照试验，4项回顾性队列研究，均为高质量文献，包括765例行全膝关节置换的患者，其中386例应用CR假体，379例应用PS假体。Meta分析的结果表明：两种假体相比较，①PS假体术后1年膝关节活动度更大(WMD=-0.94，95%CI：-1.69至-0.20，P=0.01)，术后1年膝关节伸直角度更小(WMD=-0.33，95%CI：-0.61至-0.05，P=0.02)，术后1年的屈曲角度更大(SMD=-0.62，95%CI：-1.20至-0.04，P=0.03)；②CR假体在术后的总失血量较少(WMD=-126.86，95%CI：-231.03至-22.69，P=0.02)，术后1年的WOMAC评分更低(SMD=-0.29，95%CI：-0.55至-0.04，P=0.02)，手术时间更长(WMD=4.29，95%CI：2.13-6.46，P=0.000 1)；③两组术后3个月HSS评分、术后1年AKS临床评分、术后总体并发症发生率差异无显著性意义(P > 0.05)。

结论：行全膝关节置换时，PS假体在术后1年膝关节的活动度更好，手术时间更短；CR假体的术后总失血量更少，膝关节功能恢复更好；两种假体各有其优势，术者可以根据患者的个体差异进行选择。

https://orcid.org/0000-0002-6548-841X (万大地) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨, 膝关节, 置换, CR假体, PS假体, 总失血量, 随机对照试验, Meta分析

Abstract: BACKGROUND: When performing total knee arthroplasty, one is faced with the choice of posterior cruciate ligament retaining prosthesis or posterior stabilized prosthesis. However, which prosthesis is more advantageous cannot be completely determined.  
OBJECTIVE: To investigate the safety and efficacy of posterior cruciate ligament retaining prosthesis and posterior stabilized prosthesis in total knee arthroplasty.  
METHODS: Databases, including Cochrane Library, PubMed, Web of Science, EMbase, CNKI, Wanfang, VIP and CBM, were searched for clinical studies on posterior cruciate ligament retaining and posterior stabilized for total knee arthroplasty. The risk of bias in randomized controlled trials was assessed using the Cochrane Risk of Bias Assessment Tool. The quality of literature in retrospective case-control studies was assessed using the Newcastle-Ottawa Scale. RevMan 5.3 software was used for meta-analysis. 
RESULTS: A total of 11 studies (seven randomized controlled trials and four retrospective case-control trials were of high quality) were included, including 765 patients undergoing total knee arthroplasty, including 386 posterior cruciate ligament retaining prostheses and 379 posterior stabilized prostheses. The results of the meta-analysis showed that the range of motion of knee joint was larger one year after the posterior stabilized prosthesis (WMD=-0.94, 95%CI:-1.69 to -0.20, P=0.01]; the angle of knee joint extension was smaller one year after surgery (WMD=-0.33, 95%CI:-0.61 to -0.05, P=0.02], and the angle of flexion was larger one year after surgery (SMD=-0.62, 95%CI:-1.20 to -0.04, P=0.03]. (2) The total postoperative blood loss of posterior cruciate ligament retaining prosthesis was less than posterior stabilized prosthesis (WMD=-126.86, 95%CI:-231.03 to -22.69, P=0.02]. WOMAC score was lower for posterior cruciate ligament retaining prosthesis 1 year after surgery (SMD=-0.29, 95%CI:-0.55 to -0.04, P=0.02]. The operative time of posterior cruciate ligament retaining prosthesis was longer than posterior stabilized prosthesis (WMD=4.29, 95%CI:2.13-6.46, P=0.0001]. (3) Postoperative three months HSS score, postoperative 1 year AKS clinical scoring, and postoperative complications were not statistically significant between the two groups (P > 0.05).  
CONCLUSION: In total knee arthroplasty, posterior stabilized prosthesis was better than posterior cruciate ligament retaining prosthesis in the range of knee motion and operative time. Total blood loss was less and the recovery of knee function was better in posterior cruciate ligament retaining prosthesis than those in the posterior stabilized prosthesis. Each type of prosthesis has its own advantages, and the surgeon can choose according to individual differences for the patient.

Key words: bone, knee joint, Replacement, posterior cruciate ligament retaining prosthesis, posterior stabilized prosthesis, total blood loss, randomized controlled trial, meta-analysis

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