中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (43): 8097-8103.doi: 10.3969/j.issn.1673-8225.2011.43.029

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

全膝关节置换中髌骨置换效果的系统评价

成世高1，王万春2，肖  扬1，伍旭辉1，李  健1   

  1. 1湖南省娄底市中心医院，湖南省娄底市  417000
    2中南大学湘雅二医院，湖南省长沙市  410011
  • 收稿日期:2011-08-10 修回日期:2011-09-04 出版日期:2011-10-22 发布日期:2011-10-22
  • 作者简介:成世高★，男，1976年生，湖南省娄底市双峰县人，汉族，2011年中南大学毕业，硕士，主要从事关节外科方面的研究。 chengmo2018@sina.com

Systematic evaluation of patellar replacement in total knee arthroplasty

Cheng Shi-gao1, Wang Wan-chun2, Xiao Yang1, Wu Xu-hui1, Li Jian1   

  1. 1Loudi Central Hospital, Loudi  417000, Hunan Province, China
    2Second Xiangya Hospital, Central South University, Changsha  410011, Hunan Province, China
  • Received:2011-08-10 Revised:2011-09-04 Online:2011-10-22 Published:2011-10-22
  • About author:Cheng Shi-gao★, Master, Loudi Central Hospital, Loudi 417000, Hunan Province, China chengmo2018@sina.com

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374

被引次数

11

摘要：

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。

关键词: 髌骨置换, 全膝关节置换术, 膝前痛发生率, 再手术率, kSS评分, 患者满意度, Meta分析

Abstract:

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: In accordance 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.

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