中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (12): 1924-1929.doi: 10.3969/j.issn.2095-4344.3791

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

全膝置换应用固定平台与活动平台假体疗效随访比较的Meta分析

汪  鑫1，林晓东1，刘洪亮2，黄泽鑫2，许树柴2，陈伯健2    

  1. 1广州中医药大学第二临床医学院，广东省广州市   510405；2广州中医药大学第二附属医院骨科，广东省广州市   510120
  • 收稿日期:2020-05-23 修回日期:2020-05-27 接受日期:2020-07-06 出版日期:2021-04-28 发布日期:2020-12-26
  • 通讯作者: 陈伯健，硕士，副主任医师，广州中医药大学第二附属医院骨科，广东省广州市 510120
  • 作者简介:汪鑫，男，1995年生，湖北省大冶市人，汉族，广州中医药大学在读硕士，主要从事关节与运动医学损伤方面的研究。

Fixed-bearing prosthesis versus mobile-bearing prosthesis during total knee arthroplasty for different follow-up periods: a meta-analysis

Wang Xin1, Lin Xiaodong1, Liu Hongliang2, Huang Zexin2, Xu Shuchai2, Chen Bojian2   

  1. 1Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 2Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
  • Received:2020-05-23 Revised:2020-05-27 Accepted:2020-07-06 Online:2021-04-28 Published:2020-12-26
  • Contact: Chen Bojian, Master, Associate chief physician, Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
  • About author:Wang Xin, Master candidate, Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China

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摘要：

文题释义：
固定平台假体：是传统全膝关节置换的主流设计，经过不断改进，在临床上获得了长期大量的成功经验，在临床上运用广泛，然而随着时间的延长，聚乙烯垫片的磨损以及假体松动等问题逐渐引起人们的重视。
活动平台假体：近些年来通过研究正常膝关节运动力学特点产生的设计，从理论上讲，相比于固定平台假体，能在有效关节活动范围的前提下保证屈伸时胫股关节间高匹配低压力接触，降低聚乙烯垫片磨损，减少假体松动的可能性，现在临床上逐渐流行。

目的：全膝关节置换是目前治疗老年人膝关节骨关节炎的最成功的方法之一，与固定平台假体相比，活动平台假体有减少假体磨损、增加活动度等理论优势，但临床多数研究发现两者间并无明显差异。文章通过Meta分析评价全膝关节置换中采用固定平台和活动平台假体的疗效差异。
方法：文献检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、EMBase、Cochrane Library等数据库，严格按照入组标准筛选文献，收集全膝关节置换患者应用固定平台和活动平台疗效对比的高质量的随机对照研究。采用Cochrane协作网手册评价偏倚风险工具及改良Jadad评分量表对文献质量进行质量评价，依据主要结局指标的膝关节KSS膝评分、膝关节KSS功能评分和次要结局指标的膝关节活动度、Oxford膝评分、翻修率提取文章相关资料，采用RevMan 5.3软件进行数据分析。
结果：纳入15篇符合要求的随机对照试验。按照改良Jadad评分量表进行评分，得分6分的文献4篇，得分5分的文献10篇，4分的文献1篇，其中固定平台组1 277例，活动平台组1 244例。Meta分析结果显示：①采用活动平台假体与固定平台假体相比较在短期随访(<5年)的亚组中，在KSS-膝评分、膝关节活动度、Oxford膝评分、翻修率等方面差异无显著性意义(P > 0.05)，而在KSS-功能评分方面活动平台组优于固定平台组(MD=-2.26，95%Cl：-4.71至-0.34，P=0.02)；②在中长期随访(≥5年)的亚组中，两者在KSS-膝评分、KSS-功能评分及翻修率方面差异无显著性意义(P > 0.05)，而在膝关节活动度方面活动平台组优于固定平台组(MD=-3.60，95%Cl：-6.99至-0.21，P=0.04)。
结论：对于全膝关节置换而言，无论在短期还是中长期随访中，活动平台假体在绝大多数方面与固定平台假体临床疗效无显著性差异；但较弱的证据表明，活动平台膝关节假体置换后对膝关节功能的改善略优于固定平台假体，由于文章大多数文章为短中期随访，未来仍需开展更多高质量、大样本、多中心的随机对照试验来验证文章结论的可靠性。

关键词: 骨, 膝, 膝关节, 关节置换, 移动, 固定, 平台, Meta 分析, 随机对照实验

Abstract: BACKGROUND: Total knee arthroplasty is one of the most successful methods for treating knee osteoarthritis in the elderly. Compared with fixed-bearing prosthesis, mobile-bearing prosthesis has the theoretical advantages of reducing the wear of the prosthesis and increasing the range of motion. Most of the above studies found no significant difference between the two. 
OBJECTIVE: To evaluate the differences of clinical effects between fixed-bearing and mobile-bearing prosthesis in total knee arthroplasty through meta-analysis.  
METHODS: The databases of CNKI, Wanfang, VIP, CBM, PubMed, EMBase and Cochrane Library were systematically retrieved. The literature was strictly selected according to the inclusion criteria. We collected high-quality randomized controlled trials of total knee arthroplasty patients, who were operated with fixed-bearing or mobile-bearing prosthesis. The Cochrane Collaboration manual was used to evaluate the risk of bias and the modified Jadad score scale was utilized to evaluate the quality of the literature. The relevant data were extracted according to the primary outcome measures: Knee Society score, knee Knee Society score function score; and secondary outcome measures: range of motion, Oxford knee score and revision rate. The relevant data were analyzed with RevMan 5.3 software.  
RESULTS: Fifteen randomized controlled trials were eligible for meta-analysis. According to the modified Jadad rating scale, there were 4 articles with 6 points, 10 articles with 5 points and 1 article with 4 points. There are 1 277 samples in the fixed-bearing group and 1 244 in the mobile-bearing group. Meta-analysis results demonstrated that (1) there was no statistically significant difference in Knee Society score-knee score, range of motion, Oxford knee score, and revision rates between the two groups using fixed-bearing and mobile-bearing prostheses in the short-term follow-up (< 5 years) subgroup (P > 0.05). The Knee Society score-function score in the mobile-bearing group was superior to that in the fixed-bearing group (MD=-2.26, 95%Cl: -4.71 to -0.34, P=0.02). (2) In the subgroup of long-term follow-up (≥ 5 years), there was no significant difference between the two groups in Knee Society score-knee score, Knee Society score-function score, and revision rate (P > 0.05). Range of motion in the mobile-bearing group was better than that in the fixed-bearing group (MD=-3.60, 95%Cl: -6.99 to -0.21, P=0.04).
CONCLUSION: in total knee arthroplasty, whether in short-term follow-up or mid-to-long-term follow-up, mobile-bearing prosthesis is not much different from fixed-bearing prosthesis in most respects. However, there is weak evidence that the improvement of knee joint function after knee arthroplasty with mobile-bearing prosthesis is slightly better than that with fixed-bearing prosthesis. Most of the articles were followed up in short and medium terms. More high-quality, large-sample and multi-center randomized controlled trials are needed to verify the reliability of the conclusions.


Key words: bone, knee, knee joint, joint arthroplasty, mobile-bearing, fixed-bearing, platform, meta-analysis, randomized controlled trial

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