Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (36): 5897-5904.doi: 10.12307/2021.360
Wan Dadi1,2, Duan Xiangrui1,2, Fan Xinchao1,3, Yuan Ye1,3, Huang Teng1, Pan Dikang2, Liu Jingyan2, Li Xicheng1
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
CLC Number:
Wan Dadi, Duan Xiangrui, Fan Xinchao, Yuan Ye, Huang Teng, Pan Dikang, Liu Jingyan, Li Xicheng. Efficacy of posterior cruciate ligament retaining versus posterior stabilized prostheses in total knee arthroplasty: a systematic review and a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(36): 5897-5904.
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2.3.3 各组术后1年膝关节屈曲角度差异 4项研究对术后1年膝关节活动度进行了比较[3-4,10-11],Meta分析森林图显示存在统计学异质性(I2=83%,P=0.000 7),首先查找异质性的来源,使用敏感性分析,剔除1篇文献后异质性下降最大但不明显(I2=80%)[10],且Meta分析的结果改变。阅读全文后,考虑与此篇文章研究的对象为日本人,使用的假体不同,而且样本量较少有关;同时此篇文献随访的时间最长,这些原因可能导致了研究的异质性大。所以使用随机效应模型,结果表明,全膝关节置换使用CR假体与PS假体相比,在术后1年的膝关节屈曲角更小(SMD=-0.62,95%CI:-1.20至-0.04,P=0.03),见图7。"
2.3.4 各组术后总失血量差异 共3项研究对术后总失血量进行了比较[3-4,8],Meta分析森林图显示存在统计学异质性(I2=74%,P=0.02),首先查找异质性的来源,使用敏感性分析,当剔除廖新根等[3]这篇文章时,异质性下降最明显(I2=11%),且Meta分析的结果发生改变。仔细阅读此篇文章后,考虑主要是与手术医师的熟练度、止血带使用的时间、引流管放置的位置以及术后应用低分子肝素预防下肢血栓有关,这些因素导致了文献的异质性偏大。故使用随机效应模型,结果表明,全膝关节置换使用CR假体比PS假体术后总失血量更少(WMD=-126.86,95%CI:-231.03至-22.69,P=0.02),见图8。"
2.3.5 各组术后3个月目测类比评分差异 共2项研究对术后目测类比评分进行了比较[4,6]。因为文献较少,故进行描述性分析。傅煊健等[6]对60例行全膝关节置换的膝关节炎患者进行了回顾性分析,其中30例使用CR假体,30例使用PS假体,随访3个月以上。结果表明,在术后3个月CR假体组的目测类比评分为(2.63±0.85)分,PS假体患者为(1.80±0.76)分,两者比较差异显著(P < 0.05)。张辉等[4]回顾性分析了60例行全膝关节置换的患者,其中30例使用CR假体,30例使用PS假体,随访5-16个月,结果术后3个月CR假体组患者的目测类比评分为(1.56±0.67)分,PS假体组患者为(1.66±0.71)分,两者比较无显著性差异(P > 0.05)。此2篇文献的结论不同,考虑主要与评估目测类比评分的人员、术者熟练度、术后止疼药应用的方式等不同有关[4,6]。 2.3.6 各组术后3个月HSS评分差异 共4项研究对术后3个月HSS评分进行了比较[2,4-6],Meta分析森林图显示存在统计学异质性(I2=63%,P=0.04),首先查找异质性的来源,进行敏感性分析,逐一剔除文献后发现在剔除傅煊健等[6]的研究时异质性改变最大(I2=0%),但Meta分析的结果未改变,说明结果较稳定。仔细阅读全文后,考虑主要是由于术者熟练度、HSS评分者、术后患者是否主动进行功能锻炼等原因造成的异质性。使用随机效应模型,结果表明,全膝关节置换使用CR假体与PS假体相比术后3个月HSS评分无显著性差异(WMD=-0.13,95%CI:-1.08-0.83,P=0.80),见图9。"
2.3.8 各组术后1年AKS膝功能评分差异 共2项研究对术后1年AKS膝功能评分进行了比较[3,7],因研究数较少,故行描述性分析。廖新根等[3]采用随机对照试验分析了80例行全膝关节置换的患者,其中40例PS假体,40例CR假体,随访一两年,结果表明术后1年AKS膝功能评分,在CR假体组为(76.3±7.5)分,在PS假体组为(75.2±8.2)分,差异无显著性意义(P > 0.05)。有1项随机对照试验对40例全膝关节置换患者进行了分析[7],包括20例PS假体,20例CR假体。术后2年的AKS膝功能评分在PS假体组为(76±28)分,在CR假体组为(73±24)分,差异无显著性意义(P > 0.05)。此2项研究的结果均表明术后AKS膝功能评分无显著性差异[3,7]。 2.3.9 各组总体并发症差异 共6项随机对照试验对术后总体并发症进行了比较[3,7,9-12],Meta分析森林图显示不存在统计学异质性(I2=0%,P=0.55),使用固定效应模型。结果表明,全膝关节置换使用CR假体与PS假体相比术后总体并发症无显著性差异(RR=0.72,95%CI:0.42-1.22,P=0.22),见图11。"
2.3.12 各组术后膝关节遗忘度差异 有1篇文献研究了术后膝关节遗忘度[4],侧重评估全膝关节置换后的患者在平时生活中遗忘膝关节假体存在的主观感觉,与平时医师做出的HSS、AKS等客观的膝关节评分不同。张辉等[4]回顾性分析了60例使用全膝关节置换的患者,随访5-16个月发现,术后3个月PS假体组与CR假体组患者的膝关节遗忘度评分无显著性差异(P > 0.05)。 2.3.13 各组术后膝关节KT-1000测量值变化 有1篇文献研究了术后KT-1000测量值[3],在患者屈膝30°时使用KT-1000 仪器进行测量,结果表明术后1年膝关节KT-1000 测量值在CR假体组为(3.7±1.75) mm,在PS假体组为(4.8±1.42) mm,两者的KT-1000测量值比较差异无显著性意义。 2.4 发表偏倚分析 以纳入研究最多的不良结局做漏斗图,均为随机对照试验,选用RR指标作为效应量,可见图形双侧不十分对称,可能有发表偏倚,见图14A。 再以主要结局指标之一的膝关节活动度做漏斗图,可见图形双侧不十分对称,可能有发表偏倚,见图14B。"
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