Chinese Journal of Tissue Engineering Research ›› 2019, Vol. 23 ›› Issue (24): 3916-3923.doi: 10.3969/j.issn.2095-4344.1301
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Online:
2019-08-28
Published:
2019-08-28
Contact:
Chen Desheng, MD, Chief physician, First Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
About author:
Zhao Jiangbo, Master candidate, Physician, School of Clinical Medicine, Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
Supported by:
CLC Number:
Zhao Jiangbo, Tian Jianing, Li Yan, Chen Desheng.
2.3 Meta分析结果 2.3.1 假体生存率 纳入研究中7个研究均报道了假体生存率[11-17]。非骨水泥组382例,骨水泥组361例,共743例。异质性检验结果显示,P=0.78,I2=0%,因此选取固定效应模型进行合并,分析结果显示,非骨水泥固定和骨水泥固定假体生存率差异无显著性意义[RR=1,95%CI(0.98,1.02),P=0.90],见图2。 由于随访时间的长短和假体生存率关系密切,故依据各研究平均随访时间的不同进一步分为3个亚组,分别是短期(2年)、中期(5年)、远期(5-16年)。其中有3个研究平均随访时间为2年[13-14,17],共229例,异质性检验结果显示,P=0.46,I2=0%,因此选取固定效应模型进行合并,分析结果显示,术后2年时非骨水泥固定和骨水泥固定假体生存率差异无显著性意义[RR=1.02,95%CI(0.96,1.07),P=0.55],见图3。有1个研究平均随访时间为5年[11],共86例,分析结果显示,术后5年时非骨水泥固定和骨水泥固定假体生存率差异无显著性意义[RR=0.99,95%CI(0.93,1.05),P=0.77],见图4。有3个研究平均随访时间为5年以上(5-16年)[12,15-16],共346例,异质性检验结果显示,P=0.96,I2=0%,因此选取固定效应模型进行合并,分析结果显示,术后5年以上(5-16年)非骨水泥固定和骨水泥固定假体生存率差异无显著性意义[RR=0.99,95%CI(0.96,1.01),P=0.31],见图5。 2.3.2 美国膝关节协会评分 纳入研究中有5个研究报道了美国膝关节协会评分[12-16]。共567例。异质性检验结果显示,P=0.07,I2=54%,因此选取随机效应模型进行合并,分析结果显示,非骨水泥固定和骨水泥固定美国膝关节协会评分差异无显著性意义[MD=0.28,95%CI(-1.04,1.61),P=0.68],见图6。"
其中有2个研究报道了术后2年时美国膝关节协会评 分[13-14],共139例,异质性检验结果显示,P=0.39,I2=0%,因此选取固定效应模型进行合并,分析结果显示,术后2年时骨水泥固定美国膝关节协会评分优于非骨水泥固定,差异有显著性意义[MD=-3.26,95%CI(-6.37,-0.15),P=0.04],见图7。有3个研究报道了术后10年以上时美国膝关节协会评分[12,15-16],共428例,异质性检验结果显示,P=0.45,I2=0%,因此选取固定效应模型进行合并,分析结果显示,术后10年时非骨水泥固定美国膝关节协会评分优于骨水泥固定,差异有显著性意义[MD=0.86,95%CI (0.04,1.68),P=0.04],见图7。 2.3.3 WOMAC骨关节炎指数 纳入研究中有3个研究报道了WOMAC骨关节炎指数(评价时间为末次随访,平均为10年以上)[12,15-16],共424例,异质性检验结果显示,P=0.76,I2=0%,因此选取固定效应模型进行合并,分析结果显示,非骨水泥固定和骨水泥固定WOMAC骨关节炎指数差异无显著性意义[MD=1.63,95%CI(-0.17,3.43),P=0.08],见图8。"
2.3.4 关节活动度 纳入研究中有2个研究报道了关节活动度(评价时间为末次随访,平均为10年以上)[15-16],共260例,异质性检验结果显示,P=0.68,I2=0%,因此选取固定效应模型进行合并,分析结果显示,非骨水泥固定关节活动度优于骨水泥固定,差异有显著性意义[MD=3.46,95%CI(1.12,5.80),P=0.004],见图9。 2.3.5 失血量 纳入研究中有2个研究报道了失血量(术中出血+引流量)[15-16],共260例,异质性检验结果显示,P < 0.000 01,I2=95%,因此选取随机效应模型进行合并,分析结果显示,非骨水泥固定和骨水泥固定失血量差异无显著性意义[MD=408.52,95%CI(-102.18,919.22),P=0.12],见图10。 2.3.6 关节感染 纳入研究中有6个研究报道了关节感染(包括早期感染和迟发感染)[11,13-17],共575例,异质性检验结果显示,P=0.65,I2=0%,因此选取固定效应模型进行合并,分析结果显示,非骨水泥固定和骨水泥固定关节感染发生率差异无显著性意义[RR=0.97,95%CI(0.34,2.73),P=0.95],见图11。 2.3.7 透亮线 纳入研究中有4个研究报道了透亮线(评价标准为1 mm,评价时间2年及2年以上)[12-13,15-16]。共522例。异质性检验结果显示,P=0.18,I2=38%,因此选取固定效应模型进行合并,分析结果显示,骨水泥固定在透亮线方面优于非骨水泥固定,差异有显著性意义[RR=1.67,95%CI(1.14,2.46),P=0.009],见图12。"
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