膝内侧单髁置换两种假体胫骨组件的荟萃分析

Comparison of all-polyethylene versus metal-backed tibial components in medial unicompartmental knee arthroplasty: a meta-analysis

[目的]采用循证医学的方法评价膝内侧单髁置换全聚乙烯胫骨组件(all-polyethylene prosthesis,AP)与金属背托组件(metal backed prosthesis,MB)的临床疗效。[方法]收集2018年10月以前发表的比较膝关节内侧单髁假体MB与AP的随机对照或非随机回顾性对照研究,对两种胫骨组件假体置换术后膝关节活动度、股骨胫骨角、并发症、再手术率、Kaplan-Meier生存分析等指标进行统计学分析。[结果]共9项研究,涉及1139病人,1169侧膝内侧单髁置换符合纳入标准列入本研究。AP组和MB组在术后活动度和股骨胫骨角的差异均无统计学意义(P>0.05);但AP组术后持续疼痛率、再手术率高于MB组,而AP组生存率低于MB组(P<0.05)。两组在外侧间室骨关节炎进展、胫骨平台骨折、假体下沉、假体磨损率的差异均无统计学意义(P>0.05)。在平均随访时间小于5年的对比研究中,AP组持续疼痛率、假体松动和再手术率均高于MB组(P<0.05)。在平均随访时间大于5年的对比研究中,AP组持续疼痛率显著高于MB组(P<0.05),而两组间假体松动、再手术率、外侧间室骨关节炎进展率、假体磨损率差异均无统计学意义(P>0.05)。[结论]本研究结果表明:AP假体的术后持续疼痛发生率、假体松动率、总并发症率和再手术率高于MB假体,而AP假体的生存率低于MB假体。

[Objective]To compare the clinical outcomes of all-polyethylene(AP)versus metal-backed(MB)tibial components in medial unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee.[Methods]To retrieve the comparative study of the randomized control trials and non-randomized controlled retrospective studies on AP and MB published before October 2018,the complications and postoperative function score were systematically analyzed.[Results]A total of 9 studies involving 1139 patients and 1169 knees met inclusion criteria were enrolled into this study.As result of the metaanalysis,no statistically significant differences were proved in the postoperative range of motion,femoral-tibial angle between the AP and MB groups(P>0.05).In addition,the incidence of persistent pain after operation and reoperation rate were significantly higher in AP group than the MB group,whereas the survival rate of AP group was significantly lower than the MB group(P<0.05).There were no significant differences in osteoarthritic progression of lateral compartment,tibial plate fracture,prosthesis subsidence and polyethylene wear between the two groups(P>0.05).In term of studies with follow-up period less than 5 years,the AP group had significantly higher persistent pain rate,aseptic loosening and reoperation rate than the MB group(P<0.05).In term of studies followed up period more than 5 years,the AP group had significantly higher persistent pain rate than the MB group(P<0.05),despite of no statistically significant differences in aseptic loosening,reoperation rate,osteoarthritic progression and prosthesis wear rate between them(P>0.05).[Conclusion]According to results of this meta-analysis,the AP prosthesis has higher incidence of postoperative persistent pain,aseptic loosening,complication and reoperation rate,whereas lower survival rate than the MB prosthesis.