全膝关节置换翻修术的Meta分析

Revisions of total knee arthroplasty:A Meta analysis

目的通过对已报道的全膝关节置换翻修术文献进行总结分析,讨探膝关节置换翻修术前后的膝关节功能、翻修的主要原因、主要并发症及不同假体的术后疗效。方法按照以下标准收集和分析有关全膝关节置换翻修术的文献:①1990年至2002年间发表,②报告患者数大于10例,③采用通用的膝关节评分标准。一名骨科专科医生独立收集数据,一名医学统计学专家独立采用Meta统计方法分析数据。结果共有33篇符合条件的文献被收集。患者共1356例,其中男429例,女611例(部分文献性别分类数据缺失),平均年龄67岁(45～90岁),加权平均随访时间57个月(6～108个月),加权平均术前膝关节功能总评分为49分(15～84分),术后为84分(58～109分),全膝关节置换翻修术前后的总评分、功能评分、活动范围等有显著性提高,差异有统计学意义(总评分:t=12.507,P<0.01,功能评分:t=4.704,P<0.01,活动范围:t=5.346,P<0.01)。全膝关节置换翻修术的原因主要是假体松动(55%),其它包括聚乙烯磨损(11%)、假体不稳(10%)、感染(7%)。翻修术后的主要并发症仍然为假体松动(18%),其它包括假体不稳(16%)、感染(16%)、髌骨问题(15%)及不明原因的膝关节疼痛(13%)。髌骨问题包括髌骨脱位、半脱位、髌韧带撕裂、髌股关节疼痛等。结论可以认为膝关节置换后翻修术是一种安全有效的手术。假体松动是膝关节置换翻修的主要原因和并发症。

Objective The purpose of this study was to summarize the literature describing patient outcome following revision total knee arthroplasty. The study investigators agreed a priori on four questions of patient prognosis to be addressed in this review： （1） Is there significant difference between pre-operative and post-operative in knee scores, function scores and motion？ （2） What is the revision main indication？ （3） What is the main complication after revision surgery？ 4） Are the significant differences between various implants？ Methods Data sources, original studies were included in this meta-analysis if they enrolled 10 or more patients at the time of the revision total knee arthroplasty and measured patient outcome using a global knee rating scale from 1990 to 2002. One investigator, who had been educated in the data abstraction requirements, completed the data abstraction. One investigator, who is professional statistician, completed the data analysis independently. Resuits 33 studies were found. The total number of enrolled patients was 1356 with a mean enrolment of 41 pa- tients. There were 429 men and 611 women with a mean age of 67 years （range 45 to 90 years）. The weighted mean patient follow up time was 57 months （range 6 to 108 months）. The weighted mean preoperative and postoperative global rating scale knee scores were 49 （range 15 to 82） and 84 （range 58 to 109）. There were observably significant difference between pre-operative and post-operative in Knee scores, Function scores and Motion （Knee score： t = 12. 507, P 〈0.01, Function scores： t =4. 704, P 〈0. 01, Motion： t =5. 346, P 〈0. 01）. The main indication of revision was loosening（55% ）, and other reasons include polyethylene wear （ 11% ）, instability （10% ）, infection （7%）. The main complication after revision surgery was loosening also（ 18% ）, and included instability （16% ）, infection （16% ）, patellar failure（ 15% ）. The patellar failure includes patellar subluxation, patellar dislocation, patellar tendon avulsion, patellofemoral pain, and clunk. Conclusions The revision total knee arthroplasty was a safe and effective procedure for patients reported in these studies. Loosening was the main reason and main complication of the revision total knee arthroplasty.