活动平台与固定平台假体全膝关节置换术疗效的Meta分析

A Meta-analysis of clinical outcome after mobile-bearing versus fixed-bearing for knee arthroplasty

目的对采用活动平台或固定平台假体膝关节置换术的疗效差异进行Meta分析。方法检索Ovid Medline和Pub Med（1966年至2008年6月），Embase（1980年至2008年6月），Cochrane Central Register of Controlledriftals（2008年）和中国生物医学文献数据库（1990至2008年），搜集全部有关活动平台和固定平台假体膝关节置换术疗效差异的随机对照研究，采用RevMan4．2．10统计软件进行Meta分析。结果纳入前瞻性随机对照研究9篇，英文文献8篇、德文文献1篇。Meta分析结果显示采用活动平台假体与固定平台假体两组术后膝关节最大屈曲度差异有统计学意义，加权均数差值-1．63，95％置信区间[-2．51，-0．74]，P=0．0003；术后膝关节KSS评分（加权均数差值-0．25，95％置信区间[-1．09，0．59]，P=0．56）、髌骨倾斜率（风险差0．01，95％置信区间[-0．02，0．03]，P=0．64）、假体周围放射透光影率（相对危险度0．88，95％置信区间[0．61，1．29]，P=0．52）、膝关节翻修率（风险差0．01，95％置信区间[0．00，0．03]，P=0．12）差异无统计学意义。结论早、中期随访结果显示，活动平台与固定平台的术后膝关节最大屈曲度差异有统计学差异，但活动平台平均仅增加1．6°，无明显临床意义。在膝关节评分、髌骨轨迹、假体周围放射透光影、膝关节翻修等方面活动平台没有明显优势，但却存在易脱位的风险。

Objective To evaluate the differences of clinical effects between mobile-bearing （MB） and fixed-bearing （FB） for knee arthroplasty using the method of Cochrane systematic review. Methods Randomized controlled trials （RCTs） on differences of clinical effects of MB or FB were identified from Ovid Medline, PubMed （1966-2008.6）, Embase （1980-2008.6）, Cochrane Central Register of Controlled Trials （2008） and CBM （1990-2008）. All the proofs that demonstrated these issues as the RCTs were included. RevMan 4.2.10 software was used for Meta-analysis. Results Nine prospective RCTs had average 1-7.5 years follow-up, which involving 8 English and 1 German papers. The combined results of Meta-analysis indi- cated that there was statistical difference between two groups on post-operative maximum knee flexion （WMD=-1.63, 95%CI [-2.51, -0.74], P=0.0003）. Others indicated that there were no statistical differences with respect to knee society score（WMD=-0.25, 95%C1 [-1.09, 0.59], P=0.56）, patellar tilt （RD=0.01, 95% CI [-0.02, 0.03], P=0.64）, radiological lucency around prostheses （RR=0.88, 95%CI [0.61, 1.29], P=-0.52） and revisions of knees （RD=0.01, 95%CI [0.00, 0.03], P=0.12）. Conclusion Short and median follow-up indicated that although MB has statistical difference with FB on post-operative maximum flex degree of knee, but it only increase average 1.6°, and has no major clinical significance. Furthermore, there are also no major differences on knee society score, patellar track, radiological lucency around prostheses and revisions of knee, but MB has a risk of bearing dislocation.