膝关节骨关节炎患者初次全膝关节置换术中选择髌骨置换的Meta分析

Patellar resurfacing or non-resurfacing in total knee arthroplasty for osteoarthritis:a meta-analysis

目的探讨膝关节骨关节炎(OA)进行初次全膝关节置换术(TKA)中选择髌骨置换与否的疗效,评价两种不同治疗选择的差异。方法检索Medline、Embase、Cochranelibrary、CBM,收集膝关节OA行初次TKA术中髌骨置换与否的临床对照试验,提取数据分析,采用RevMan5.0.18进行Meta分析。结果纳入8个前瞻性随机对照试验,共822例手术,其中髌骨置换组373例,髌骨非置换组444例。髌骨置换与非置换组比较,前膝痛与KSS评分均无明显的统计学意义(P>0.5),置换组的因髌股关节问题而再次手术率低于非置换组[RR=0.53,95%CI(0.29,0.96),P=0.04],但置换组再次手术的原因除了常见的前膝痛,还包括髌骨假体相关的并发症。结论膝关节OA的患者行初次TKA术中选择髌骨置换与否的前膝痛与KSS评分无明显的统计学意义,置换组的因髌股关节问题再次手术率低于非置换组,但置换组再次手术的复杂性大于非置换组。

Objective To compare the clinical effects between patellar resurfacing and non-resurfacing in total knee arthroplasty （TKA） for osteoarthritis （OA）.Methods The databases of Cochrane library,Medline,Embase and Chinese Biomedical Databases were searched online.All the trials comparing patellar resurfacing with non-resurfacing in TKA for OA were included.Methodology quality was assessed and the data of the complications within both groups was extracted.The Revman 5.0.18 software package was used for data-analysis.The major causes of the reoperations in the patellar resurfacing group including pain in anterior knee and the complications related to patellar component failure.Results Eight trials with 822 knees were included （373 patellar resurfacing/444 patellar non-resurfacing）.The Meta-analysis showed that there were no significant differences in Knee Society Clinical Scores and anterior knee pain between the two groups in at least two years follow-up （P〉0.5）,but reoperation rate for patellofemoral problems of the non-resurfacing group was significantly lower [RR=0.53,95%CI （0.29,0.96）,P=0.04].Conclusions Our results indicate that patellar resurfacing would reduce the risk of reoperation after total knee arthroplasty for OA,but it seems that the benefits are limited on Knee Society Clinical Scores and anterior knee pain,and the reoperations in the patellar resurfacing group are usually more difficult than the non-resurfacing group.