髌骨置换与否对全膝关节置换术疗效影响的Meta分析

Patellar resurfacing versus non-resurfacing in total knee arthroplasty:a meta-analysis

[目的]系统评价髌骨置换与不置换髌骨的全膝关节置换术的术后疗效。[方法]收集1966～2010发表的所有比较髌骨置换与不置换髌骨全膝关节置换后疗效的随机对照试验,对其逐个进行质量评价,提取关于置换后再手术率、前膝痛发生率、患者满意率及各种评分系统测评的膝关节评分的改善,并作系统评价。[结果]11个随机对照试验共纳入1473例膝,置换髌骨与未置换组的再次手术率差异有显著性意义(相对危险度=0.54,95%可信区间为0.35～0.84);未置换髌骨组再次接受手术的概率比较大。置换髌骨与未置换组的置换后前膝疼痛发生率差异有显著性意义(相对危险度=0.53,95%可信区间为0.39～0.71)。置换髌骨与未置换组的术后患者满意率差异无显著性意义(相对危险度=1.14,95%可信区间为0.74～1.76)。置换髌骨与未置换组的术后KSS评分差异无显著性意义(加权均数差=1.15,95%可信区间为-0.23～2.53)。[结论]置换髌骨的全膝关节置换术中,远期随访再手术率、置换后前膝痛发生率低于未置换髌骨组,患者满意率及置换后膝关节KSS评分方面,两种髌骨处理方式无显著性差异。由于纳入文献质量差异较大,对此结论的解释应保持谨慎。

[Objective] To compare the effects of total knee arthroplasty performed with patellar resurfacing or nonresurfacing by meta-analysis.[Method]Randomized clinical controled trials relevant to total knee arthroplasty with or without natellar resurfacing published between 1966 and 2010 were collected.The quality of the trials was assessed.The outcome data including the prevalence of reoperations,postoperative anterior knee pain,patient satisfaction,and the improvement in various knee scores were extracted and reviewed systematically.[Result]A total of 1473 knees were included in the 11 published trials,including 842 knees in the resurfaced group and 889 in the nonresurfaced group.There was significant difference between the patella resurfaced and nonresurfaced groups in reoperation rate（relative risk=0.54,95% CI-0.35～0.84）,whereas the reoperation rate in the nonresurfaced group was significantly greater than in resurfaced group.On the prevalence of postoperative anterior knee pain,there was significant difference between two groups（relative risk=0.53,95%CI-0.39～0.71）.No significant difference was found in patient satisfaction （relative risk=1.14,95%CI-0.74～1.76）.There was no significant difference between the resurfaced and nonresurfaced groups in the KSS scores（weighing mean difference：1.15,95%CI -0.23～2.53）.[Conclusion]The long-term rate of reoperations and postoperative anterior knee pain in total knee arthroplasty performed with patellar resurfacing was lower than that with patellar nonresurfacing.There were no significant differences in patient satisfaction,and improvement in various knee scores between patella resurfaced and nonresurfaced groups.The results of this systematic review should be explained prudently because of some limitations of included trials.