同期与分期双膝关节置换术后死亡率的Meta分析

Mortality following simultaneous bilateral or staged bilateral total knee arthroplasty： a meta-analysis

目的比较同期双膝关节置换术与分期双膝关节置换术的术后死亡率，评价同期与分期双膝关节置换术的安全性。方法参照Cochrane协作网（cochrane musculoskeletal group）建议的检索策略，计算机检索PubMed（1990至2010年）、OVID MEDLINE（1990至2010年）和Cochrane图书馆查找有关同期双膝关节置换术与分期双膝关节置换术术后并发症的临床研究。英文检索词包括：bilateral total knee arthroplasty、staged total knee arthroplasty、total knee arthroplasty等。由两名评价者独立选择实验，提取有效数据，采用Stata10．0软件进行Meta分析。结果最终纳入6篇文献，同期双膝关节置换术组死亡率[OR=2．925，95％CI（2．352，3．638）]、30天死亡率[OR=5．078，95％CI（2．192，11．763）]及高龄患者（年龄〉70岁）死亡率[OR=4．087，95％CI（1．947，8．582）]与分期双膝关节置换术组相比，均明显增高。结论现有的有限证据表明，同期双膝关节置换术术后死亡率高于分期双膝关节置换术。对于术前存在高风险（如高龄）的患者，宜考虑采用分期双膝关节置换术，慎重选择同期双膝关节置换术，并应充分评估手术风险，积极预防术后并发症的发生。受纳入文献数量和质量的限制，Meta分析结果尚有待于高质量的大样本随机对照试验以予证实。

Objective To evaluate mortality associated with simultaneous bilateral or staged bilat- eral TKA, and better understand the risks involved in the simultaneous versus staged bilateral procedures. Methods A systematic review was conducted, following an a priori protocol, according to the methods rec- ommended by the Cochrane Muscaloskeletal Group in the Cochrane Collaboration. Eligible studies were i- dentified in PubMed （1990-2010）, OVID MEDLINE （1990-2010）, and the Cochrane library, concerning postoperative complications of bilateral or staged bilateral total knee arthroplasty. All of the English-lan- guage abstracts were obtained, and retrieval words including bilateral total knee arthroplasty, staged total knee arthroplasty, and total knee arthroplasty, etc. An extensive analysis was then performed to identify arti- cles fulfilling the inclusion criteria for the study. The details of the reported data were extracted and evalu- ated by two reviewers independently. Data analyses were conducted with Stata 10.0. Results Six studies met our inclusion criteria for review. The combined results showed that the prevalence of mortality [OR= 2.925, 95% CI （2.352, 3.638）], mortality 30 days postoperatively [OR=5.078, 95% CI （2.192, 11.763）] and mortality in 70 years or older patients [OR=4.087, 95% CI （1.947, 8.582）] were statistically higher in the population that had undergone simultaneous TKA compared with staged TKA. Conclusion Compared with staged bilateral TKA, simultaneous bilateral TKA might carries a higher potential risk of postoperative mor- tality. Patients should be aware of this information when deciding whether to proceed with simultaneous bi- lateral TKA. Further well-designed and large-scale randomized controlled trials are required to confirm these findings.