全膝关节置换中应用旋转平台和固定平台假体效果的Meta分析

Effects of rotating platform prosthesis and fixed platform prosthesis applied in total knee replacement:A Meta analysis

背景:旋转假体是否优于固定假体学术界目前仍有争议。目的:全膝关节置换中应用旋转或固定平台型假体的临床结果比较,分析两类假体的疗效差异。方法:检索Medline、Embase、Cochranelibrary、中国生物医学文献数据库及相关参考文献,收集比较旋转和固定型假体全膝关节置换的随机对照试验,采用Cochrane的随机方法学评价文献质量,应用RevMan5.1.2进行Meta分析。使用GRADEproversion3.2.2软件对纳入研究进行证据评级。结果与结论:纳入10个随机对照试验,总共764例,置换旋转假体的实验组381例,置换平台假体的对照组383例。纳入研究的方法学偏倚均较低。术后疗效均较术前明显提高,组间比较的Meta分析结果显示,两组膝关节评分、关节活动度及置换后并发症、翻修率均未发现明显的统计学差异。结果显示,目前证据未能证明旋转平台假体优于固定平台假体,需要开展更多高质量的对照试验加以证实,但无论选择何种假体均有可能获得满意的临床效果。

BACKGROUND：Currently,whether rotating prosthesis is superior to fixed prosthesis is still unclear.OBJECTIVE：To compare the clinical outcomes of rotating platform prosthesis and fixed platform prosthesis applied in total knee replacement in order to analyze their different curative effects.METHODS：Relative articles were obtained from Medline database,Embase database,and China Biology Medicine disc.Randomized controlled trials（RCTs） about rotating and fixed platform prosthesis in total knee replacement were selected and compared.The quality of the included studies was assessed by the Cochrane＇s random methodology.RevMan 5.1.2 software was used for data analysis,and GRADEpro version 3.2.2 software was used for evidence rating of the included studies.RESULTS AND CONCLUSION：Totally 764 cases form 10 RCTs were involved.Of which 381 cases with rotating prosthesis replacement were taken as experimental group and 383 cases with platform prosthesis replacement were control group.The methodological bias involved in the study was lower,and the curative effect was improved.The Meta-analysis results compared between the two groups showed that there was no significant difference in the knee scores,ranges of motion and postoperative complications,as well as overhaul rates.The results show that the evidence cannot prove that rotating platform prosthesis is better than fixed platform prosthesis.More high-quality RCTs are needed to verify this.However,no matter which type of prosthesis can achieve satisfactory clinical effect.