人工全膝关节置换术中髌骨置换与否疗效的比较分析

A analysis on the effect of with or without patellar replacement in total knee arthroplasty

目的 比较全膝关节置换术中髌骨置换与否在膝关节临床评分、膝关节功能评分、术后膝前痛发生率3方面的差异,为手术方式的选择提供依据.方法 计算机检索中国知网、PubMed、ScienceDirect、Highwire等数据库1998-2010年有关人工全膝关节置换术髌骨置换与否的随机对照试验（RCT）,评价纳入研究的方法学质量后,提取有效数据,采用Review Manager 4.2软件进行Meta分析,以膝关节临床评分、膝关节功能评分及术后膝前痛发生率作为评价指标.结果 共13篇文献纳入分析,其中9篇用于膝关节临床评分、膝关节功能评分的分析,9篇用于术后膝前痛的分析,共1362例膝关节.Meta分析结果示：置换组与不置换组比较膝关节临床评分（WMD=-0.49,95％ CI：-1.79～0.81,P=0.46）、膝关节功能评分（WMD=1.10,95％ CI：-1.77～3.98,P=0.45）差异均无统计学意义；置换组术后膝前痛发生率比非置换组发生率显著降低（RR =0.78,95％ CI：0.61～0.99,P=0.04）.结论 髌骨置换与否在膝关节临床评分、膝关节功能评分无明显差异,髌骨置换可以降低膝前痛的发生.

Objective To evaluate the outcome of total knee arthroplasty with or without resurfacing of the patella with particular attention to knee score,knee function score and incidence of postoperative anterior knee pain,providing the basis for the choice of surgical procedure.Methods CNKI,PubMed,ScienceDirect,Highwire and other databases were searched for the randomized controlled trials relevant to the patellar with or without replacement in total knee replacement arthroplasty between 1998 and 2010,evaluating of the methodological quality of included studies and extracting valid data.Results The 80 citations were identified as related to patellar resurfacing during total knee arthroplasty,13 articles meet all inclusion criteria for this study.The incidence of postoperative anterior knee pain is greater in knees without replaced patellas（RR =0.78,95% CI：0.61-0.99,P =0.04）.No differences are observed between the 2 groups for knee score and knee function score.Knee score（WMD =-0.49,95% CI：-1.79-0.81,P =0.46）,knee function score（WMD=1.10,95% CI：-1.77-3.98,P=0.45）.Conclusions The patella replacement can significantly reduce the incidence of postoperative anterior knee pain.There is no difference in the knee score and knee function score between two groups.