活动平台与固定平台内侧单髁膝关节置换术后疗效对比的Meta分析

Clinical outcomes comparison of mobile-bearing and fixed-bearing medial unicompartmental knee arthroplasties:a meta-analysis

目的对使用活动平台和固定平台膝关节内侧单髁假体置换术的疗效差异进行Meta分析。方法检索Ovid Medline和Pubmed(1966年至2013年3月)、Embase(1980年至2013年3月)、Cochrane Central Register of Controlled trials(2013年)和中国生物医学文摘数据库(1990年至2013年),检索全部有关活动平台与固定平台膝关节内侧单髁假体置换术后的疗效对比的随机或非随机对照研究,采用Revman 5.2统计软件进行Meta分析。结果纳入前瞻性随机对照研究3篇,回顾性对照研究4篇。因数据不足无法对术后临床结果,影像学及运动学评估进行Meta分析。两种假体术后聚乙烯衬垫磨损发生率(风险差0.11,95%可信区间[0.02,0.61],P<0.05)和衬垫脱位发生率(风险差7.10,95%可信区间[1.51,33.43],P<0.05)之间差异有统计学意义;手术翻修率(风险差1.05,95%可信区间[0.67,1.64],P>0.05)及其它翻修原因两种假体之间差异无统计学意义。影像学评估发现活动平台假体术后下肢力线通过中央区的例数明显高于固定平台假体(P<0.05),非正常的力线分布两种假体之间也存在明显差异(P<0.05)。结论本Meta分析发现活动平台与固定平台内侧单髁假体置换术后的临床结果和手术翻修率均无差异。两种假体术后聚乙烯衬垫磨损和衬垫脱位的发生率差异有统计学意义。活动平台假体在恢复下肢正常力线方面更有优势。

Objective To compare the clinical effects of mobile-bearing and fixed-bearing medial unicompartmental knee arthroplasty （UKA） using meta-analysis. Methods Randomized and non- randomized control trials of comparison studies on mobile-bearing and fixed-bearing medial unicompartmental knee arthroplasties were searched from Ovid Medline, PubMed （1966 -2013.3）, Embase （ 1980 - 2013.3 ）, Cochrane Central Register of Controlled Trials （ 2013 ） and CBM （ 1990 - 2013）. The statistical analysis was carried out by Revman 5.2. Results Three RCTs and four retrospective comparative studies were included. Clinical, radiological and kinematic outcomes were not analyzed because of lack of data. There was statistical difference between the two prostheses on the incidence of polyethylene wear （ risk ratio （RR） 0. 11,95% confidence interval （CI） 0.02 to 0. 61, P 〈 0. 05 ） and bearing dislocation （ RR 7. 10, 95% CI 1.51 to 33.43, P 〈 0. 05 ）. No difference was found in the revision rate （RR 1.05, 95% CI 0. 67 to 1.64, P〉O. 05） and other reasons for revision between the two prostheses. Radiologieal results showed higher rate of knee alignment passing through the central zone in the mobile-bearing UKA than in the fixed-bearing UKA postoperatively （ P 〈 0. 05 ）. Significant difference was also found in abnormal alignment distribution between the two prostheses （ P 〈 0. 05 ）.Conclusion This meta analysis found no difference in clinical outcomes and revision rate between mobile and fixed bearing medial unicompartmental knee arthroplasties. There was statistical difference between the two prosthese on the incidence of polyethylene wear and bearing dislocation. The mobile-bearing UKA is better at restoration of normal knee alignment than the fixed-bearing UKA.