全膝关节置换术后获得性低位髌骨的系统评价

Meta-analysis on patellar baja following total knee arthroplasty

目的评价不同机制及干预措施在全膝关节置换术后发生低位髌骨的发生率。方法电子检索英文数据库:PUBMED、Cochrane Library、OVID、Springer-link;中文数据库中国知识资源总库(CNKI)、万方学术期刊数据库、维普中文期刊数据库(VIP)、中国生物医学文献服务系统(CBM)等作为资料来源,检索时间均从建库至2013年10月。评价纳入研究的质量,提取数据用Revman 5.1软件进行Meta分析。结果共纳入7个对照试验,615例患膝。合并结果表明,术前胫骨高位截骨与非胫骨高位截骨患者行全膝关节置换后低位髌骨的发生率相当[RD=0.19,95%CI(-0.30,0.69)]。术后髌腱短缩5%或10%诊断为获得性低位髌骨,避免髌骨外翻有利于减少低位髌骨的发生[RD=-0.23,95%CI(-0.35,-0.11)],[RD=-0.09,95%CI(-0.17,-0.00)]。不同干预措施术后Insall-Salvati指数比较无统计学差异。结论 TKA中避免髌骨外翻及髌下脂肪垫切除可能利于减少TKA术后低位髌骨的发生。尚不足证据证明术前行胫骨高位截骨及TKA术中髌骨置换与否对术后发生低位髌骨的优劣。

Objective To evaluate the prevalence of patella baja after total knee arthroplasty （ TKA） using different surgical techniques .Methods Database such as PUBMED , Cochrane Library , OVID, Springer-link, CNKI, VIP, Wanfang and CBM , ect, were searched from the date of their＆amp;nbsp;establishment to October 2013.The quality of the included studies was evaluated , and the meta-analysis was conducted with RevMan 5.1 software.Results Two RCTs and four CCTs involving 533 knees were included .The meta-analysis showed that the result of patellar baja following the TKA with or without prior high tibial osteotomy （HTO） was no significant difference [RD=0.19,95%CI （ -0.30,0.69）].The patellar position was measured by the Insall-Salvati ratio , which showed no significant difference among different surgical techniques .Conclusions Avoiding infrapatellar fat pad excision and patella eversion in TKA may result in a decreasing percentage of postoperative patella baja .The present studies suggest that whether prior HTO or resurfacing the patella is performed has no significant negative effect on the patella baja following TKA .