髌骨周围去神经化对保留髌骨的全膝关节置换术后影响的meta分析

Circumferential electrocautery of the patellar in primary total knee replacement without patella re- placement： a meta-analysis and systematic review

目的验证髌骨周围去神经化是否能改善保留髌骨的初次全膝关节置换术后。方法本研究通过检索MEDLINE、EMBASE、PubMed、Springer Link、Web of Knowledge、OVID CINAHL、OVID EBM等数据库，筛选2014年1月之前发表的文献。应用meta分析方法评价髌骨去神经化对于保留髌骨的全膝关节置换术后膝前痛及膝关节功能的影响，以说明去神经化在全膝关节置换术中的作用。结果本研究共纳入8篇随机对照文献，总病例数为1048例，其中去神经化组526例，对照组（未去神经化组）522例。Meta分析结果表明髌骨周围去神经化对保留髌骨的全膝关节置换术后膝前痛的发生率（P=0．18）及VAS评分（P=0．23）差异均无统计学意义。然而，Patellar评分（P=0．01）、WOMAC评分（P〈0．01）及术后膝关节活动范围（ROM）（P〈0．01）均显示髌骨去神经化可以明显改善保留髌骨的全膝关节置换术后膝关节功能。结论虽然髌骨去神经化没有明显改善保留髌骨的全膝关节置换术后膝前痛的发生，但是可以明显改善术后膝关节功能。因此笔者认为保留髌骨的全膝关节置换术中髌骨周围去神经化的处理可以明显改善患者术后。

Objective To identify and assess whether circumferential electrocautery is useful to improve outcomes after primary total knee replacement. Methods We searched MEDLINE, EMBASE, PubMed, SpringerLink, Web of Knowledge, OVID CINAHL, OVID EBM and Google Scholar, and included articles published through January 2014. This study used the methods of meta-analysis to assess whether circumferential electrocautery could improve anterior knee pain and knee function after total knee replace- ment, and identified the function of circumferential electrocautery in total knee replacement. Results A to- tal of eight articles met the inclusion criteria. Among the 1 048 cases included in the analysis, 526 cases had patellar denervation, and 522 cases were in the control group. The meta-analysis revealed no significant difference in the incidence of anterior knee pain （ P =0.18） and visual analogue scale （VAS） （ P = 0. 23） between two groups. However, patellar score （ P = 0. 01 ）, Western Ontario and McMaster Univer- sities osteoarthritis index （WOMAC） score （ P 〈 0. 01 ） , and range of motion （ROM） （ P 〈 0. 01 ） indi- cated that circumpatellar electrocautery improved clinical outcomes compared to non-electrocautery groups. Conclusions The results indicated that circumferential electrocautery of the patellar did not significantly improve anterior knee pain relative to non-electrocautery techniques. However, circumferential electrocau- tery significantly improved patients＇ knee function after surgery. Therefore, circumferential electrocautery might be beneficial to the outcome of primary total knee replacement surgery without patella replacement.