关节镜下清理术改善膝关节骨关节炎患者临床症状有效性的Meta分析

Alleviation of clinical symptom after arthroscopic debridement for knee osteoarthritis: a meta-analysis

目的以膝关节Lysholm评分为基准研究膝关节清理术对KOA的早中晚期疗效的随访及对膝骨关节炎的分级治疗的临床疗效。方法通过搜集CNKI、维普数据库与万方数据库相关的近8年的文献,查找所有关节镜下清理术治疗KOA的病例回顾性研究,检索时限均从2006-2014年。由2位研究者按照纳入和排除标准独立筛选文献、提取资料并评价质量后,采用Rev Man 5.0软件及Stata SE12.0对提取的数据进行统计学分析。结果共纳入23个病例回顾性研究,Meta分析结果显示:关节镜清理术对膝骨关节炎临床症状的缓解效果,在术后第1个月[MD=4.53,95%CI(3.65,5.42),P<0.000 01]、3[MD=4.53,95%CI(3.65,5.42),P<0.000 01]及6[MD=6.05,95%CI(4.23,7.87),P<0.000 01]时评分与术前评分比较差异有统计学意义;术后第3个月与第6个月时的评差异无统计学意义[MD=0.26,95%CI(-1.09,1.60),P<0.000 01],但两者与术后第1个月时的评分差异有统计学意义[MD=2.60,95%CI(0.17,5.02),P<0.000 01,MD=2.67,95%CI(0.13,5.20),P<0.000 01];关节镜清理术对Kellgren-Lawrance(K-L)分级I、Ⅱ、Ⅲ级的KOA患者的临床症状均有改善,因骨关节炎病程的继续,随着随访时间的延长术前及术后Lysholm评分的差异逐渐减少。结论关节清理术对KOA患者临床症状的改善有积极意义。受纳入研究数量和质量限制,上述结论尚需开展更多高质量的随机对照试验加以验证。

Objective To systematically evaluate the effectiveness of arthroscopic debridement for knee os-teoarthritis （KOA） in the middle and late stage and Ⅰ, Ⅱ, Ⅲ grade KOA that graded by Kellgren-Lawrance （K-L） Grade based on the Lysholm score. Methods Databases including CNKI, PubMed, Cochrane, WeiPu and WanFang Data base were searched to collect randomized controlledtrials （RCTs） or retrospective study of the Lysholm score be-fore and after arthroscopic debridementin treating KOA from 2006 to 2014. Two reviewers independently screened lit-erature according to inclusion criteria and exclusion criteria, evaluated quality, and extracted data. Then the meta-anal-ysis was conducted using RevMan5.0 software and StataSE12.0 software. Results A total of 23 studies were includ-ed. The results of meta-analyses showed that there was significant difference on the Lysholm score at the end of the first [MD=4.53, 95%CI （3.65, 5.42）, P〈0.000 01], third [MD=4.53, 95%CI （3.65, 5.42）, P〈0.000 01] and the sixth [MD=6.05, 95%CI （4.23, 7.87）, P〈0.000 01] month after the arthroscopic debridement compared to that before the sur-gery. And the difference on the Lysholm score at the end of the third and the sixth month was of no significance [MD=0.26, 95%CI （-1.09, 1.60）, P〈0.000 01]. However, compared to the Lysholm score at the end of the first month, the treatment effect at the end of the third and the sixth month was more significant [MD=2.60, 95%CI （0.17, 5.02）, P〈0.000 01 MD=2.67, 95%CI （0.13, 5.20）, P〈0.000 01]. The arthroscopic debridement had therapeutical effect on I,Ⅱ,Ⅲ grade KOA that graded by K-LGrade. Due to the disease progress, the difference on the Lysholm score between preoperation and postoperation faded as the follow-up continued. Conclusion Arthroscopic debridement has thera-peutic effects on KOA. Due to the limited quantity and quality of the included studies, this conclusion needs to be proved by more high quality RCTs.