移动平台型假体与固定平台型假体全膝置换术治疗膝关节炎疗效的Meta分析

Meta-analysis on clinical outcomes comparison of mobile-bearing and fixed-bearing total knee arthroplasties for knee arthritis

目的用Meta分析方法对移动平台型全膝关节置换术（mobile-bearing TKA）与固定平台型全膝置换术（fixed-bearing TKA）术后疗效进行系统评价的文献近期未见有发表,本文即用Meta分析方法对使用两种假体全膝关节置换术术后两年以上的疗效进行评价。方法检索关于移动平台型全膝关节置换术和固定平台型全膝关节置换术病例对照的相关文献,按照特定的纳入和排除标准选择文献并提取数据,用Review Manager5.0软件对数据进行meta分析。结果最终共纳入12篇随机对照研究（Jadad评分均在3~5分之间）。数据分析结果显示,应用两组假体的临床疗效在KSS-膝关节评分[MD=0.76,95%CI（-0.07,1.69）,P=0.07]、SF-12生命质量生理评分[MD=-0.16,95%CI（-2.15,1.83）,P=0.88]和SF-12生命质量心理评分[MD=0.64,95%CI（-1.28,2.57）,P=0.51]方面的差别无统计学意义,而在KSS-膝功能评分[MD=3.26,95%CI（1.39,5.13）,P=0.0006]和关节活动度[MD=2.68,95%CI（1.73,3.61）,P〈0.00001]方面的差别有统计学意义。结论本Meta分析发现,使用移动平台型假体全膝置换术后,能在一定程度上提高患者的KSS-膝功能评分和关节活动度,但并不能提高患者KSS-膝关节评分、SF-12生命质量生理和心理方面评分。

Objective To compare the therapeutic effects of mobile-bearing total knee arthroplasty（ TKA） and fixed-bearing TKA at a minimum follow-up of two years by meta-analysis. Methods The randomized controlled trials of comparison of mobile-bearing TKA and fixed-bearing TKA were searched and the data were extracted according to the inclusion and exclusion criteria. The extracted data were analyzed by Review Manager 5. 0. Results Twelve randomized controlled trials（ Jadad score： from 3 to 5） were eligible for meta-analysis. There was no statistically significant difference in the knee society knee score[MD = 0. 76,95% CI（- 0. 07,1. 69）,P = 0. 07],the SF- 12 physical score[MD =- 0. 16,95% CI（- 2. 15,1. 83）,P = 0. 88]and the SF- 12 mental score[MD = 0. 64,95% CI（- 1. 28,2. 57）,P =0. 51]. However,the differences in the knee society function score[MD = 3. 26,95% CI（ 1. 39,5. 13）,P = 0. 0006]and the range of motion（ ROM） [MD = 2. 68,95% CI（ 1. 73,3. 61）,P 0. 00001]were significant. Conclusion This meta-analysis discovers that using rotating-platform prosthesis can improve knee society function score and ROM of the patient,but not the knee society knee score,SF- 12 physical and mental score.