高屈曲膝假体与普通膝假体置换后膝关节屈曲度比较的Meta分析

Comparison of Knee Flexion Degree after High-flexion versus Standard Total Knee Arthroplasty: A Meta-analysis

目的通过Meta分析比较高屈曲膝假体与普通膝假体置换后膝关节屈曲度。方法检索Cochrane图书馆、Pub Med、EMbase、中国知网等数据库,检索时间为各数据库建库至2015年10月,收集所有比较高屈曲膝假体与普通膝假体置换后膝关节屈曲度的随机对照试验,比较两组间的膝关节屈曲度、膝关节功能评分及并发症发生情况。采用Rev Man 5.2.0软件进行Meta分析。结果共纳入21篇随机对照研究,包括2 158例患者。Meta分析结果显示:高屈曲假体组术后膝关节屈曲度稍高于普通假体组,差异有统计学意义[WMD=2.71°,95%CI(0.96,4.46)°,P=0.002],但排除6篇低质量文献行敏感性分析,高屈曲假体组术后膝关节屈曲度与普通假体组差异无统计学意义[WMD=0.72°,95%CI(-0.15,1.60)°,P=0.10];高屈曲假体组术后膝关节功能评分与普通假体组差异无统计学意义[WMD=-0.54分,95%CI(-1.34,0.25)分,P=0.18];两组患者术后并发症发生率差异无统计学意义[OR=0.99,95%CI(0.53,1.84),P=0.98]。结论高屈曲膝假体术后膝关节屈曲度并不优于普通膝假体,且术后功能和并发症发生率方面也无差别。在临床应用中应根据患者自身进行更为审慎的选择,同时注意手术操作及术后康复,才能充分发挥高屈曲膝关节假体的设计特点。

Objective To compare the knee flexion degree after high-flexion versus standard total knee arthroplasty（TKA）. Methods Relevant randomized controlled trials on comparison of knee l exion degree at er highflexion versus standard TKA were identified from Cochrane Library, Pub Med, Embase, China National Knowledge Infrastructure from the establishment of these databases until October 2015. A systematic review was performed to compare knee l exion degree, knee function score and complications between the two types of prostheses. Analyses were conducted using Rev Man version 5.2.0 sot ware. Results Twenty-one studies were included in this Meta-analysis. h e results showed that the knee l exion degree was higher in high-l exion group than that in the standard group [WMD=2.71°, 95%CI（0.96, 4.46）°, P=0.002]; while the dif erence was not signii cant leaving out six low-quality literatures [WMD=0.72°, 95%CI（-0.15, 1.60）°, P=0.10]. There was no significant difference in knee function score between the two groups [WMD=-0.54, 95%CI（-1.34, 0.25）, P=0.18]. There was no significant difference in complications between the two groups [OR=0.99, 95%CI（0.53, 1.84）, P=0.98]. Conclusion h e important i nding from the current study is that there is no evidence to support that the use of high-l exion prostheses is superior to the standard prostheses during total knee arthroplasty.