全膝关节置换术中髌骨置换对手术效果影响的Meta分析

A meta analysis of influence of patellar resurfacing on effect of total knee arthroplasty

目的评价髌骨置换与非髌骨置换对全膝关节置换术疗效的影响,为临床治疗方案的选择提供循证依据。方法检索Pubmed、Cochrane、Medline、Embase、中国期刊全文数据库（CNKI）及万方等数据库,收集有关全膝关节置换术时髌骨置换与否的随机对照研究。按照纳入、排除标准由两名研究人员独立进行筛选并提取相关数据,以再次手术率、膝关节疼痛分数以及膝关节评分作为测量指标。采用RevMan 5.3软件进行Meta分析。结果 15篇文献纳入分析,共1 788例患者,其中髌骨置换组患者共871例,非髌骨置换组患者共917例。髌骨置换组患者的再次手术率明显低于非髌骨置换组患者（RR=0.50,95%CI：0.33-0.76;P=0.001）,且膝关节功能也得到明显改善（WMD=3.04,95%CI：0.41-5.67;P=0.02）。而两种手术方式患者的前膝关节疼痛（WMD=0.96,95%CI：-0.85-2.76;P=0.30）、膝关节评分（RR=0.81,95%CI：0.50-1.32;P=0.41）差异无统计学意义。结论全膝关节置换术时进行髌骨置换可以降低再次手术的风险,改善术后膝关节功能,但不能改善术后膝关节疼痛分数及膝关节评分指数。

Objective To evaluate the influence of patellar resurfacing and non-patellar resurfacing on the effect of total knee arthroplasty to provide the evidence-based basis for selecting the clinical treatment scheme.Methods The clinical randomized controlled trials（RCT）on the whether having patellar replacement in total knee arthroplasty were retrieved from the databases of Pubmed,Cochrane,Medline,Embase,CNKI and WanFang data.The screening was independently performed by two researchers according to the including and excluding criterion.The related data were extracted.The reoperation rate,knee joint pain score and knee joint score served as the measurement criteria.The RevMan 5.2software was adopted to conduct the meta analysis.ResultsFifteen literatures were included to analyze,involving 1 788 patients,among them 871 cases were in the patellar resurfacing group and 917 case sin the non-patellar resurfacing group.The reoperation rate in the patellar resurfacing group was significantly lower than that in the non-patellar resurfacing group（RR=0.50,95%CI：0.33-0.76;P=0.001）,moreover the knee joint function was significantly improved（WMD=3.04,95%CI：0.41-5.67;P=0.02）.However,the anterior knee joint pain（WMD=0.96,95%CI：-0.85-2.76;P=0.30）and knee joint score（RR=0.81,95%CI：0.50-1.32;P=0.41）had no statistical difference between the two operation modes.Conclusion Conducting patellar resurfacing in total knee arthroplasty can reduce the reoperation risk and improves the postoperative knee joint function,but does not improve postoperative knee joint pain score and knee joint score