初次全膝关节置换骨水泥与非骨水泥型假体疗效差异的Meta分析

Treatment efficacy of cementless versus cemented prosthesis in primary total knee arthroplasty: a meta-analysis

背景:对于需要行全膝关节置换的患者,非骨水泥固定与骨水泥固定中哪种固定方式在临床疗效、功能活动及假体生存率等方面更具优势存在争议。目的:利用Meta分析比较初次全膝关节置换术中非骨水泥固定和骨水泥固定的疗效,以评估最佳固定方法。方法:利用计算机全面检索PubMed、EMbase、Cochrane Library以及中国期刊全文数据库、万方数据库、中国生物医学文献数据库。搜集所有关于初次全膝关节置换术中非骨水泥固定和骨水泥固定疗效比较的随机对照试验,检索时限均为建库至2018年6月。2名研究者根据制定的纳入和排除标准进行独立筛选,提取文献中的资料和数据,并进行质量评价。采用RevMan 5.3软件进行Meta分析。结果与结论:①共纳入7篇文献,均为随机对照试验,共743例患者;②Meta分析结果显示,主要指标假体生存率2组差异无显著性意义[RR=1,95%CI(0.98,1.02),P=0.90];③次要指标美国膝关节协会评分[MD=0.28,95%CI(-1.04,1.61),P=0.68]、美国西部Ontario和McMaster大学骨关节炎指数[MD=1.63,95%CI(-0.17,3.43),P=0.08]、失血量(术中出血+引流量)[MD=408.52,95%CI(-102.18,919.22),P=0.12]、关节感染发生率[RR=0.97,95%CI(0.34,2.73),P=0.95]2组差异均无显著性意义;但在关节活动度方面,非骨水泥固定优于骨水泥固定[MD=3.46,95%CI(1.12,5.80),P=0.004];透亮线方面,骨水泥固定优于非骨水泥固定[RR=1.67,95%CI(1.14,2.46),P=0.009];④综上,对于初次全膝关节置换患者,非骨水泥固定与骨水泥固定的治疗效果相似,但在关节活动度和透亮线方面两者各具优势。

BACKGROUND: For patients who need total knee arthroplasty, whether to use cementless or cementless fixation, which fixation method has more advantages in clinical efficacy, functional activity and prosthesis survival rate are controversial. OBJECTIVE: To compare the efficacy of cementless and cemented fixations in primary total knee arthroplasty by meta-analysis in order to evaluate the best fixation method. METHODS: PubMed, EMbase, Cochrane Library, CNKI, WanFang and CBM databases were searched. All randomized controlled trials on the efficacy of cementless and cemented fixations in primary total knee arthroplasty before June 2018 were collected. Two researchers independently screened the literature according to the inclusion and exclusion criteria, then extracted data, and conducted quality evaluation. RevMan 5.3 software was used for meta-analysis. RESULTS AND CONCLUSION:(1) Seven randomized controlled trials were included, involving 743 patients.(2) Meta-analysis results showed that there was no significant difference in the primary measurement outcome, survival rate of prosthesis [RR=1, 95%CI (0.98, 1.02), P=0.90].(3) Secondary measurement outcomes, Knee Society Score [MD=0.28, 95%CI (-1.04, 1.61), P=0.68], Western Ontario and McMaster Universities Osteoarthritis Index score [MD=1.63, 95%CI (-0.17, 3.43), P=0.08], blood loss (intraoperative bleeding + drainage)[MD=408.52, 95%CI (-102.18, 919.22), P=0.12], incidence of joint infection [RR=0.97, 95%CI (0.34, 2.73), P=0.95] had no significant difference between two groups. The range of motion in the cementless group was superior to the cemented group [MD=3.46, 95%CI (1.12, 5.80), P=0.004]. Cementless fixation was better than bone cement fixation in clear line [RR=1.67, 95%CI (1.14, 2.46), P=0.009].(4) In summary, for patients undergoing primary total knee arthroplasty, the effect of cementless fixation is similar to that of cemented fixation, but both of them have certain advantages in terms of joint range of motion and clear line.