生物型与水泥型单髁置换术治疗膝关节病的Meta分析

Meta analysis on efficacy of cement and cementless unicompartmental arthroplasties in treatment of medial compartmental gonarthrosis

目的比较生物型与水泥型人工膝关节单髁置换术治疗内侧间室膝骨关节病的临床疗效。方法检索Pubmed、荷兰医学文摘数据库(Embase)、循证医学数据库(Cochrane Library)、Web of science、中国期刊全文数据库(CNKI)和万方数据库2000年1月至2019年10月所有关于生物型与水泥型人工膝关节单髁置换术治疗内侧间室膝关节病的临床随机对照研究(RCT)和非随机对照研究(CCT)。排除重复文献,低质量文献,观察指标不符文献以及无法获得全文的文献。采用Cochrane风险评估工具及纽卡斯尔-渥太华量表(NOS)对纳入研究的文献进行质量评价。使用Revman 5.3进行Meta分析,比较两种固定方式在假体周围透亮线,5年假体生存率,牛津大学膝关节评分(OKS),并发症,手术时间等方面的差异。结果共纳入文献9篇,累计病例18702例,其中生物组8735例,水泥组9967例。Meta分析结果显示:生物型单髁组与水泥型单髁组比较,生物型单髁组假体周围完全透亮线的发生率更低[比值比(OR)=0.08,95%置信区间(CI)(0.01,0.42),P=0.003],膝关节OKS功能评分更高[均数差(MD)=2.08,95%CI(0.51,3.65),P=0.009],5年假体生存率更高[OR=1.39,95%CI(1.20,1.60),P<0.0001],手术时间更短[MD=-9.23,95%CI(-13.72,-4.74),P<0.0001],在并发症的发生率方面,两组间差异无统计学意义[OR=0.43,95%CI(0.17,1.09),P=0.07]。结论与水泥型单髁相比,生物型单髁可以降低假体周围完全透亮线的发生率,提高膝关节功能及5年假体生存率,缩短手术时间,且不会增加并发症的发生,在临床值得推广应用。

Objective To compare the efficacy of cemented unicompartmental knee arthroplasty(UKA)with cementless UKA in treatment of medial compartmental gonarthrosis.Methods The data related to randomized controlled trial(RCT)and clinical controlled trial(CCT)which compare the treatment of cemented UKA with cementless UKA for medial gonarthrosis from Jan 2000 to Oct 2019 were searched in the Pubmed、The Excerpta Medica Database(Embase)、Cochrane Library、Web of Science、China National Knowledge Infrastructure(CNKI)and Wanfang database.The literatures that were duplicated,low quality,irrelevant to the observation index or not accessed to the full-text were excluded.Two authors independently extracted data and assessed the methodological quality with Cochrane risk tool and Newcastle Ottawa Scale(NOS).Meta analysis was performed using Revman 5.3 to compare the differences in the two fixation UKA about the radiolucency,the 5-year survival rate of the prosthesis,the Oxford knee score(OKS),complications,and operation time.Results A total of nine articles were included,with a total of 18702 cases,including 8735 in the cementless group and 9967 in the cement group.The results of meta analysis showed that the incidence of complete radiolucency around the prosthesis in the cementless group was lower than that of the cemented group[odds rate(OR)=0.08,95%confidence interval(CI)(0.01,0.42),P=0.003],the OKS is higher[mean difference(MD)=2.08,95%CI(0.51,3.65),P=0.009],The 5-year prosthesis survival rate was higher[OR=1.39,95%CI(1.20,1.60),P<0.0001],and the operation time was shorter[MD=-9.23,95%CI(-13.72,-4.74),P<0.0001].There was no statistically significant difference between the two groups in the incidence of complications[OR=0.43,95%CI(0.17,1.09),P=0.07].Conclusion Compared with cemented UKA,cementless UKA has less complete radiolucency lines,higher OKS score,higher 5-year survival rate,shorter operation time and comparable complication rate,which is worthy of being promoted.