膝骨性关节炎单髁与全膝置换的荟萃分析

Unicompartmental knee arthroplasty versus total knee arthroplasty for knee osteoarthritis:a meta-analysis

[目的]系统评价膝骨性关节炎单髁与全膝置换的临床疗效。[方法]检索建库至2021年1月Cochrane Library、PubMed、Web of science、EMBASE、中国知网数据库、万方数据库及中国生物医学(CBM)数据库,收集关于膝骨性关节炎单髁与全膝置换治疗的研究文献。根据纳入与排除标准独立进行文献筛选、质量评价及资料提取,使用Revman 5.3软件对结局指标进行荟萃分析。[结果]共纳入24项研究,包括3066例膝关节。荟萃分析结果显示:单髁膝关节置换组在术中出血量(P<0.05)、引流量(P<0.05)、输血率(P<0.05)、手术时间(P<0.05)、KSS评分(P<0.05)、HSS评分(P<0.05)和膝关节活动度(P<0.05)方面优于全膝关节置换组,但前者翻修率显著高于后者(P<0.05)。而在术后并发症和优良率方面,二者差异无统计学意义(P>0.05)。[结论]单髁膝关节置换有利于减少术中出血量、引流量、输血率和手术时间,改善膝关节评分和活动范围,全膝关节置换的优势在于降低翻修率。临床为膝骨关节炎患者制定手术方案应更加注重患者的自身状况和需求。

[Objective]To compare the clinical outcomes of unicompartmental knee arthroplasty(UKA)versus total knee arthroplasty(TKA)for knee osteoarthritis(KOA).[Methods]The data bases,such as Cochrane Library,PubMed,Web of science,EMBASE,CNKI,Wanfang Data and CBM Data were searched for the comparison of clinical outcomes of UKA versus TKA for KOA from the creating to Janu⁃ary 2021.Literature screening,quality assessment,and data extraction were conducted to meet the inclusion and exclusion criteria.Rev⁃Man 5.3 was used to perform the meta-analysis of parameters related to the consequences.[Results]A total of 24 studies were included,in⁃volving 3066 knees.As results of the Meta-analysis,UKA proved significantly superior to the TKA in terms of intraoperative blood loss(P<0.05),drainage volume(P<0.05),blood transfusion rate(P<0.05),operating time(P<0.05),KSS(P<0.05),HSS(P<0.05)and ROM(P<0.05).However,the former had significantly higher revision rate than the latter(P<0.05).There was no significant difference between the two groups in terms of postoperative complications and excellent and good rates.[Conclusion]Regardless of high revision rate,the UKA has advantages of reducing intraoperative blood loss,drainage,blood transfusion rate,and operating time,whereas improving knee score and ROM over the TKA.Clinical formulation of surgical plans for KOA patients should pay more attention to their conditions and needs.