全膝关节置换术与关节镜下滑膜切除术治疗晚期膝关节色素沉着绒毛结节性滑膜炎的Meta分析

Comparison of total knee arthroplasty and arthroscopic synovectomy for treatment of terminal knee pigmented villonodular synovitis:a meta analysis

目的:评价全膝关节置换术(total knee arthroplasty, TKA)与关节镜下滑膜切除术(arthroscopic synovectomy, AS)治疗晚期膝关节色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis, PVNS)的临床疗效和安全性。方法:以"色素沉着绒毛结节性滑膜炎""关节镜""膝关节置换"为中文检索词,以"pigmented villonodular synovitis""arthroscope""endoscopes""total knee arthroplasty""knee replacement arthroplasties""replacement, total knee""knee arthroplasty"为英文检索词,以计算机检索为主,手工检索、参考文献追溯为辅,检索中国知网、维普网、万方数据库及PubMed、Embase、the Cochrane Library建库至2021年2月收集的TKA与AS治疗晚期膝关节PVNS的相关文献。筛选文献、提取数据,并对纳入的研究进行质量评价后,进行Meta分析。结果:初检共检出文献36篇,其中中文文献29篇,英文文献7篇;经筛选后最终纳入文献8篇,均为中文文献。Meta分析结果显示,TKA组术后膝关节Lysholm评分高于AS组[I^(2)=3%,P=0.310,MD=7.93,95%CI(5.72,10.13),P=0.000],膝关节活动度大于AS组[I^(2)=19%,P=0.300,MD=27.93,95%CI(25.36,30.50),P=0.000],PVNS复发率低于AS组[I^(2)=0%,P=0.940,OR=0.14,95%CI(0.04,0.53),P=0.004];2组患者并发症发生率比较,差异无统计学意义[I^(2)=0%,P=0.970,OR=0.49,95%CI(0.23,1.04),P=0.060]。结论:对于晚期PVNS,采用TKA治疗在缓解膝关节疼痛、改善膝关节功能、降低PVNS复发率方面优于采用AS治疗,而2种方法的并发症发生率相当。

Objective:To evaluate the curative ffect and safety of total knee arthroplasty(TKA)versus arthroscopic synovectomy(AS)for treatment of terminal knee pigmented illonodular synovitis(PVNS).Methods:All elinical trial articles about TKA and AS for treatment of terminal knee PVNS included from database establishing to February 2021 were retrieved from Chima national knowledge internet,VIP Dat abase,W anFang Data,Pubmed,Embase and the Cochrane Library through computer assisted by manual retrieval and reference retrospec-tion.The logical combination of"色素沉著绒毛结节性滑膜炎""关节镜"and"膝关节置换"were used as Chinese index termns,and the logical combination of pigmented villonodular synoritis,arthroscope,endoscopes,total knee arthroplasty,knee replacement arthroplasties,re-placement,total knee and knee arthroplasty as the English index tems.The articles were screened and the information was extracted.The methodological quality of research in the articles was evaluated and a Meta-analysis was conducted.Results:Thirty-six articles were searched out,including 29 Chinese articles and 7 Einglish articles.After screening,8 Chinese articles were included in the final analysis.The results of Meta-analysis revealed that the lysholm scores were higher,the knee range of motion was greater and the recurrence rate of PVNS was lower in TKA group compared to AS group(I^(2)=3%,P=0.310,MD=7.93,95%CI(5.72,10.13),P=0.000;I^(2)=19%,P=0.300,MD=27.93,95%CI(25.36,30.50),P=0.000;I^(2)=0%,P=0.940,0R=0.14,95%CI(0.04,0.53),P=0.004.There was no statistical iference in ineidence rate of complications between the two groups(I^(2)=0%,P=0.970,OR=0.49,95%CI(0.23,1.04),P=0.060.Conclusion:TKA surpasses AS in relieving knee pain,improving knee function and decreasing recurrence rate of PVNS for treat-ment of teminal knee PVNS,however,they are similar to each other in incidence rate of complications.