膝关节镜手术对随后全膝关节置换术疗效影响的Meta分析

Effect of knee arthroscopy on subsequent total knee arthroplasty:Meta-analysis

目的 :通过Meta分析评估膝关节镜手术对随后的全膝关节置换术(total knee arthroplasty,TKA)疗效影响。方法:计算机检索建库至2020年10月PubMed、Embase、Cochrane Library、中国知网、万方等数据库关于膝关节镜手术对随后的TKA疗效影响的文献,根据纳入与排除标准进行文献筛选、质量评价及数据提取,采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)评估非随机对照研究的文献质量。采用RevMan 5.3软件对TKA术后翻修率,再手术率,术后僵硬率,假体周围感染率,术后静脉栓塞(venous thromboembolism,VTE)发生率及术后膝关节屈曲活动度进行Meta分析。结果:最终纳入8篇文献,共182 815例,其中膝关节镜手术组6 998例,无膝关节镜手术组175 817例。Meta分析结果显示:膝关节镜手术组与无膝关节镜手术组在TKA术后翻修率[OR=1.66,95%CI (1.37,2.00),P<0.000 01],再手术率[OR=2.31,95%CI(1.59,3.36),P<0.000 1],术后僵硬率[OR=1.78,95%CI (1.02,3.11),P=0.04]及假体周围感染率[OR=1.40,95%CI(1.19,1.66),P<0.000 1]方面比较差异有统计学意义;而在术后VTE发生率[OR=1.06,95%CI(0.83,1.35),P=0.64],术后膝关节屈曲活动度[MD=-1.21,95%CI(-3.07,0.65),P=0.20]方面比较差异无统计学意义。结论:膝关节镜手术对随后的TKA术后存在负面影响。先前的关节镜手术会增加TKA术后僵硬、假体周围感染、翻修及再手术的风险,而对术后膝关节屈曲活动度及VTE发生率方面无显著差异。

Objective:To evaluate effect of knee arthroscopy on prognosis of subsequent total knee arthroplasty(total knee arthroplasty,TKA) by Meta-analysis. Methods:Databases including PubMed,Embase,Cochrane Library,CNKI,Wanfang and other databases were searched by computer from establishing to October 2020 to collect literatures on effect of knee arthroscopy on prognosis of subsequent TKA. Quality evaluation and data extraction were carried out according to inclusion,exclusion criteria and literature screening. Newcastle-Ottawa Scale(NOS) was used to evaluate literature quality of non-randomized controlled studies. RevMan 5.3 software was applied to Meta-analysis on revision rate,reoperation rate,postoperative stiffness rate,periprosthetic infection rate,postoperative venous thrombosis venous thromboembolism(VTE) rate and postoperative knee flexion range of motion after TKA. Results:Eight literatures were finally included with totally sample size of 182815 patients. Among them,6 998 patients were in knee arthroscopy group and 175 817 patients were in knee arthroscopy group. Meta-analysis results showed that there were statistical differences in revision rate after TKA [OR =1.66,95% CI(1.37,2.00),P <0.000 01],re-operation rate [OR =2.31,95% CI(1.59,3.36),P <0.000 1],postoperative stiffness rate [OR =1.78,95%CI(1.02,3.11),P=0.04] and infection rate around prosthesis [OR=1.40,95%CI(1.19,1.66),P<0.000 1]. While there were no difference in VTE rate [OR=1.06,95%CI(0.83,1.35),P=0.64],postoperative knee flexion range of motion[MD=-1.21,95%CI(-3.07,0.65),P=0.20]. Conclusion:Knee arthroscopy has a negative impact on subsequent TKA surgery.Previous arthroscopic increased risk of stiffness,periprosthetic joint infection,revision and reoperation after TKA,but there was no significant difference in postoperative knee flexion range of motion and incidence of VTE.