个性化截骨板辅助单髁置换与传统截骨辅助单髁置换治疗内侧膝关节骨关节炎疗效的meta分析

Efficacy of personalized osteotomy plate assisted unicondylar replacement versus conventional unicondylar replacement in treating medial knee osteoarthritis:a meta analysis

目的比较个性化截骨板(PSI)辅助膝关节单髁置换术(UKA)与传统截骨(CI)辅助UKA治疗内侧膝关节骨关节炎的疗效。方法检索PubMed、Embase、Cochrane Library、中国知网、万方等数据库,时间为建库至2022年3月。按照纳入与排除标准筛选文献、质量评价及提取数据,使用RevMan5.3软件对结局指标进行meta分析。结果共纳入9篇文献,共556例患者,PSI组278例,CI组278例。meta分析结果显示,与CI组相比,PSI组在手术时间[MD=-9.89,95%CI(-19.20,-0.58),P=0.04]、总失血量[MD=-155.60,95%CI(-229.42,-81.79),P<0.01]、术后6个月膝关节特种外科医院(HSS)评分[MD=-1.37,95%CI(-2.59,-0.14),P=0.03]较低(P<0.05),在术后1个月膝关节HSS评分[MD=1.06,95%CI(0.18,1.94),P=0.02]较高(P<0.05)。两组在冠状位股骨假体离群值[OR=3.07,95%CI(0.31,30.34),P=0.34]、矢状位股骨假体离群值[OR=0.85,95%CI(0.28,2.63),P=0.78]、冠状位胫骨假体离群值[OR=0.49,95%CI(0.24,0.99),P=0.05]、矢状位胫骨假体离群值[OR=0.73,95%CI(0.34,1.59),P=0.43]、术后3个月膝关节HSS评分[MD=-0.29,95%CI(-1.08,0.50),P=0.47]及术后3个月膝关节VAS评分[MD=-0.22,95%CI(-1.00,0.55),P=0.57]差异无统计学意义(P>0.05)。结论PSI与CI辅助UKA都取得了较好的假体植入精准度及临床疗效,但是PSI辅助UKA在手术时间、总失血量更少。

Objective To compare the efficacy of unicompartmental knee arthroplasty(UKA)assisted by patient-specific instrument(PSI)versus conventional instrument(CI)for treating medial knee osteoarthritis.Methods The databases of PubMed,Embase,Cochrane Library,CNKI and Wanfang were retrieved from their establishment to March 2022.The literatures screening,quality evaluation and data extract were conducted according to the inclusion and exclusion standards.The outcome indicators conducted the meta analysis by the RevMan 5.3 software.Results Totally 9 papers were included,with 556 cases of knee joint,there were 278 cases in the PSI group and 278 cases in the CI group.The meta analysis results showed that compared with the CI group,the operation time[MD=-9.89,95%CI(-19.20,-0.58),P=0.04],total blood loss amount[MD=-155.60,95%CI(-229.42,-81.79),P<0.01],the Hospital for Special Surgery(HSS)score in postoperative 6 months[MD=-1.37,95%CI(-2.59,-0.14),P=0.03]in the PSI group were significantly lower(P<0.05),the HSS score in postoperative 1 month[MD=1.06,95%CI(0.18,1.94),P=0.02]was higher(P<0.05),there was no statistically significant differences in coronal femoral component outliers[OR=3.07,95%CI(0.31,30.34),P=0.34],sagittal femoral component outliers[OR=0.85,95%CI(0.28,2.63),P=0.78],coronal tibial component outliers[OR=0.49,95%CI(0.24,0.99),P=0.05],sagittal tibial component outliers[OR=0.73,95%CI(0.34,1.59),P=0.43],HSS in postoperative 3 months[MD=-0.29,95%CI(-1.08,0.50),P=0.47]and knee joint VAS score in postoperative 3 months[MD=-0.22,95%CI(-1.00,0.55),P=0.57]between the two groups(P>0.05).Conclusion Both PSI assisted UKA and traditional UKA have achieved the prosthesis implantation accuracy and clinical efficacy,but PSI assisted UKA has little operation time and little total blood loss.