全膝关节置换术对血友病性关节炎治疗效果的meta分析

Meta analysis of treatment effect of total knee replacementon hemophiliac arthritis

目的采用meta分析评价全膝关节置换术(TKA)在血友病性关节炎(HA)患者中的治疗效果,总结血友病患者术后关节功能康复质量及并发症发生率,为临床干预提供循证医学依据。方法检索中国知网(CNKI)、中国生物医学文献服务系统(CBM)、万方、维普、Pubmed、Web of Science、Embase数据库,收集报道HA患者行TKA后功能康复质量的研究,检索时限为各库建库至2023年3月,由2位评价员进行独立文献筛选、提取资料并评价纳入研究质量后,采用Stata15.0软件进行meta分析。结果共纳入20篇文献,共计686例患者,897个关节,平均随访时间6个月至18年,膝关节协会评分(KSS)量表临床维度评分为81.20(95%CI:75.36~87.03),KSS量表功能维度评分为81.95(95%CI:71.34~92.57),并发症发生率为0.16(95%CI:0.11~0.22),美国特种外科医院膝关节评分(HHS)量表评分为88.72(95%CI:85.11~92.33),膝关节关节活动度(ROM)为85.06(95%CI:75.73~94.39),膝关节屈曲挛缩为5.76(95%CI:2.62~8.91)。结论现有证据表明,TKA能够有效提高HA患者的关节功能,保障患者术后康复质量,可作为HA患者的治疗选择。

Objective To evaluate the therapeutic effect of total knee replacement(TKA)in patients with hemophilia arthritis(HA)using meta analysis,and to summarize the quality of postoperative joint function rehabilitation and complication rates in patients with hemophilia to provide the evidence-based medical basis for clinical intervention.Methods The studied on the functional rehabilitation after TKA were retrieved from the databases of CNKI,CBM,WanFang,VIP,Pubmed,Web of science and Embase.The retrieval time limit was from the establishment of each database to February 2023.The two evaluators independently screened the literatures,extracted the data and evaluated the quality of included studies.Then the Stata 15 software was used for conducting the meta analysis.Results A total of 20 studies were included,including 686 patients and 897 joints.The mean follow-up time was 6 months to 18 years.The clinical dimension score of the knee association score(KSS)was 81.20(95%CI:75.36-87.03).The KSS functional dimension score was 81.95(95%CI:71.34-92.57),the complications occurrence rate was 0.16(95%CI:0.11-0.22),and the American Hospital for Special Surgery Knee Sale(HHS)score was 88.72(95%CI:85.11-92.33),the knee joint range of motion(ROM)was 85.06(95%CI:75.73-94.39),and the flexion contracture score was 5.760(95%CI:2.62-8.91).Conclusion The present evidence shows that TKA is effective in improving the joint function in the patients with HA,ensure the quality of postoperative rehabilitation,which could serve as a treatment option for the patients with HA.