同期和分期双侧全膝关节置换术安全性的Meta分析

Meta-analysis on safety of simultaneous versus staged bilateral total knee arthroplasties

目的通过Meta分析比较同期和分期双侧全膝关节置换术的安全性。方法检索关于同期和分期双侧全膝关节置换术的相关文献,根据特定的纳入与排除标准筛选文献并提取相关数据,采用Review Manager 5.0软件进行Meta分析。结果纳入17篇临床对照试验,共93201例,其中同期全膝关节置换术(SB-TKA)48017例,分期双侧全膝关节置换术(staged B-TKA)45184例。Meta分析结果显示,同期双侧全膝关节置换术术后总死亡率(OR=1.32,95%CI[1.07,1.64],P=0.009)、术后30 d内死亡率(OR=4.42,95%CI[1.78,10.95],P=0.001)、肺栓塞发生率(OR=1.28,95%CI[1.07,1.53],P=0.007)均高于分期手术,两组差异有统计学意义。此外,两组有关心血管并发症、深静脉血栓、神经系统并发症、感染率、翻修率的发病率无明显统计学差异。结论同期双侧全膝关节置换术术后总死亡率、30 d死亡率和肺栓塞发生率高于分期手术,术前应全面系统评估全身情况,严格把握手术适应证。

Objective To compare the safety of simultaneous bilateral total kneearthroplasty(SB-TKA) versus staged bilateral total knee arthroplasty( staged B-TKA) .Methods The literatures about the safety of simultaneous or staged bilateral total knee arthroplasties were searched under the inclusion and exclusion criteria and the related data were extracted.The data were analyzed by Review Manager 5.0. Results Seventeen studies met the inclusion criteria, which included a total of 93201 cases (48017 SB-TKA and 45184 staged B-TKA).The results of meta-analysis showed that the prevalence of overall mortality[OR =1.32, 95%CI (1.07,1.640, P=0.009], mortality in 30 days[OR =4.42, 95% CI (1.78, 10.95), P=0.001] and pulmonary embolism[OR=1.28, 95%CI (1.07, 1.53), P=0.007] were significantly higher in the SB-TKA group compared to the staged TKA group.In addition, there was no significant difference in the risk of deep vein thrombosis, cardiac complication, neurological complications, infection, and revision rates between the two groups.Conclusions Compared with staged bilateral TKA, simultaneous bilateral TKA carries higher rates of overall mortality, mortality in 30 days and pulmonary embolism; the preoperative health status must be carefully assessed, and the operation indications must be strictly followed.