中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2009年
2期
97-102
,共6页
曹力%龚时国%康雄%彭理斌
曹力%龔時國%康雄%彭理斌
조력%공시국%강웅%팽리빈
关节成形术,置换,膝%Meta分析%假体设计
關節成形術,置換,膝%Meta分析%假體設計
관절성형술,치환,슬%Meta분석%가체설계
Arthroplasty,replacement,knee%Meta-analysis%Prosthesis design
目的 对采用活动平台或固定平台假体膝关节置换术的疗效差异进行Meta分析.方法 检索Ovid Medline和PubMed(1966年至2008年6月),Embase(1980年至2008年6月),Cochrane Central Register of Controued Trials(2008年)和中国生物医学文献数据库(1990至2008年),搜集全部有关活动平台和固定平台假体膝关节置换术疗效差异的随机对照研究,采用RevMan 4.2.10统计软件进行Meta分析.结果 纳入前瞻性随机对照研究9篇,英文文献8篇、德文文献1篇.Meta分析结果显示采用活动平台假体与固定平台假体西组术后膝关节最大屈曲度差异有统计学意义,加权均数差值-1.63,95%置信区间[-2.51,-0.74],P=0.0003;术后膝关节KSS评分(加权均数差值-0.25,95%置信区间[1.09,0.59],P=0.56)、髌骨倾斜率(风险差0.01,95%置信区间[-0.02,0.03],P=0.64)、假体周围放射透光影率(相对危险度0.88,95%置信区间[0.61,1.29],P=0.52)、膝关节翻修率(风险差0.01,95%置信区间[0.00,0.03],P=0.12)差异无统计学意义.结论 早、中期随访结果显示,活动平台与固定平台的术后膝关节最大屈曲度差异有统计学差异,但活动平台平均仅增加1.6°,无明显临床意义.在膝关节评分、髌骨轨迹、假体周围放射透光影、膝关节翻修等方面活动平台没有明显优势,但却存在易脱位的风险.
目的 對採用活動平檯或固定平檯假體膝關節置換術的療效差異進行Meta分析.方法 檢索Ovid Medline和PubMed(1966年至2008年6月),Embase(1980年至2008年6月),Cochrane Central Register of Controued Trials(2008年)和中國生物醫學文獻數據庫(1990至2008年),搜集全部有關活動平檯和固定平檯假體膝關節置換術療效差異的隨機對照研究,採用RevMan 4.2.10統計軟件進行Meta分析.結果 納入前瞻性隨機對照研究9篇,英文文獻8篇、德文文獻1篇.Meta分析結果顯示採用活動平檯假體與固定平檯假體西組術後膝關節最大屈麯度差異有統計學意義,加權均數差值-1.63,95%置信區間[-2.51,-0.74],P=0.0003;術後膝關節KSS評分(加權均數差值-0.25,95%置信區間[1.09,0.59],P=0.56)、髕骨傾斜率(風險差0.01,95%置信區間[-0.02,0.03],P=0.64)、假體週圍放射透光影率(相對危險度0.88,95%置信區間[0.61,1.29],P=0.52)、膝關節翻脩率(風險差0.01,95%置信區間[0.00,0.03],P=0.12)差異無統計學意義.結論 早、中期隨訪結果顯示,活動平檯與固定平檯的術後膝關節最大屈麯度差異有統計學差異,但活動平檯平均僅增加1.6°,無明顯臨床意義.在膝關節評分、髕骨軌跡、假體週圍放射透光影、膝關節翻脩等方麵活動平檯沒有明顯優勢,但卻存在易脫位的風險.
목적 대채용활동평태혹고정평태가체슬관절치환술적료효차이진행Meta분석.방법 검색Ovid Medline화PubMed(1966년지2008년6월),Embase(1980년지2008년6월),Cochrane Central Register of Controued Trials(2008년)화중국생물의학문헌수거고(1990지2008년),수집전부유관활동평태화고정평태가체슬관절치환술료효차이적수궤대조연구,채용RevMan 4.2.10통계연건진행Meta분석.결과 납입전첨성수궤대조연구9편,영문문헌8편、덕문문헌1편.Meta분석결과현시채용활동평태가체여고정평태가체서조술후슬관절최대굴곡도차이유통계학의의,가권균수차치-1.63,95%치신구간[-2.51,-0.74],P=0.0003;술후슬관절KSS평분(가권균수차치-0.25,95%치신구간[1.09,0.59],P=0.56)、빈골경사솔(풍험차0.01,95%치신구간[-0.02,0.03],P=0.64)、가체주위방사투광영솔(상대위험도0.88,95%치신구간[0.61,1.29],P=0.52)、슬관절번수솔(풍험차0.01,95%치신구간[0.00,0.03],P=0.12)차이무통계학의의.결론 조、중기수방결과현시,활동평태여고정평태적술후슬관절최대굴곡도차이유통계학차이,단활동평태평균부증가1.6°,무명현림상의의.재슬관절평분、빈골궤적、가체주위방사투광영、슬관절번수등방면활동평태몰유명현우세,단각존재역탈위적풍험.
Objective To evaluate the differences of clinical effects between mobile-bearing (MB) and fixed-bearing (FB) for knee arthroplasty using the method of Cochrane systcmatic review. Methods Randomized controlled trials (RCTs) on differences of clinical effects of MB or FB were identified from Ovid Medline, PubMed (1966-2008.6), Embase (1980-2008.6), Cochrane Central Register of Controlled Trials (2008) and CBM (1990-2008). All the proofs that demonstrated these issues as the RCTs were included. RevMan 4.2.10 software was used for Meta-analysis. Results Nine prospective RCTs had average 1-7.5years follow-up, which involving 8 English and 1 German papers. The combined results of Meta-aualysis indi-cated that there was statistical difference between two groups on post-operative maximum knee flexion (WMD=-1.63, 95%CI [-2.51, -0.74], P=0.0003). Others indicated that there were no statistical differences with respect to knee society score(WMD=-0.25, 95%CI[-1.09, 0.59], P=0.56), patellar tilt (RD=0.01, 95% CI [-0.02, 0.03], P=0.64), radioiogical lucency around prostheses (RR--0.88, 95%C1 [0.61, 1.29], P=0.52) and revisions of knees (RD=0.01, 95%CI [0.00, 0.03], P=0.12). Conclusion Short and median follow-up indicated that although MB has statistical difference with FB on post-operative maximum flex degree of knee, but it only increase average 1.6°, and has no major clinical significance. Furthermore, there are also no ma-jor differences on knee society score, patellar track, radiological lucency around prostheses and revisions of knee, but MB has a risk of bearing dislocation.
