CAJ | 학술논문

目的比较同期双膝关节置换术与分期双膝关节置换术的术后死亡率,评价同期与分期双膝关节置换术的安全性.方法参照Cochrane协作网(cochrane musculoskeletal group)建议的检索策略,计算机检索PubMed(1990至2010年)、0VID MEDLINE(1990至2010年)和Cochrane图书馆查找有关同期双膝关节置换术与分期双膝关节置换术术后并发症的临床研究.英文检索词包括:bilateral total knee arthroplasty、staged total knee arthroplasty、total knee arthroplasty等.由两名评价者独立选择实验,提取有效数据,采用Stata 10.0软件进行Meta分析.结果最终纳入6篇文献,同期双膝关节置换术组死亡率[OR=2.925,95% CI(2.352,3.638)]、30天死亡率[0R=5.078,95%CI(2.192,11.763)]及高龄患者(年龄＞70岁)死亡率[OR=4.087,95%CI(1.947,8.582)]与分期双膝关节置换术组相比,均明显增高.结论现有的有限证据表明,同期双膝关节置换术术后死亡率高于分期双膝关节置换术.对于术前存在高风险(如高龄)的患者,宜考虑采用分期双膝关节置换术,慎重选择同期双膝关节置换术,并应充分评估手术风险,积极预防术后并发症的发生.受纳入文献数量和质量的限制,Meta分析结果尚有待于高质量的大样本随机对照试验以予证实.
목적 비교동기쌍슬관절치환술여분기쌍슬관절치환술적술후사망솔,평개동기여분기쌍슬관절치환술적안전성.방법 삼조Cochrane협작망(cochrane musculoskeletal group)건의적검색책략,계산궤검색PubMed(1990지2010년)、0VID MEDLINE(1990지2010년)화Cochrane도서관사조유관동기쌍슬관절치환술여분기쌍슬관절치환술술후병발증적림상연구.영문검색사포괄:bilateral total knee arthroplasty、staged total knee arthroplasty、total knee arthroplasty등.유량명평개자독립선택실험,제취유효수거,채용Stata 10.0연건진행Meta분석.결과 최종납입6편문헌,동기쌍슬관절치환술조사망솔[OR=2.925,95% CI(2.352,3.638)]、30천사망솔[0R=5.078,95%CI(2.192,11.763)]급고령환자(년령＞70세)사망솔[OR=4.087,95%CI(1.947,8.582)]여분기쌍슬관절치환술조상비,균명현증고.결론 현유적유한증거표명,동기쌍슬관절치환술술후사망솔고우분기쌍슬관절치환술.대우술전존재고풍험(여고령)적환자,의고필채용분기쌍슬관절치환술,신중선택동기쌍슬관절치환술,병응충분평고수술풍험,적겁예방술후병발증적발생.수납입문헌수량화질량적한제,Meta분석결과상유대우고질량적대양본수궤대조시험이여증실.
Objective To evaluate mortality associated with simultaneous bilateral or staged bilateral TKA, and better understand the risks involved in the simultaneous versus staged bilateral procedures.Methods A systematic review was conducted, following an a priori protocol, according to the methods recommended by the Cochrane Musculoskeletal Group in the Cochrane Collaboration. Eligible studies were identified in PubMed (1990-2010), OVID MEDLINE (1990-2010), and the Cochrane library, concerning postoperative complications of bilateral or staged bilateral total knee arthroplasty. All of the English-language abstracts were obtained, and retrieval words including bilateral total knee arthroplasty, staged total knee arthroplasty, and total knee arthroplasty, etc. An extensive analysis was then performed to identify articles fulfilling the inclusion criteria for the study. The details of the reported data were extracted and evaluated by two reviewers independently. Data analyses were conducted with Stata 10.0. Results Six studies met our inclusion criteria for review. The combined results showed that the prevalence of mortality[OR=2.925, 95% CI (2.352, 3.638)], mortality 30 days postoperatively[OR=5.078, 95% CI (2.192, 1 1.763)]and mortality in 70 years or older patients[OR=4.087, 95% CI (1.947, 8.582)]were statistically higher in the population that had undergone simultaneous TKA compared with staged TKA. Conclusion Compared with staged bilateral TKA, simultaneous bilateral TKA might carries a higher potential risk of postoperative mortality. Patients should be aware of this information when deciding whether to proceed with simultaneous bilateral TKA. Further well-designed and large-scale randomized controlled trials are required to confirm these findings.