人工全膝關節置換術髕骨置換有效性的系統評價_《中國循證醫學雜志》

作者：

 李連華 , 孫天勝 , 王靜 , 朱兵 , 吳軍 , 姚建華 , 湯宇

北京軍區總醫院骨科全軍創傷骨科研究所（北京 100700）;

關鍵詞：

人工全膝關節置換術髕骨置換隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20090188

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目的　系統評價人工全膝關節置換術（Total knee arthroplasty，TKA）髕骨置換的療效。
方法　計算機檢索PubMed（1950 ～ 2008.6）、OVID MEDLINE（1950 ～ 2008.6）、OVID CINAHL（1950 ～ 2008.6）、OVID EBM（2008年第2 季度）、CBMdisc（1978 ～ 2008.6）、CNKI（1981 ～ 2008.6），手工檢索《中華外科雜志》等6 種中文主要外科雜志。收集比較人工全膝關節置換術髕骨置換與髕骨不置換的隨機對照試驗（RCT），評價納入研究的方法學質量，并提取有效數據采用Stata 10.0 軟件進行Meta 分析，以比較髕骨置換組和髕骨不置換組中因髕股關節問題再手術、膝前痛及膝關節HSS 評分（The Knee Society score）的差異。
結果　共納入13 個RCT，包括1 566 例患者。Meta 分析結果顯示：髕骨置換組因髕股關節問題再手術的發生率顯著低于髕骨不置換組［n=13，RR=0.34，95%CI（0.19，0.59），P lt;0.01］。按隨訪時間進行亞組分析，隨訪 lt;5 年亞組再手術發生率差異無統計學意義［RR=0.40，95%CI （0.16，1.00），P=0.05］，隨訪≥ 5 年亞組，再手術發生率髕骨置換組顯著低于髕骨不置換組［RR=0.30，95%CI（0.14，0.62），P lt;0.01］。在顯著性膝前痛及隨訪時膝關節HSS 功能評分上，兩組差異均無統計學意義。
結論　髕骨置換術后因髕股關節問題再手術的發生率顯著低于非髕骨置換組，這種差異在長期隨訪時更為明顯。在膝前痛發生率和膝關節HSS 評分上，髕骨置換組與髕骨不置換組相比差異無統計學意義。由于納入研究存在不同形式的偏倚，得出的結論還需要大樣本、多中心及長期隨訪的隨機對照試驗來進一步證實。

引用本文： 李連華,孫天勝,王靜,朱兵,吳軍,姚建華,湯宇. 人工全膝關節置換術髕骨置換有效性的系統評價. 中國循證醫學雜志, 2009, 09(10): 1060-1066. doi: 10.7507/1672-2531.20090188 復制

1.	Barrack RL, Burak C. Patella in total knee arthroplasty. Clin Orthop Rel Res, 2001, 389: 62.
2.	Kelly MA. Patellofemoral complications following total knee arthroplasty. Instruct Course Lect, 2001, 50: 403.
3.	Barrack RL, Bertot AJ, Wolfe MW, et al. Patellar resurfacing in total knee arthroplasty: a prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am, 2001, 83: 1376.
4.	Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br, 1996, 78(2): 226-228.
5.	Schroeder-Boersch H, Scheller G, Fischer J, et al. Advantages of patellar resurfacing in total knee arthroplasty. Two-year results of a prospective randomized study. Arch Orthop Trauma Surg, 1998, 117(1-2): 73-78.
6.	Newman JH, Ackroyd CE, Shah NA, et al. Should the patella be resurfaced during total knee replacement? The Knee, 2000, 7(1): 17-23.
7.	Barrack RL, Bertot AJ, Wolfe MW, et al. Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am, 2001, 83-A(9): 1376-1381.
8.	Wood DJMSF, Smith AJB, Collopy DMF, et al. Patellar Resurfacing in Total Knee Arthroplasty: A Prospective, Randomized Trial. Journal of Bone & Joint Surgery - American Volume, 2002, 84-A(2): 187-193.
9.	Kordelle J, Schleicher I, Kaltschmidt I, et al. [Patella resurfacing in patients without substantial retropatellar knee pain symptoms?]. Z Orthop Ihre Grenzgeb, 2003, 141(5): 557-562.
10.	Mayman D, Bourne RB, Rorabeck CH, et al. Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results. J Arthroplasty, 2003, 18(5): 541-545.
11.	Waters TS, Bentley G. Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am, 2003, 85-A(2): 212-217.
12.	Burnett RS, Haydon CM, Rorabeck CH, et al. Patella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years’ followup. Clin Orthop Relat Res, 2004(428): 12-25.
13.	Gildone A, Manfredini M, Biscione R, et al. Patella resurfacing in posterior stabilised total knee arthroplasty: a follow-up study in 56 patients. Acta Orthop Belg, 2005, 71(4): 445-451.
14.	Campbell DG, Duncan WW, Ashworth M, et al. Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. J Bone Joint Surg Br, 2006, 88(6): 734-739.
15.	Myles CM, Rowe PJ, Nutton RW, et al. The effect of patella resurfacing in total knee arthroplasty on functional range of movement measured by flexible electrogoniometry. Clin Biomech (Bristol, Avon), 2006, 21(7): 733-739.
16.	Smith AJ, Wood DJ, Li MG. Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system. J Bone Joint Surg Br, 2008, 90(1): 43-49.
17.	Kurup H, Hossain M, Andrew JG. Plating versus intramedullary nailing for humeral shaft fractures in adults. Cochrane Database of Systematic Reviews, 2007, Issue 3.
18.	Breslow NE, Day DE. Combination of results from a series of 2x2 tables; control of confounding. In: Statistical methods in cancer research. Vol. 1. The analysis of case-control studies. Lyon, France: International Agency for research on cancer, 1980, 136-146.
19.	Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
20.	Freeman MA, Samuelson KM, Elias SG, et al. The patellofemoral joint in total knee prostheses design considerations. J Arthroplasty, 1989, 4 suppl: S69-S74.
21.	Le Lorier J, Gregoire G, Benhaddad A, et al. Discrepencies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med, 1997, 337: 536-542.
22.	Chan AW, Hrobjartsson A, Haahr MT, et al. Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. JAMA, 2004, 291: 2457-2465.

1. Barrack RL, Burak C. Patella in total knee arthroplasty. Clin Orthop Rel Res, 2001, 389: 62.
2. Kelly MA. Patellofemoral complications following total knee arthroplasty. Instruct Course Lect, 2001, 50: 403.
3. Barrack RL, Bertot AJ, Wolfe MW, et al. Patellar resurfacing in total knee arthroplasty: a prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am, 2001, 83: 1376.
4. Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br, 1996, 78(2): 226-228.
5. Schroeder-Boersch H, Scheller G, Fischer J, et al. Advantages of patellar resurfacing in total knee arthroplasty. Two-year results of a prospective randomized study. Arch Orthop Trauma Surg, 1998, 117(1-2): 73-78.
6. Newman JH, Ackroyd CE, Shah NA, et al. Should the patella be resurfaced during total knee replacement? The Knee, 2000, 7(1): 17-23.
7. Barrack RL, Bertot AJ, Wolfe MW, et al. Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up. J Bone Joint Surg Am, 2001, 83-A(9): 1376-1381.
8. Wood DJMSF, Smith AJB, Collopy DMF, et al. Patellar Resurfacing in Total Knee Arthroplasty: A Prospective, Randomized Trial. Journal of Bone & Joint Surgery - American Volume, 2002, 84-A(2): 187-193.
9. Kordelle J, Schleicher I, Kaltschmidt I, et al. [Patella resurfacing in patients without substantial retropatellar knee pain symptoms?]. Z Orthop Ihre Grenzgeb, 2003, 141(5): 557-562.
10. Mayman D, Bourne RB, Rorabeck CH, et al. Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results. J Arthroplasty, 2003, 18(5): 541-545.
11. Waters TS, Bentley G. Patellar resurfacing in total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am, 2003, 85-A(2): 212-217.
12. Burnett RS, Haydon CM, Rorabeck CH, et al. Patella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years’ followup. Clin Orthop Relat Res, 2004(428): 12-25.
13. Gildone A, Manfredini M, Biscione R, et al. Patella resurfacing in posterior stabilised total knee arthroplasty: a follow-up study in 56 patients. Acta Orthop Belg, 2005, 71(4): 445-451.
14. Campbell DG, Duncan WW, Ashworth M, et al. Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial. J Bone Joint Surg Br, 2006, 88(6): 734-739.
15. Myles CM, Rowe PJ, Nutton RW, et al. The effect of patella resurfacing in total knee arthroplasty on functional range of movement measured by flexible electrogoniometry. Clin Biomech (Bristol, Avon), 2006, 21(7): 733-739.
16. Smith AJ, Wood DJ, Li MG. Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system. J Bone Joint Surg Br, 2008, 90(1): 43-49.
17. Kurup H, Hossain M, Andrew JG. Plating versus intramedullary nailing for humeral shaft fractures in adults. Cochrane Database of Systematic Reviews, 2007, Issue 3.
18. Breslow NE, Day DE. Combination of results from a series of 2x2 tables; control of confounding. In: Statistical methods in cancer research. Vol. 1. The analysis of case-control studies. Lyon, France: International Agency for research on cancer, 1980, 136-146.
19. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
20. Freeman MA, Samuelson KM, Elias SG, et al. The patellofemoral joint in total knee prostheses design considerations. J Arthroplasty, 1989, 4 suppl: S69-S74.
21. Le Lorier J, Gregoire G, Benhaddad A, et al. Discrepencies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med, 1997, 337: 536-542.
22. Chan AW, Hrobjartsson A, Haahr MT, et al. Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. JAMA, 2004, 291: 2457-2465.

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《中國循證醫學雜志》

人工全膝關節置換術髕骨置換有效性的系統評價

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