人工全膝关节置换术髌骨置换有效性的系统评价_《中国循证医学杂志》

作者：

 李连华 , 孙天胜 , 王静 , 朱兵 , 吴军 , 姚建华 , 汤宇

北京军区总医院骨科全军创伤骨科研究所（北京 100700）;

关键词：

人工全膝关节置换术髌骨置换随机对照试验系统评价

DOI：

10.7507/1672-2531.20090188

视频：

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目的　系统评价人工全膝关节置换术（Total knee arthroplasty，TKA）髌骨置换的疗效。
方法　计算机检索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），手工检索《中华外科杂志》等6 种中文主要外科杂志。收集比较人工全膝关节置换术髌骨置换与髌骨不置换的随机对照试验（RCT），评价纳入研究的方法学质量，并提取有效数据采用Stata 10.0 软件进行Meta 分析，以比较髌骨置换组和髌骨不置换组中因髌股关节问题再手术、膝前痛及膝关节HSS 评分（The Knee Society score）的差异。
结果　共纳入13 个RCT，包括1 566 例患者。Meta 分析结果显示：髌骨置换组因髌股关节问题再手术的发生率显著低于髌骨不置换组［n=13，RR=0.34，95%CI（0.19，0.59），P lt;0.01］。按随访时间进行亚组分析，随访 lt;5 年亚组再手术发生率差异无统计学意义［RR=0.40，95%CI （0.16，1.00），P=0.05］，随访≥ 5 年亚组，再手术发生率髌骨置换组显著低于髌骨不置换组［RR=0.30，95%CI（0.14，0.62），P lt;0.01］。在显著性膝前痛及随访时膝关节HSS 功能评分上，两组差异均无统计学意义。
结论　髌骨置换术后因髌股关节问题再手术的发生率显著低于非髌骨置换组，这种差异在长期随访时更为明显。在膝前痛发生率和膝关节HSS 评分上，髌骨置换组与髌骨不置换组相比差异无统计学意义。由于纳入研究存在不同形式的偏倚，得出的结论还需要大样本、多中心及长期随访的随机对照试验来进一步证实。

引用本文： 李连华,孙天胜,王静,朱兵,吴军,姚建华,汤宇. 人工全膝关节置换术髌骨置换有效性的系统评价. 中国循证医学杂志, 2009, 09(10): 1060-1066. doi: 10.7507/1672-2531.20090188 复制

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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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《中国循证医学杂志》

人工全膝关节置换术髌骨置换有效性的系统评价

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