全膝关节置换术中骨水泥假体与非骨水泥假体生存率比较的系统评价Meta-analysis of survival rate of cemented and uncemented prostheses in total knee arthroplasty
张启栋;郭万首;程立明;刘朝晖;丁冉;朱迪;冯法博;
摘要(Abstract):
[目的]系统评价全膝关节置换术中应用骨水泥固定假体与非骨水泥固定假体的生存疗效,为临床治疗提供参考。[方法]全面搜索国内外关于全膝关节置换术中应用骨水泥固定假体和非骨水泥固定假体的临床对照研究资料,按照既定的纳入、排除标准,核定检出符合评价标准的文献,提取所需研究数据,采用RevM an 5.0.18软件进行M eta分析。[结果]纳入临床对照研究12篇,共计3 244膝全膝关节置换术,骨水泥固定假体组和非骨水泥固定假体组分别为1 877膝和1 367膝,假体生存率分别为96.7%和93.0%,荟萃分析加权后OR=2.58,95%C I(1.76,3.78),P<0.05。亚组分析结果显示,不论是小于等于5年组还是大于5年组,均是骨水泥固定假体生存率高于非骨水泥假体生存率。[结论]全膝关节置换术中假体应用骨水泥固定与非骨水泥固定相比,术后假体生存率高,但二者间的比较仍需大规模多中心的RCT来进一步研究。
关键词(KeyWords): 全膝关节置换术;骨水泥假体;非骨水泥假体;Meta分析
基金项目(Foundation):
作者(Author): 张启栋;郭万首;程立明;刘朝晖;丁冉;朱迪;冯法博;
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DOI:
参考文献(References):
- [1]Bozic KJ,Kinder J,Meneghini RM,et al.Implant survivorship andcomplication rates after total knee arthroplasty with a third-genera-tion cemented system:5 to 8 years followup[J].Clin Orthop,2005,435:277.
- [2]Thomas A,Rojer D,Imrie S,et al.Cemented total knee arthroplastyin patients with juvenile rheumatoid arthritis[J].Clin Orthop,2005,433:140-146.
- [3]Duffy GP,Crowder AR,Trousdale RR,et al.Cemented total knee ar-throplasty using a modern prosthesis in young patients with osteoarthri-tis[J].J Arthroplasty,2007,2:67-70.
- [4]Signorelli JJ,Bernini PM,Shirreffs TG.Uncemented total knee arthroplas-ty:2-year follow-up of 100 knees with a rotating platform,cruciate-retaining design[OL/J].J Arthroplasty,http://www.ncbi.nlm.nih.gov/pubmed/2014 9580.
- [5]Fanning JW,Joseph JJ,Kaufman EE.Follow up on uncemented totalknee arthroplasty[J].Orthopedics,1996,11:933-939.
- [6]Naudie DD,Ammeen DJ,Engh GA,et al.Wear and osteolysis aroundtotal knee arthroplasty[J].J Am Acad Orthop Surg,2007,1:53-64.
- [7]Gupta SK,Chu A,Ranawat AS,et al.Osteolysis after total knee ar-throplasty[J].J Arthroplasty,2007,6:787-799.
- [8]Moher D,Schulz KF,Galtman D,等.CONSORT声明:提高平行随机试验报告质量的修订建议[J].中国循证医学杂志,2005,9:702-707.
- [9]Scott PA,Kingsley GH,Scott DL.Non-steroidal anti-inflammatorydrugs and cardiac failure:meta-analyses of observational studies andrandomised controlled trials[J].Eur J Heart Fail,2008,11:1102-1107.
- [10]王家良.循证医学与临床医学[J].中国循证医学,2001,1:5-7.
- [11]康德英,王家良,洪旗,等.循证医学中统计结果的准确表达:P值与可信区间[J].华西医学,2000,4:402-403.
- [12]Cloke DJ,Khatri M,Pinder IM,et al.284 press-fit Kinemax totalknee arthroplasties followed for10 years:poor survival of uncementedprostheses[J].Acta Orthop,2008,1:28-33.
- [13]Gioe TJ,Novak C,Sinner P,et al.Knee arthroplasty in the young pa-tient:survival in a community registry[J].Clin Orthop,2007,464:83-87.
- [14]Pecina M,Djapic T,Haspl M.Survival of cementless and cementedporous-coated anatomic knee replacements:retrospective cohortstudy[J].Croat Med J,2000,2:168-172.
- [15]Duffy GP,Berry DJ,Rand JA.Cement versus cementless fixation intotal knee arthroplasty[J].Clin Orthop,1998,356:66-72.
- [16]Bassett RW.Results of 1 000 performance knees:cementless versuscemented fixation[J].J Arthroplasty,1998,4:409-413.
- [17]Mccaskie AW,Deehan DJ,Green TP,et al.Randomised,prospectivestudy comparing cemented and cementless total knee replacement:re-sults of press-fit condylar total knee replacement at five years[J].JBone Joint Surg Br,1998,6:971-975.
- [18]Nilsson KG,Karrholm J.Increased varus-valgus tilting of screw-fixated knee prostheses.Stereoradiographic study of uncemented versuscemented tibial components[J].J Arthroplasty,1993,5:529-540.
- [19]Khaw FM,Kirk LM,Morris RW,et al.A randomised,controlled trialof cemented versus cementless press-fit condylar total knee replace-ment.Ten-year survival analysis[J].J Bone Joint Surg Br,2002,5:658-666.
- [20]Nilsson KG,Bjornebrink J,Hietala SO,et al.Scintimetry after totalknee arthroplasty.Prospective 2-year study of 18 cases of arthrosisand 15 cases of rheumatoid arthritis[J].Acta Orthop Scand,1992,2:159-165.
- [21]Collins DN,Heim SA,Nelson CL,et al.Porous-coated anatomic totalknee arthroplasty.A prospective analysis comparing cemented and ce-mentless fixation[J].Clin Orthop,1991,267:128-136.
- [22]Rosenberg AG,Barden RM,Galante JO.Cemented and ingrowth fixa-tion of the miller-galante prosthesis.Clinical and roentgenographiccomparison after three-to six-year follow-up studies[J].Clin Or-thop,1990,260:71-79.
- [23]Dodd CA,Hungerford DS,KrackowKA.Total knee arthroplasty fixa-tion.Comparison of the early results of paired cemented versus unce-mented porous coated anatomic knee prostheses[J].Clin Orthop,1990,260:66-70.
- [24]KhawFM,Kirk LM,Morris RW,et al.Arandomised,controlled tri-al of cemented versus cementless press-fit condylar total knee re-placement.Ten-year survival analysis[J].J Bone Joint Surg Br,2002,5:658-666.