范熹微;曾羿;吴元刚;裴福兴;沈彬;

• 1:四川大学华西医院骨科

摘要(Abstract)：

[目的]比较固定平台和活动平台内侧单髁置换治疗膝内侧间室骨性关节炎的疗效[方法]检索1980年～2018年5月发表的随机对照和非随机对照固定平台和活动平台单髁置换治疗膝关节内侧间室骨性关节炎的比较研究文献,对两类假体置换的并发症、功能评分、生存率进行统计分析。[结果] 12项研究符合纳入标准。荟萃分析结果表明:FB衬垫聚乙烯磨损率显著高于MB,差异有统计学意义(P<0.05)。而MB置换的脱位率、再手术率、外翻发生率高于FB置换,差异有统计学意义(P>0.05)。但是,两组间在术后KSS评分(WMD=-0.05, 95%CI-2.28～2.17,P=0.961),术后WOMAC评分(WMD=0.02,95%CI-0.17～0.20,P=0.869),假体无菌松动率、持续疼痛发生率、骨性关节炎的进展、术中胫骨平台骨折的发生率、内翻发生率的差异均无统计学意义(P>0.05)。0～8年假体生存率两组间差异无统计学意义,但8～16年FB组假体生存率显著高于MB组(P<0.05)。[结论]本研究显示FB衬垫磨损率高于MB假体,衬垫脱位率、外翻发生率及再手术率低于MB,远期生存率高于MB。两者在术后功能评分上没有显著性差异。

关键词(KeyWords)： 单髁置换;假体;临床结果;并发症;Meta分析

Abstract:

Keywords:

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作者(Author): 范熹微;曾羿;吴元刚;裴福兴;沈彬;

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参考文献(References)：

• [1]Cross MB,Yi PY,Moric M,et al.Revising an HTO or UKA to TKA:is it more like a primary TKA or a revision TKA[J].J Arthroplasty,2014,29(9 Suppl):229-231.
• [2]Hurst JM,Berend KR.Mobile-bearing unicondylar knee arthroplasty:the Oxford experience[J].Orthop Clin North Am,2015,46(1):113-124.
• [3]Peersman G,Stuyts B,Vandenlangenbergh T,et al.Fixed-versus mobile-bearing UKA:a systematic review and meta-analysis[J].Knee Surg Sports Traumatol Arthrosc,2015,23(11):3296-3305.
• [4]Arirachakaran A,Choowit P,Putananon C,et al.Is unicompartmental knee arthroplasty(UKA)superior to total knee arthroplasty(TKA)?A systematic review and meta-analysis of randomized controlled tria[J].Eur J Orthop Surg Traumatol,2015,25(5):799-806.
• [5]Cheng T,Chen D,Zhu C,et al.Fixed-versus mobile-bearing unicondylar knee arthroplasty:are failure modes different[J].Knee Surg Sports Traumatol Arthrosc,2013,21(11):2433-2441.
• [6]Ko YB,Gujarathi MR,Oh KJ.Outcome of unicompartmental knee arthroplasty:a systematic review of comparative studies between fixed and mobile bearings focusing on complications[J].Knee Surg Relat Res,2015,27(3):141-148.
• [7]Smith TO,Hing CB,Davies L,et al.Fixed versus mobile bearing unicompartmental knee replacement:a meta-analysis[J].Orthop Traumatol Surg Res,2009,95(8):599-605.
• [8]Van Der List JP,Zuiderbaan HA,Pearle AD.Why do medial unicompartmental knee arthroplasties fail today[J].J Arthroplasty,2016,31(5):1016-1021.
• [9]王弘毅,冯建民,何川.活动平台与固定平台内侧单髁膝关节置换术后疗效对比的Meta分析[J].中华关节外科杂志(电子版),2013,7(4):499-508.
• [10]Emerson RH Jr,Hansborough T,Reitman RD,et al.Comparison of a mobile with a fixed-bearing unicompartmental knee implant[J].Clin Orthop,2002,(404):62-70.
• [11]Emerson RH Jr,Head WC,Peters PC Jr.Soft-tissue balance and alignment in medial unicompartmental knee arthroplastyv[J].Bone Joint Surg Br,1992,74(6):807-810.
• [12]Catani F,Benedetti MG,Bianchi L,et al.Muscle activity around the knee and gait performance in unicompartmental knee arthroplasty patients:a comparative study on fixed-and mobile-bearing designs[J].Knee Surg Sports Traumatol Arthrosc,2012,20(6):1042-1048.
• [13]Neufeld ME,Albers A,Greidanus NV,et al.A comparison of mobile and fixed-bearing unicompartmental knee arthroplasty at a minimum 10-year follow-up[J].J Arthroplasty,2018,33(6):1713-1718.
• [14]Bulbul AM,Kuyucu E,Kara A,et al.Which unicondylar prosthesis has better mid-term results:fixed or mobile[J].JAREM,2016,6:31-34.
• [15]Inoue A,Arai Y,Nakagawa S,et al.Comparison of alignment correction angles between fixed-bearing and mobile-bearing UKA[J].J Arthroplasty,2016,31(1):142-145.
• [16]戴雪松,宓云峰,熊炎,等.活动与固定平台的单髁假体置换治疗膝关节内侧间室骨关节炎[J].中华骨科杂志,2015,(7):691-698.
• [17]Biau DJ,Greidanus NV,Garbuz DS,et al.No difference in qualityof-life outcomes after mobile and fixed-bearing medial unicompartmental knee replacement[J].J Arthroplasty,2013,28(2):220-226.
• [18]Parratte S,Pauly V,Aubaniac JM,et al.No Long-term difference between fixed and mobile medial unicompartmental arthroplasty[J].Clin Orthop,2012,470(1):61-68.
• [19]Bhattacharya R,Scott CEH,Morris HE,et al.Survivorship and patient satisfaction of a fixed bearing unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component[J].Knee,2012,19(4):348-351.
• [20]Whittaker JP,Naudie DD,McAuley JP,et al.Does bearing design influence midterm survivorship of unicompartmental arthroplasty[J].Clin Orthop,2010,468(1):73-81.
• [21]Li MG,Yao F,Joss B,et al.Mobile vs.fixed bearing unicondylar knee arthroplasty:a randomized study on short term clinical outcomes and knee kinematics[J].Knee,2006,13(5):365-370.
• [22]Gleeson RE,Evans R,Ackroyd CE,et al.Fixed or mobile bearing unicompartmental knee replacement?A comparative cohort study[J].Knee,2004,11(5):379-384.
• [23]Confalonieri N,Manzotti A,Pullen C.Comparison of a mobile with a fixed tibial bearing unicompartimental knee prosthesis:a prospective randomized trial using a dedicated outcome score[J].Knee,2004,11(5):357-362.
• [24]Kennedy WR,White RP.Unicompartmental arthroplasty of the knee.Postoperative alignment and its influence on overall results[J].Clin Orthop,1987,(221):278-285.
• [25]Citak M,Dersch K,Kamath AF,et al.Common causes of failed unicompartmental knee arthroplasty:a single-centre analysis of four hundred and seventy one cases[J].Int Orthop,2014,38(5):961-965.
• [26]Bartley RE,Stulberg SD,Robb 3rd WJ,et al.Polyethylene wear in unicompartmental knee arthroplasty[J].Clin Orthop,1994,299(299):18-24.
• [27]Palmer SH,Morrison PJ,Ross AC.Early catastrophic tibial component wear after unicompartmental knee arthroplasty[J].Clin Orthop,1998,350(350):143-148.
• [28]Swank M,Stulberg SD,Jiganti J,et al.The natural history of unicompartmental arthroplasty:an eight-year follow-up study with survivorship analysis[J].Clin Orthop,1993,286(286):130-142.
• [29]Ettinger M,Zoch JM,Becher C,et al.In vitro kinematics of fixed versus mobile bearing in unicondylar knee arthroplasty[J].Arch Orthop Trauma Surg,2015,135(6):871-877.
• [30]Kendrick BJ,Simpson DJ,Kaptein BL,et al.Polyethylene wear of mobile-bearing unicompartmental knee replacement at 20 years[J].J Bone Joint Surg Br,2011,93(4):470-475.
• [31]Kalra S,Smith TO,Berko B,et al.Assessment of radiolucent lines around the Oxford unicompartmental knee replacement:sensitivity and specificity for loosening[J].J Bone Joint Surg Br,2011,93(6):777-781.
• [32]van der List JP,McDonald LS,Pearle AD.Systematic review of medial versus lateral survivorship in unicompartmental knee arthroplasty[J].Knee,2015,22(6):454-460.