髌周去神经化处理对保留髌骨型初次全膝关节置换术疗效的Meta分析

发布时间：2018-08-12 13:25

【摘要】：目的:运用Meta分析方法评价髌周去神经化处理对保留髌骨型初次全膝关节置换术的疗效。方法:根据PICO原则(Participant,Intervention,Comparator,Outcome)制定文献纳入排除标准。通过计算机在MEDLINE、EMBASE、Cochrane Library、中国知网(China National Knowledge Infrastructure,CNKI)、万方数据资源(wanfang Data system)、中文期刊全文数据库(VIP)、中国生物医学文献数据库(China Biomedical Database,CBM)等中英文数据库,检索髌周去神经化处理在保留髌骨型初次全膝关节置换中疗效的随机对照试验研究(Randomized Controlled Trial,RCT),结合Google学术进行补充检索。由两名独立的研究人员对文献进行筛查、质量评价及数据提取。结局观察指标包括:膝前痛(anterior knee pain,AKP)发生率、视觉模拟评分(Visual Analogue Scale,VAS)、Feller髌骨评分、美国膝关节社会评分(American Knee Society Scole,KSS)-临床评分、KSS-功能评分、膝关节活动度(range of motion,ROM)、术后感染及并发症情况。采用Cochrane协作网中的Jadad评分量表结合分配隐藏方法对纳入文献行质量评价,同时应用Cochrane协作网提供的Revman 5.3软件进行数据处理分析,其中连续变量资料用加权均数差(weight mean difference,WMD)及95%可信区间(confidence interval,CI)表达;二分类变量资料用相对危险度(relative risk,RR)和95%CI表达。对各研究资料行异质性分析,根据I2定量分析异质性大小:当I250%时,提示异质性较低,选取固定效应模式合并数据;当I2≥50%时,提示异质性较高,选取随机效应模式合并数据。结果:初步检索得到453篇文献,经仔细筛查后6篇符合要求的RCT被纳入本研究,共涉及723膝,其中试验组(去神经化组)362膝,对照组(非去神经化组)361膝。纳入文献质量评价较高,基线大致均衡。Meta分析结果:试验组术后AKP发生率低于对照组,且在Feller髌骨评分、KSS-临床评分、KSS-功能评分、活动度(ROM)等功能预后方面均优于对照组,具有统计学差异;而在VAS评分、术后感染率等方面,两组间无统计学差异。结论:Meta分析结果显示:在保留髌骨型初次全膝关节置换中,髌周去神经化处理能减少术后AKP发生率,改善功能预后,短期随访内相对安全。
[Abstract]:Objective: to evaluate the efficacy of peripatellar denervation in primary total knee arthroplasty with patellar preservation by Meta analysis. Methods: according to the PICO principle, the inclusion exclusion criteria were established. The Chinese and English databases, such as MEDLINE EMBASE and Cochrane Library, (China National Knowledge Infrastructure and CNKI, and Wanfang data Resources (wanfang Data system), Chinese Journal Full-text Database, (VIP), Chinese Biomedical Literature Database, (China Biomedical Database, etc. A randomized controlled trial study of the efficacy of peripatellar denervation in patella preserving primary total knee arthroplasty (Randomized Controlled Trial RCT) was conducted. The literature was screened, evaluated, and extracted by two independent researchers. The outcome indexes included: the incidence of anterior knee pain (anterior knee pain), visual analogue score (Visual Analogue scale), American knee joint social score (American Knee Society score), clinical score (KSS-functional score, knee motion (range of), postoperative infection and complications. In this paper, the Jadad score scale in Cochrane cooperation network and the method of assignment and concealment are used to evaluate the quality of the literature, and the Revman 5.3 software provided by the Cochrane cooperation network is used to process and analyze the data. The data of continuous variables were expressed by weighted mean difference (weight mean difference (WMD) and 95% confidence interval (confidence CI), and the data of two-class variables were expressed by relative risk (RR) and 95%CI. According to the heterogeneity analysis of each research data, quantitative analysis of heterogeneity was made according to I2: when I250%, the heterogeneity was lower, fixed effect mode was selected to combine data, and when I2 鈮，

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