后稳定型与超形合度假体初次全膝置换的荟萃分析

A meta-analysis on ultracongruent prosthesis versus posterior stabilized counterpart in primary total knee arthroplasty

摘要:

[目的] 系统评价后稳定型（posterior stabilized, PS） 假体与超形合度（ultracongruent, UC） 假体的临床疗效、运动学功能和膝关节稳定性。[方法] 系统检索PubMed、EMBASE、Cochrane 图书馆、万方、知网及中国生物医学文献数据库中关于后稳定型假体与超形合度假体用于初次全膝关节置换的相关研究，检索时限为数据库建库至2021 年12 月。由2 名研究人员独立进行文献筛选和数据提取。根据NOS 评分量表和Cochrane 风险偏倚评估工具进行文献质量评价，采用Review Manager 5.4 进行荟萃分析。[结果]共纳入22 项研究，其中随机对照试验11 项、回顾性研究9 项、前瞻性研究2 项，包括2 904 个膝关节。荟萃分析结果显示，在初次全膝关节置换术中，UC 组的股骨后滚显著小于PS 组（WMD=-5.2, 95%CI -5.85~-4.54, P＜0.001）、UC 组的最大屈曲度显著小于PS 组（WMD=-2.27, 95% CI -3.75~-0.79, P=0.003）、UC 组的胫骨矢状显著松弛大于PS 组（WMD=5.10，95% CI 3.45~6.76, P＜0.001）。两组功能评分（SMD=-0.08, 95% CI -0.30~0.13, P=0.43）、疼痛评分（WMD=1.88, 95%CI-2.32~6.08, P=0.38）、ROM （WMD=-0.82, 95% CI -2.38~0.75, P=0.31）、屈曲挛缩（SMD=-0.05, 95%CI -0.25~0.14, P=0.59）、两组峰值扭矩（WMD=0.26, 95% CI -2.91~3.43, P=0.87）的差异均无统计学意义。[结论] 在初次全膝关节置换术中，后稳定型假体具有更好的运动学功能和膝关节稳定性，仍是后交叉韧带替代型假体的最佳选择。

Abstract:

[Objective] To determine whether posterior stabilized (PS) prosthesis can obtain better clinical efficacy, kinematic functionand knee stability than ultracongruent (UC) prosthesis in primary total knee arthroplasty (TKA). [Methods] The databases, includingPubMed, EMBASE, Cochrane Library, Wanfang, CNKI, and China Biology Medicine Disc database, were searched for relevant studies onthe comparison of PS and UC prosthesis in primary TKA from the establishment of the database to December 2021. Two reviewers indepen-dently screened literature and extracted data. The quality of the studies was evaluated according to the Newcastle-Ottawa Scale (NOS) andthe Cochrane risk of bias assessment tool. Review Manager 5.4 was used for a meta-analysis. [Results] A total of 22 studies were included inthis meta-analysis, including 11 randomized controlled trials, 9 retrospective studies, and 2 prospective studies, with a total of 2 904 kneesinvolved. The results of meta-analysis showed that the UC group were less than PS group the in terms of femoral rollback (WMD=-5.20, 95%CI -5.85~-4.54, P＜0.001) and the maximal flexion (WMD=-2.27, 95%CI -3.75~-0.79, P=0.003), whereas the UC group was significantlygreater than the PS group in term of the tibial sagittal laxity (WMD=5.10, 95%CI 3.45~6.76, P＜0.001). There were no significant differencesin function score (SMD=-0.08, 95% CI- 0.30~0.13, P=0.43), pain score (WMD=1.88, 95% CI-2.32~6.08, P=0.38), ROM (WMD=-0.82,95%CI -2.38~0.75, P=0.31), flexion contracture (SMD=-0.05, 95%CI -0.25~0.14, P=0.59), and peak torque (WMD=0.26, 95%CI -2.91~3.43, P=0.87) between the two groups. [Conclusion] In the primary TKA, the PS prosthesis has better kinematics and knee stability, and isstill the best choice of posterior cruciate ligament replacement prosthesis.