全膝置换股骨髓外与髓内定位截骨的荟萃分析△

Extramedullary versus intramedullary localizations for femoral osteotomy in total knee arthroplasty: a metaanalysis

摘要:

[目的] 系统评价在全膝关节置换术 （total knee arthroplasty, TKA） 中，股骨髓外 （extramedullary, EM） 定位与传统髓内 （intramedullary, IM） 定位截骨的临床结果。[方法] 检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、 Embase、Cochrane Library 和 Web of Science 数据库，收集所有 TKA 中应用 EM 和 IM 截骨技术的对照研究，采用 Stata 15.0 软件进行荟萃分析。[结果]8 项随机对照研究纳入本研究，共计 804 例患者，其中，EM 法 404 例，IM 法 400 例。荟萃分析结果显示：EM 组术后股骨假体冠状位角度显著优于 IM 组 （RR=0.184, 95%CI 0.07~0.45, P＜0.001），EM 组的失血量显著少于 IM 组 （MD=-161.24, 95%CI: -233.93~-88.55, P=0.016）。两组下肢冠状位对线（RR=1.2, 95%CI 0.28~5.21, P=0.809）、股骨假体矢状面角度（RR=0.18, 95%CI 0.07~0.45, P=0.541）、手术时间（MD=-0.74, 95%CI -4.04~-2.57, P=0.665）的差异均无统计学意义。[结论] 在 TKA 中，EM 定位在股骨假体冠状位角度方面比 IM 定位更准确，术后失血量更少，在下肢冠状位对线、股骨假体矢状位角度和手术时间方面，两者具有一致性。

Abstract:

[Objective] To systematically evaluate the clinical consequences of the extramedullary (EM) localizations versus the intramedullary (IM) counterpart for femoral osteotomy in primary total knee arthroplasty (TKA). [Methods] The controlled studies on EM and IM for femoral osteotomy in TKA were searched from data bases, including CNKI, Wanfang, VIP, Chinese Biomedical Literature Database, PubMed, Embase, Cochrane Library and Web of Science databases. A metaanalysis was performed using Stata 15.0 software. [Results] Eight randomized controlled studies were included in this study, with a total of 804 patients, including 404 cases in the EM group and 400 cased in the IM group. As results of the meta-analysis, The EM group was significantly superior to the IM group in terms of coronal angle of femoral prosthesis (RR=0.184, 95%CI 0.07-0.45, P＜0.001), and the blood loss (MD=-161.24, 95%CI -233.93~-88.55, P=0.016). However, there were no significant differences in terms of coronal alignment of lower limbs (RR=1.2, 95%CI 0.28~5.21, P=0.809), sagittal angle of femoral prosthesis (RR=0.18, 95%CI 0.07~0.45, P=0.541), operative time (MD=-0.74, 95%CI -4.04~-2.57, P=0.665) between the two groups. [Conclusion] EM localization for femoral osteotomy in TKA get more accurate coronal angle of femur prosthesis with less blood loss over the IM localization, while the two techniques are similar in terms of coronal position alignment of lower limb, sagittal angle of femur prosthesis and operation time.