基于PearlDiver数据库水泥与非水泥全膝置换比较△（开放获取）

Comparison of cemented and non-cemented total knee arthroplasty based on the PearlDiver database（OA）

摘要:

[目的] 基于 PearlDiver 数据库的大数据，比较非水泥型与水泥型人工全膝关节置换术 （total knee arthroplasty, TKA）的临床效果。[方法]检索美国大型医疗记录数据库 PearlDiver 2015 年 10 月—2020 年 10 月采用 TKA 治疗的 103 231 例膝关节骨关节炎患者的资料。其中 17 299 例采用非水泥型 TKA，85 932 例采用水泥型 TKA。比较两组患者术后 90 d 内的内科并发症及术后 2 年内的外科并发症。[结果]非水泥组 TKA 术后 90 d 内输血率 [例 (%), 403 (2.3) vs 1 631 (1.9), P＜0.001] 和患者再入院率 [例 (%), 1 440 (8.3) vs 6 542 (7.6), P＜0.001] 显著高于水泥组，但前者的深静脉血栓发生率显著低于后者 [例 (%), 495 (2.9) vs 2 725 (3.2), P=0.032] 。两组间肺炎、肺栓塞等其他内科并发症发生率的差异均无统计学意义（P＞0.05）。非水泥组术后 2 年假体无菌松动发生率显著低于水泥组 [例 (%), 318 (1.8) vs 1 811 (2.1), P=0.031] 。两组伤口并发症、假体周围感染、关节僵硬、假体周围骨折、关节翻修等发生率差异均无统计学意义（P＞0.05）。[结论] 在初次 TKA 中，与水泥 TKA 相比，非水泥 TKA 的围手术期失血风险显著升高，而其术后假体无菌松动的概率则相对降低。两种 TKA 在假体周围感染、关节翻修及其他并发症风险方面无明显差异。

Abstract:

[Objective] To compare the clinical outcomes of non-cemented total knee arthroplasty (TKA) with cemented TKA through a large-scale retrospective analysis. [Methods] A retrospective analysis was conducted on the data of a major U.S. medical records database PearlDiver, covering 103,231 cases of knee osteoarthritis patients who underwent TKA between October 2015 and October 2020. Among them, 17,299 cases received non-cemented TKA, while the remaining 85,932 cases underwent cemented TKA. The medical complications within 90 days after surgery and surgical complications within 2 years after surgery were compared between the two groups. [Results] The non-cemented cohort proved significantly higher than the cemented counterpart in terms of blood transfusion rate within 90 days after TKA [cases (%), 403 (2.3) vs 1 631 (1.9), P＜0.001] and readmission rate [case (%), 1 440 (8.3) vs 6 542 (7.6), P＜0.001], whereas the former had significantly lower incidence of deep vein thrombosis than the latter [cases (%), 495 (2.9) vs 2 725 (3.2), P=0.032]. There was no significant difference in the incidence of other medical complications such as pneumonia and pulmonary embolism (P＞0.05). However, the non-cemented cohort had significantly lower incidence of aseptic prosthesis loosening within 2 years after surgery than the cemented cohort [cases (%), 318 (1.8) vs 1 811 (2.1), P=0.031]. There were no significant differences in the incidence of wound complications, periprosthetic joint infection, joint stiffness, periprosthetic fracture and revision TKA between the two groups (P＞0.05). [Conclusion] In term of primary arthroplasty, the non-cemented TKA has significantly higher risk of perioperative blood loss compared with the cemented counterpart, however, the former has relative lower chance of postoperative aseptic loosening of the prosthesis than the latter. There was no significant difference in the risk of periprosthetic joint infection, revision surgery, or other complications between the two types of TKA.