摘要
目的:应用Meta分析研究同期双侧全膝关节置换或分期双侧全膝关节置换的安全性和疗效。方法:通过检索中国万方、知网及PubMed、Cochrane Library、Web of Science等数据库,检索关于同期或分期行全膝关节置换术的研究,应用Review Manager 5.3软件对所提取的数据进行Meta分析。结果:(1)共纳入18项回顾性队列研究,共176426例患者,同期组患者72831例,分期组患者103595例;(2)Meta结果显示:分期组的术后心脏并发症发生率[OR=1.21,95%CI=(1.10~1.34),P<0.0001]、神经系统并发症发生率[OR=1.67,95%CI=(1.29~2.16),P<0.0001]、深静脉血栓发生率[OR=1.38,95%CI(1.27~1.50),P<0.00001]、死亡率[OR=2.18,95%CI=(1.67~2.84),P<0.00001]以及围手术期失血量[OR=205.14,95%CI=(115.25~295.03),P<0.00001]均优于同期组;同期组术后深部感染率[OR=0.61,95%CI=(0.52至0.71),P<0.00001]小于分期组;二者术后浅表感染率[OR=0.96,95%CI=(0.66~1.40),P=0.85]、关节置换翻修率[OR=1.04,95%CI=(0.96~1.12),P=0.39]、HSS评分[OR=0.10,95%CI=(−0.61~0.80),P=0.79]以及膝关节活动度评分[OR=−0.23,95%CI=(−1.25~0.78),P=0.65]差异无统计学意义。结论:分期双侧全膝关节置换可以更有效降低围手术期各项并发症发生率,还能减少输血量,而同期双侧全膝关节置换可减少深部感染率。为进一步比较同期或分期双侧全膝关节置换的疗效和安全性,进一步的研究必须以随机临床试验的形式进行,以评估本评论中提到的结果。
Objective:To study the safety and efficacy of concurrent bilateral total knee arthroplasty or staged bilateral total knee replacement using meta-analysis.Methods:The databases of China Wanfang,CNKI,PubMed,Cochrane Library,and Web of Science were searched conducted for meta‐analysis of the extracted data using Review Manager 5.3 software.Results:①A total of 18 retrospective cohort studies were included,72831 patients in the same period group and 103595 patients in the staging group.②The results of meta showed that in the staging group,the incidence of postoperative cardiac complications[OR=1.21,95%CI=(1.10~1.34),P<0.0001],neurological complications[OR=1.67,95%CI=(1.29~2.16),P<0.0001],deep vein thrombosis[OR=1.38,95%CI(1.27~1.50),P<0.00001],mortality[OR=2.18,95%CI=(1.67~2.84),P<0.00001]and perioperative blood loss[OR=246.75,95%CI=(233.30~260.20)]were less than those in the same period group(P<0.00001);The postoperative deep infection rate in the same period group[OR=0.61,95%CI=(0.52~0.71),P<0.00001]was lower than that in the staging group;The postoperative superficial infection rate[OR=0.96,95%CI=(0.66~1.40)],revision rate of joint re‐placement[OR=1.04,95%CI=(0.96~1.12)],HSS score[OR=0.10,95%CI=(‐0.61~0.80),P=0.79]and knee joint ac‐tivity score[OR=‐0.23,95%CI=(‐1.25~0.78)]were not statistically significant between the two groups(P>0.05).Conclu⁃sion:Staging bilateral total knee replacement can more effectively reduce the incidence of perioperative complications and reduce the amount of blood transfusion,while concurrent bilateral total knee replacement can reduce the rate of deep infection.To further compare the efficacy and safety of concurrent or staged bilateral total knee arthroplasty,further studies must be conducted in the form of a randomized clinical trial to evaluate the results mentioned in this meta-analysis.
作者
阿里木江·玉素甫
阿卜杜吾普尔·海比尔
王继荣
李伟
冉建
ALIMUJIANG·Yusufu;ABUDUWUPUER·Haibier;WANG Ji‐rong;LI Wei;RAN Jian(The Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,China;PLA Army 951st Orthopaedic Hospital,Korlag 841000,China;General Hospital of the Third Division,Tumushuk 843900,China)
出处
《海南医学院学报》
2023年第14期1098-1107,1114,共11页
Journal of Hainan Medical University
基金
新疆维吾尔自治区自然科学基金资助项目(2019D01C244)。
