摘要
[目的]通过Meta分析方法探讨初次全膝关节置换术(total knee arthroplasty,TKA)中切除滑膜对失血量和临床疗效的影响。[方法]计算机检索数据库Pub Med、EBSCO、The Cochrane Library、WANFANG、CNKI、VIP中关于人工全膝关节置换术中切除滑膜与不切除的随机对照试验(RCT)或半随机对照试验(q-RCT),检索时限为2000年01月~2017年10月。本Meta分析使用Rev Man5.2软件,采用质量评价和发表偏倚评价筛选的文献。[结果]纳入7篇文献,968例患者,切除滑膜组473例,不切除滑膜组495例。Meta分析结果显示:切除滑膜组与不切除组相比,术后引流量[WMD=133.18,95%CI(94.36,172.00),P<0.001]、隐性失血量[WMD=191.35,95%CI(106.48,276.22),P<0.001]、手术时间[WMD=0.16,95%CI(0.05,0.26),P=0.004]两组间差异有统计学意义;术后VAS评分[WMD=-0.03,95%CI(-0.46,0.40),P=0.890]、ROM[WMD=0.60,95%CI(-0.84,2.05),P=0.400]、CKSS[WMD=-0.35,95%CI(-0.91,0.22),P=0.230]、FKSS[WMD=-0.70,95%CI(-1.42,0.01),P=0.050]差异无统计学意义。[结论]TKA术中切除滑膜显著增加了术后引流量、隐性失血量,同时延长了手术时间,而对术后疼痛的缓解和功能恢复并无显著优势。
[Objective] To review the effect of synovectomy on bleeding and clinical outcomes of primary total knee arthroplasty （TKA）. [Methods] We electronically searched PubMed, EBSCO, the Cochrane Library, CNKI and Wanfang Data from January 2000 to October 2017 to identify randomized controlled trial （RCT） and quasi-randomized controlled trial （qRCT） with or without synovectomy in primary TKA. The methodological quality of the included trials was assessed. Data were analyzed using RevMan 5.2 software. [Results] A total of seven articles were taken in this study involving 968 patients, including 473 in the synovectomy group and 495 in the non-synovectomy group. There were significant differences between the two groups regarding postoperative blood loss from drains [WMD=133.18, 95%CI （94.36, 172.00）, P〈0.000 01] , concealed blood loss [WMD= 191.35, 95%CI （106.48, 276.22）, P〈0.000 01], operating time [WMD=0.16, 95%CI （0.05, 0.26）, P=0.004]. However, there were no significant differences between the two groups regarding to VAS for pain [WMD=-0.03, 95%CI （-0.46, 0.40）, P=0.89], ROM [WMD=0.60, 95%CI （-0.84, 2.05）, P=0.4], Clinical Knee Society Score [WMD=-0.35, 95%CI （-0.91, 0.22）, P=0.23], Functional Knee Society Score [WMD=-0.70, 95%CI （-1.42, 0.01）, P=0.05]. [Conclusion] The patients with synovectomy in TKA have a higher postoperative blood loss from drain, concealed blood loss and longer surgery time without any clinical advantages in pain relief and functional recovery.
作者
王建明
徐闯
李健
杜长岭
任强
刘明廷
WANG Jian-ming;XU Chuang;LI Jian;DU Chang-ling;REN Qiang;LIU Ming-ting(Department of Bone and Joint Surgery, The Affiliated Hospital, Binzhou Medical College, Binzhou 256600, Chin)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第11期1010-1016,共7页
Orthopedic Journal of China
基金
山东省自然科学基金项目(编号:ZR2015PH006)
滨州医学院科研计划项目(编号:BY2016KJ29)
