单髁置换术治疗膝关节自发性骨坏死临床疗效的Meta分析

陈能　吕燃　马少云　全华山　贾晓军　谭方　李敏龙

【摘 要】目的：系統评价单髁置换术治疗自发性膝关节骨坏死的有效性和翻修率情况。方法：计算机检索Web of Science、Pubmed、EMbase等英文数据库，以及中国知网（CNKI）、万方（WANFANG）、维普（VIP）、中国生物医学文献数据库（CBM）等中文数据库，检索时间均为数据库建立至2018年9月30日。检索单髁置换术治疗膝关节自发性骨坏死的单臂随机对照试验，经文献筛选、提取资料后，采用Stata 15.1软件进行疗效Meta分析。结局指标包括治疗前后视觉模拟评分法（VAS）评分、美国特种外科医院膝关节评分（HSS评分）、关节活动度（ROM）、股骨胫骨角（FTA）以及翻修率，采用随机效应模型分析。结果：初次检索获得文献277篇，按照纳入及排除标准，最终纳入21篇文献，共计703例，Meta分析结果显示，9篇文献报道了治疗前后VAS评分，治疗前VAS评分为7.04分（95%CI = [6.50，7.58]，P < 0.001，I? = 93.5%）;治疗后VAS评分为1.96分（95%CI = [1.39，2.54]，P < 0.001，I? = 95.2%）。10篇文献报道了治疗前后HSS评分，治疗前HSS评分为62.76分（95%CI = [59.00，66.53]，P < 0.001，I? = 94.5%）;治疗后HSS评分为89.68分（95%CI = [86.90，92.45]，P < 0.001，I?= 95.6%）。10篇文献报道了治疗前后ROM，治疗前ROM为112.82°（95%CI = [105.52，120.12]，P < 0.001，I? = 98.8%）;治疗后ROM为119.63°（95%CI = [114.05，125.21]，P < 0.001，I? = 97.2%）。11篇文献报道了手术前后FTA，手术前FTA为179.44°（95%CI = [177.99，180.89]，P < 0.001，I? = 94.0%）;手术后FTA为177.36°（95%CI = [176.85，177.88]，P < 0.001，I? = 60.3%）。21篇文献报道了翻修率，为0.02（95%CI = [0.01，0.05]，P = 0.01，I? = 46.63%）。结论：单髁置换术治疗膝关节自发性骨坏死疗效良好，翻修率低。

【关键词】 膝关节自发性骨坏死;单髁置换术;翻修率;Meta分析

【ABSTRACT】Objective：To systematically evaluate the effectiveness and revision rate of unicondylar replacement in the treatment of spontaneous knee osteonecrosis.Methods：The English databases of Web of Science，Pubmed，EMbase and Chinese databases such as CNKI，WANFANG，VIP and CBM were searched by computer.The searching time was from the establishment of above databases to September 30，2018.Retrieval was done for the single arm randomized controlled trials of unicondylar replacement for the treatment of spontaneous osteonecrosis of the knee joint.After literature screening and data extraction，meta-analysis of the efficacy was carried out with Stata 15.1 software.Outcome indicators included VAS before and after treatment，HSS，ROM，FTA and revision rate.Random effect model was used to analyze the outcome.Results：Two hundred and seventy-seven articles were retrieved for the first time，and 21 of them were included according to inclusion and exclusion criteria.A total of 703 patients were included.Meta analysis showed that nine articles reported VAS scores before and after treatment.The VAS score before treatment was 7.04（95% CI = [6.50，7.58]，P < 0.001，I? = 93.5%）.The VAS score after treatment was 1.96（95% CI = [1.39，2.54]，P < 0.001，I? = 95.2%.Ten articles reported HSS scores before and after treatment.HSS score before treatment was 62.76（95% CI = [59.00，66.53]，P < 0.001，I? = 94.5%），while HSS score after treatment was（95%CI = [86.90，92.45]，P < 0.001，I? = 95.6%）;Ten articles reported ROM before and after treatment.ROM before treatment was 112.82°（95%CI = [105.52，120.12]，P < 0.001，I? = 98.8%），while ROM after treatment was 119.63°（95%CI = [114.05，125.21]，P < 0.001，I? = 97.2%）.Eleven articles reported FTA before and after surgery.FTA before surgery was 179.44°（95% CI = [177.99，180.89]，P < 0.001，I? = 94.0%），while FTA after surgery was 177.36°（95%CI = [176.85，177.88]，P < 0.001，I? = 60.3%）.Twenty-one articles reported he renovation rate 0.02（95%CI = [0.01，0.05]，P = 0.01，I? = 46.63%）.Conclusion：Unicondylar arthroplasty is effective in the treatment of knee spontaneous osteonecrosis with low revision rate.It is expected to be further verified by high quality，large sample and long-term follow-up randomized controlled trials.