间隙平衡与测量截骨技术对全膝关节置换术疗效影响的Meta分析

doi:10.3877/cma.j.issn.2095-8757.2022.04.007

目的

评价全膝关节置换术（TKA）中间隙平衡（GB）技术和测量截骨（MR）技术的应用效果。

方法

检索PubMed、Embase、中国知网、维普、万方、中国生物医学文献数据库等数据库中2009年5月至2021年5月发表的有关TKA术中GB和MR应用效果对比的随机对照临床试验文献，同时手工检索杂志目录以及参考文献。所有文献严格按照Cochrane标准进行偏倚风险评估，并根据改良Jadad量表评价文献质量。采用Review Manager 5.3软件对术后膝关节协会功能评分（KSFS）、术后膝关节协会评分（KSS）、术后关节活动度、术后下肢力线与小腿解剖轴夹角、术后机械轴夹角、术后关节间隙、术中截骨量、手术时间进行Meta分析。

结果

共纳入16篇文献进行Meta分析，其中外文文献12篇，中文文献4篇。总体上采用MR技术的TKA术后KSFS、KSS优于GB技术（MD=2.12，95%CI：0.74~3.50，P<0.01），但采用GB的TKA术后下肢力线与小腿解剖轴夹角（MD=-1.00，95%CI：-1.86~-0.13，P<0.05）、机械轴夹角（MD=-0.39，95%CI：-0.65~-0.13，P<0.01）均优于MR。

结论

采用TKA治疗中重度膝关节骨性关节炎时，MR技术具有更好的功能学评分，而GB技术在影像学评价中更具优势。

关键词: 间隙平衡, 测量截骨, 全膝关节置换术, 效果, Meta分析

Objective

To evaluate the effect of gap balance (GB) and measured resection (MR) in total knee arthroplasty (TKA).

Methods

Searches for randomized controlled clinical trials on the comparison of GB and MR effects during TKA published from May 2009 to May 2021 were performed in PubMed, Embase, CNKI, Vip, Wanfang, China Biomedical Literature Database, etc. And the magazine catalogue and references were searched manually. Cochrane risk of bias tool was used to assess the underling risk of bias of the included literature, and the quality of included literature was assessed with Jadad score. Meta analysis was performed in postoperative knee society function score (KSFS), postoperative knee society score (KSS), postoperative range of motion, postoperative angle between lower limb force line and leg anatomical axis, postoperative mechanical axis angle, postoperative joint space, intraoperative osteotomy and operation time using Review Manager 5.3.

Results

A total of 16 articles were included for meta analysis, including 12 in foreign languages and 4 in Chinese. MR was better in the overall KSFS and KSS than GB (MD=2.12, 95%CI: 0.74~3.50, P < 0.01), while GB was better in the angle between the lower limb force line and the leg anatomical axis (MD=-1.00, 95%CI: -1.86~0.13, P < 0.05), and the angle between the mechanical axis than MR (MD=-0.39, 95%CI: -0.65~-0.13, P < 0.01).

Conclusion

In the treatment of moderate and severe knee osteoarthritis with TKA, MR has a better functional score, while GB has more advantages in imaging results.

Key words: Gap balance, Measuring resection, Total knee arthroplasty, Effect, Meta analysis

图1 文献筛选流程图

表1 纳入文献的基本特征

作者	国家	发表年份	分组（GB组/MR组，例）	平均年龄（GB组/MR组，岁）	男性（GB组/MR组，例）	随访时间（月）	结局指标	改良Jadad质量评价
Babazadeh等^[10]	澳大利亚	2014	51/52	69.9/70.2	14/22	24	①⑤⑥	6
Baier等^[11]	德国	2014	19/21	70.0/72.4	15*	6	①②	5
Cidambi等^[12]	美国	2018	48/43	62.3*	41*	—	⑤	4
Hommel等^[13]	德国	2017	100/100	67.1/66.9	38/37	120	①②④⑦	7
Hernández-Hermoso等^[14]	西班牙	2019	39/33	70.2±6.7/69.9±7.4	8/4	24	①	4
Lee等^[15]	韩国	2010	60/56	68.7/69.2	3/2	24	④⑤	5
Lee等^[16]	韩国	2011	30/30	68.9/68.9	2/2	24	⑤⑦	4
袁兴期等^[17]	中国	2020	45/45	69.71±5.25/69.38±5.04	19/17	12	①②③⑥⑦	6
Moorthy等^[18]	新加坡	2020	50/50	68.4±7.0/66.1±7.2	10/12	24	①②	4
Pang等^[19]	新加坡	2011	70/70	68/70	10/12	24	①②④	5
Tapasvi等^[20]	印度	2020	50/50	66±7.4*	10*	24	②④⑥	5
Teeter等^[21]	加拿大	2017	12/12	67.2±7.0/70.0±7.9	7/3	12	①	4
Tigani等^[22]	意大利	2010	57/66	67/69	15/20	—	④	4
吴建明等^[23]	中国	2019	38/38	60.1±6.3/58.8±6.4	16/13	12	①③⑥⑦	6
柴瑞宝等^[24]	中国	2020	39/39	71.46±4.97/70.30±4.11	20/21	24	③⑦	4
王帝等^[25]	中国	2020	44/44	65.19±3.19/65.35±3.28	24/28	12		4

表1 纳入文献的基本特征

作者	国家	发表年份	分组（GB组/MR组，例）	平均年龄（GB组/MR组，岁）	男性（GB组/MR组，例）	随访时间（月）	结局指标	改良Jadad质量评价
Babazadeh等^[10]	澳大利亚	2014	51/52	69.9/70.2	14/22	24	①⑤⑥	6
Baier等^[11]	德国	2014	19/21	70.0/72.4	15*	6	①②	5
Cidambi等^[12]	美国	2018	48/43	62.3*	41*	—	⑤	4
Hommel等^[13]	德国	2017	100/100	67.1/66.9	38/37	120	①②④⑦	7
Hernández-Hermoso等^[14]	西班牙	2019	39/33	70.2±6.7/69.9±7.4	8/4	24	①	4
Lee等^[15]	韩国	2010	60/56	68.7/69.2	3/2	24	④⑤	5
Lee等^[16]	韩国	2011	30/30	68.9/68.9	2/2	24	⑤⑦	4
袁兴期等^[17]	中国	2020	45/45	69.71±5.25/69.38±5.04	19/17	12	①②③⑥⑦	6
Moorthy等^[18]	新加坡	2020	50/50	68.4±7.0/66.1±7.2	10/12	24	①②	4
Pang等^[19]	新加坡	2011	70/70	68/70	10/12	24	①②④	5
Tapasvi等^[20]	印度	2020	50/50	66±7.4*	10*	24	②④⑥	5
Teeter等^[21]	加拿大	2017	12/12	67.2±7.0/70.0±7.9	7/3	12	①	4
Tigani等^[22]	意大利	2010	57/66	67/69	15/20	—	④	4
吴建明等^[23]	中国	2019	38/38	60.1±6.3/58.8±6.4	16/13	12	①③⑥⑦	6
柴瑞宝等^[24]	中国	2020	39/39	71.46±4.97/70.30±4.11	20/21	24	③⑦	4
王帝等^[25]	中国	2020	44/44	65.19±3.19/65.35±3.28	24/28	12		4

图2 全膝关节置换术中GB与MR技术对术后KSFS、KSS影响的Meta分析注：GB指间隙平衡技术；MR指测量平衡技术；KSFS指膝关节协会功能评分；KSS指膝关节协会评分

图3 全膝关节置换术中GB与MR技术对术后关节活动度影响的Meta分析注：GB指间隙平衡技术；MR指测量平衡技术；ROM：关节活动度

图4 全膝关节置换术中GB与MR对术后下肢力线与小腿解剖轴夹角影响的Meta分析注：GB指间隙平衡技术；MR指测量平衡技术

图5 全膝关节置换术中GB与MR对术后机械轴夹角影响的Meta分析注：GB指间隙平衡技术；MR指测量平衡技术

图6 全膝关节置换术中GB与MR对术后关节间隙影响的Meta分析注：GB指间隙平衡技术；MR指测量平衡技术

图7 全膝关节置换术中GB与MR对术中截骨量影响的Meta分析注：GB指间隙平衡技术；MR指测量平衡技术

图8 全膝关节置换术中GB与MR对手术时间影响的Meta分析注：GB指间隙平衡技术；MR指测量平衡技术

图9 全膝关节置换术中GB与MR技术应用效果的文献发表偏倚漏斗图注：A：术后膝关节功能评分、膝关节协会评分；B：术后关节活动度；C：术后下肢力线与小腿解剖轴夹角；D：术后机械轴夹角；E：术后关节间隙；F：术中截骨量；G：手术时间。GB指间隙平衡技术；MR指测量平衡技术

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Meta analysis of the effect of gap balance and measurement osteotomy in total knee arthroplasty

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Meta analysis of the effect of gap balance and measurement osteotomy in total knee arthroplasty