初次人工全膝关节置换术中切除滑膜与否对失血量和临床疗效影响的Meta分析
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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 Pub Med, 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( q RCT) with or without synovectomy in primary TKA. The methodological quality of the included trials was assessed. Data were analyzed using Rev Man 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.
[Objective] To review the effect of synovectomy on bleeding and clinical outcomes of primary total knee arthroplasty(TKA). [Methods] We electronically searched Pub Med, 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( q RCT) with or without synovectomy in primary TKA. The methodological quality of the included trials was assessed. Data were analyzed using Rev Man 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.
引文
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[2]Jones EA,Crawford A,English A,et al.Synovial fluid mesenchymal stem cells in health and early osteoarthritis:detection and functional evaluation at the single cell level[J].Arthritis Rheumatism,2008,58(6):1731-1740.
[3]王华军,李锋,聂喜增,等.全膝关节置换术中滑膜切除对术后功能恢复及失血影响的临床研究[J].中国矫形外科杂志,2015,23(7):610-614.
[4]Lavand'Homme P,Thienpont E.Pain after total knee arthroplasty:a narrative review focusing on the stratification of patients at risk for persistent pain[J].Bone&Joint J,2015,97-B(10_Supple_A):45-48.
[5]Yasgur DJ,Scuderi GR,Insall JN.Medial release for fixed-varus deformity[M]//Knee Arthroplasty Handbook.Springer New York,2006:25-40.
[6]Tanaka N,Sakahashi H,Sato E,et al.Influence of the infrapatellar fat pad resection in a synovectomy during total knee arthroplasty in patients with rheumatoid arthritis[J].J Arthroplasty,2003,18(7):897-902.
[7]赵旭红,伍骥,李松林,等.全膝关节置换同时进行滑膜切除术与否对初期骨关节炎患者术后炎性周期及临床结果的影响[J].中国矫形外科杂志,2013,21(3):238-242.
[8]Tanavalee A,Honsawek S,Rojpornpradit T,et al.Inflammation related to synovectomy during total knee replacement in patients with primary osteoarthritis[J].J Bone Joint Surg Br,2011,93(8):1065-1070.
[9]Kilicarslan K,Yalcin N,Cicek H,et al.The effect of total synovectomy in total knee arthroplasty:a prospective randomized controlled study[J].Knee Surg Sports Traumatol Arthroscopy,2011,19(6):932-935.
[10]Krackow KA.The technique of total knee arthroplasty[M].Mosby Inc,1990.
[11]Roch-Bras F,Daurès JP,Legouffe MC,et al.Treatment of chronic knee synovitis with arthroscopic synovectomy:longterm results[J].J Rheumatol,2002,29(6):1171-1175.
[12]姜军,倪磊.膝骨关节炎关节镜清理后即刻与2周后注射玻璃酸钠的比较[J].中国组织工程研究,2013,17(35):6375-6380.
[13]Zhaoning X,Xu Y,Shaoqi T,et al.The effect of synovectomy on bleeding and clinical outcomes for total knee replacement[J].Bone Joint J,2013,95(9):1197-1200.
[14]宁纪斌,田少奇,杨旭,等.滑膜切除对全膝关节置换治疗骨性关节炎的影响[J].齐鲁医学杂志,2014(6):519-521.
[15]李治国,杨晓茂,杨洪军,等.切除滑膜对骨性关节炎全膝关节置换患者术后近期疗效及康复效果的影响[J].检验医学与临床,2014,11(5):636-637.
[16]董乃健,柯铭锋,黄柳平.全膝关节置换术中滑膜切除对患者失血量及膝关节功能的影响[J].医学理论与实践,2016,29(21):108-110.
[17]石士平,李伟,张伟,等.膝骨性关节炎分级与全膝关节置换后隐性失血[J].中国组织工程研究,2013,17(35):6234-6239.
[18]赵辉,殷力,韩奇财,等.全膝关节置换术后高屈曲活动度对改善患者生活质量的作用[J].中华实验外科杂志,2015,32(4):916-918.
[19]高玉镭,张寅权,宋方龙,等.切除与不切除滑膜对人工全膝关节置换术后感染影响的比较[J].中国矫形外科杂志,2016,24(5):411-415.
[20]Attur M,Samuels J,Krasnokutsky S,et al.Targeting the synovial tissue for treating osteoarthritis(OA):where is the evidence[J].Best Practice Res Clin Rheumatol,2010,24(1):71-79.
[21]Lyb?ck CO,Belt EA,Savolainen HA,et al.Previous synovectomy or epiphyseal stapling and the influence on knee replacement in juvenile chronic arthritis[J].Int Orthop,2004,28(3):134-137.
[22]Demey G,Servien E,Pinaroli A,et al.The influence of femoral cementing on perioperative blood loss in total knee arthroplasty[J].J Bone Joint Surg,2010,92(3):536-541.
[23]罗正亮,尚希福,胡飞,等.全膝关节置换术后关节腔引流管两种处理方式的临床观察[J/CD].中华临床医师杂志:电子版,2012(20):6541-6543.
[24]Mc Manus KT,Velchik MG,Alavi A,et al.Non-invasive assessment of postoperative bleeding in TKA patients with Tc-99m RNCs[J].J Nuclear Med,1987,28(8):565-567.
[25]Pattison E,Protheroe K,Pringle RM,et al.Reduction in haemoglobin after knee joint surgery[J].Annals Rheumatic Dis,1973,32(6):582.
[26]Kooner SS,Clark M.The effect of synovectomy in total knee arthroplasty for primary osteoarthritis:a meta-analysis[J].J Knee Surg,2016.
[27]Pan X,Zhang X,Liu Z,et al.Treatment for chronic synovitis of knee:arthroscopic or open synovectomy[J].Rheumatol Int,2012,32(6):1733-1736.
[2]Jones EA,Crawford A,English A,et al.Synovial fluid mesenchymal stem cells in health and early osteoarthritis:detection and functional evaluation at the single cell level[J].Arthritis Rheumatism,2008,58(6):1731-1740.
[3]王华军,李锋,聂喜增,等.全膝关节置换术中滑膜切除对术后功能恢复及失血影响的临床研究[J].中国矫形外科杂志,2015,23(7):610-614.
[4]Lavand'Homme P,Thienpont E.Pain after total knee arthroplasty:a narrative review focusing on the stratification of patients at risk for persistent pain[J].Bone&Joint J,2015,97-B(10_Supple_A):45-48.
[5]Yasgur DJ,Scuderi GR,Insall JN.Medial release for fixed-varus deformity[M]//Knee Arthroplasty Handbook.Springer New York,2006:25-40.
[6]Tanaka N,Sakahashi H,Sato E,et al.Influence of the infrapatellar fat pad resection in a synovectomy during total knee arthroplasty in patients with rheumatoid arthritis[J].J Arthroplasty,2003,18(7):897-902.
[7]赵旭红,伍骥,李松林,等.全膝关节置换同时进行滑膜切除术与否对初期骨关节炎患者术后炎性周期及临床结果的影响[J].中国矫形外科杂志,2013,21(3):238-242.
[8]Tanavalee A,Honsawek S,Rojpornpradit T,et al.Inflammation related to synovectomy during total knee replacement in patients with primary osteoarthritis[J].J Bone Joint Surg Br,2011,93(8):1065-1070.
[9]Kilicarslan K,Yalcin N,Cicek H,et al.The effect of total synovectomy in total knee arthroplasty:a prospective randomized controlled study[J].Knee Surg Sports Traumatol Arthroscopy,2011,19(6):932-935.
[10]Krackow KA.The technique of total knee arthroplasty[M].Mosby Inc,1990.
[11]Roch-Bras F,Daurès JP,Legouffe MC,et al.Treatment of chronic knee synovitis with arthroscopic synovectomy:longterm results[J].J Rheumatol,2002,29(6):1171-1175.
[12]姜军,倪磊.膝骨关节炎关节镜清理后即刻与2周后注射玻璃酸钠的比较[J].中国组织工程研究,2013,17(35):6375-6380.
[13]Zhaoning X,Xu Y,Shaoqi T,et al.The effect of synovectomy on bleeding and clinical outcomes for total knee replacement[J].Bone Joint J,2013,95(9):1197-1200.
[14]宁纪斌,田少奇,杨旭,等.滑膜切除对全膝关节置换治疗骨性关节炎的影响[J].齐鲁医学杂志,2014(6):519-521.
[15]李治国,杨晓茂,杨洪军,等.切除滑膜对骨性关节炎全膝关节置换患者术后近期疗效及康复效果的影响[J].检验医学与临床,2014,11(5):636-637.
[16]董乃健,柯铭锋,黄柳平.全膝关节置换术中滑膜切除对患者失血量及膝关节功能的影响[J].医学理论与实践,2016,29(21):108-110.
[17]石士平,李伟,张伟,等.膝骨性关节炎分级与全膝关节置换后隐性失血[J].中国组织工程研究,2013,17(35):6234-6239.
[18]赵辉,殷力,韩奇财,等.全膝关节置换术后高屈曲活动度对改善患者生活质量的作用[J].中华实验外科杂志,2015,32(4):916-918.
[19]高玉镭,张寅权,宋方龙,等.切除与不切除滑膜对人工全膝关节置换术后感染影响的比较[J].中国矫形外科杂志,2016,24(5):411-415.
[20]Attur M,Samuels J,Krasnokutsky S,et al.Targeting the synovial tissue for treating osteoarthritis(OA):where is the evidence[J].Best Practice Res Clin Rheumatol,2010,24(1):71-79.
[21]Lyb?ck CO,Belt EA,Savolainen HA,et al.Previous synovectomy or epiphyseal stapling and the influence on knee replacement in juvenile chronic arthritis[J].Int Orthop,2004,28(3):134-137.
[22]Demey G,Servien E,Pinaroli A,et al.The influence of femoral cementing on perioperative blood loss in total knee arthroplasty[J].J Bone Joint Surg,2010,92(3):536-541.
[23]罗正亮,尚希福,胡飞,等.全膝关节置换术后关节腔引流管两种处理方式的临床观察[J/CD].中华临床医师杂志:电子版,2012(20):6541-6543.
[24]Mc Manus KT,Velchik MG,Alavi A,et al.Non-invasive assessment of postoperative bleeding in TKA patients with Tc-99m RNCs[J].J Nuclear Med,1987,28(8):565-567.
[25]Pattison E,Protheroe K,Pringle RM,et al.Reduction in haemoglobin after knee joint surgery[J].Annals Rheumatic Dis,1973,32(6):582.
[26]Kooner SS,Clark M.The effect of synovectomy in total knee arthroplasty for primary osteoarthritis:a meta-analysis[J].J Knee Surg,2016.
[27]Pan X,Zhang X,Liu Z,et al.Treatment for chronic synovitis of knee:arthroscopic or open synovectomy[J].Rheumatol Int,2012,32(6):1733-1736.