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中华老年骨科与康复电子杂志 ›› 2019, Vol. 05 ›› Issue (03) : 173 -178. doi: 10.3877/cma.j.issn.2096-0263.2019.009

所属专题: 文献

Meta分析

髌下脂肪垫对全膝关节置换术后患者膝关节功能恢复影响的meta分析
张禄锴1, 张博雅2, 张治金1, 朱芳兵1, 侯桥1, 全仁夫1,()   
  1. 1. 311200 杭州市萧山区中医院骨伤科
    2. 300000 天津中医药大学
  • 收稿日期:2018-05-06 出版日期:2019-06-05
  • 通信作者: 全仁夫

Effect of infrapatellar fat pad on the knee functional recovery following total knee replacement in patients: a Meta-analysis

Lukai Zhang1, Boya Zhang2, Zhijin Zhang1, Fangbing Zhu1, Qiao Hou1, Renfu Quan1,()   

  1. 1. Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou 311200, China
    2. Tianjin University of Traditional Chinese Medicine, Tianjin 300000, China
  • Received:2018-05-06 Published:2019-06-05
  • Corresponding author: Renfu Quan
引用本文:

张禄锴, 张博雅, 张治金, 朱芳兵, 侯桥, 全仁夫. 髌下脂肪垫对全膝关节置换术后患者膝关节功能恢复影响的meta分析[J/OL]. 中华老年骨科与康复电子杂志, 2019, 05(03): 173-178.

Lukai Zhang, Boya Zhang, Zhijin Zhang, Fangbing Zhu, Qiao Hou, Renfu Quan. Effect of infrapatellar fat pad on the knee functional recovery following total knee replacement in patients: a Meta-analysis[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2019, 05(03): 173-178.

目的

通过meta分析评价髌下脂肪垫对全膝关节置换患者术后功能恢复的影响。

方法

检索Cochrane Library、Embase、PubMed英文数据库和万方数据库、维普数据库以及中国知网数据库有关于髌下脂肪垫对全膝关节置换术后影响的临床随机对照试验(RCTs)和回顾性队列研究实验(RCSs),使用Revman5.3软件进行meta分析。

结果

最终共纳入8篇文献,其中英文文献4篇,中文文献4篇,共纳入全膝关节置换术病例1 474例,其中髌下脂肪垫切除术696例,髌下脂肪垫保留组778例。与髌下脂肪垫切除相比,髌下脂肪垫保留组可降低术后髌韧挛缩(MD=-2.34,95% CI:-3.38~-1.31,P<0.05),麦克马斯特骨关节炎指数(WOMAC)评分(MD=2.34,95% CI:2.04~2.65,P<0.05);提高膝关节功能评分(MD=-0.77,95% CI:-1.02~-0.52,P<0.05),降低术后膝关节前侧疼痛发生率(RR=12.58,95% CI:3.24~48.75,P<0.05)。两组患者在术后膝关节活动度(MD=-7.53,95% CI:-20.27~5.21,P>0.05),髌腱长度与髌骨最大长轴比值(Insall-Savatict)评分法(MD=-0.04,95% CI:-0.09~0.01,P>0.05);术后膝关节返修率:(RD=0.01,95% CI:-0.01~0.02,P>0.05)方面无明显差异。

结论

与髌下脂肪垫去除组相比,全膝关节置换术后髌下脂肪垫保留可以降低髌韧带痉挛程度,提高膝关节功能评分,同时可降低膝关节前侧疼痛。

Objective

To evaluate the effect of infrapatellar fat pad in knee functional recovery following total knee replacement.

Methods

All randomized controlled trials (RCTs) and retrospective Cohort Studies (RCSs) comparing the effect of infrapatellar fat pad in knee functional recovery in primary TKA were searched from Cochrane Library, Embase, PubMed, CBM, VIP, Wang Fang date and CNKI. At the same time conference papers were identified manually. A quality assessment of the included literatures was evaluated by Cochrane system evaluation manually. Revman 5.3 was used for the Meta-analysis.

Results

Eight literatures involving 1,474 TKA were identified including 696 cases underwent infrapatellar fat excised and 778 cases preserved infrapatellar fat. The two groups were comparable regarding length of patellar tendon (MD=-2.34, 95% CI: -3.38-1.31, P<0.05), WOMAC scores (MD=2.34, 95% CI: 2.04-2.65, P<0.05), AKS (MD=-0.77, 95% CI: -1.02-0.52, P<0.05), Insall-Salvati (MD=-0.04, 95%CI: -0.09-0.01, P>0.05), postoperative pain (MD=12.58, 95% CI: 3.24-48.75, P<0.05), knee flexion (MD=-7.53, 95% CI: -20.27-5.21, P>0.05), wound revision (MD=0.01, 95% CI: -0.01-0.02, P>0.05).

Conclusions

Compared to in frapatellar fat excised group, the preserved group had lesser degree of patellar tendon spasm, higher knee function lower and can reduce anterior pain of the knee.

图1~2 纳入文献的偏倚风险评价
表1 纳入文献患者的一般资料情况
图9 髌骨下脂肪垫保留组与去除组术后膝关节返修率比较
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