【摘要】：目的:運用Meta分析方法評價髕周去神經(jīng)化處理對保留髕骨型初次全膝關(guān)節(jié)置換術(shù)的療效。方法:根據(jù)PICO原則(Participant,Intervention,Comparator,Outcome)制定文獻納入排除標準。通過計算機在MEDLINE、EMBASE、Cochrane Library、中國知網(wǎng)(China National Knowledge Infrastructure,CNKI)、萬方數(shù)據(jù)資源(wanfang Data system)、中文期刊全文數(shù)據(jù)庫(VIP)、中國生物醫(yī)學文獻數(shù)據(jù)庫(China Biomedical Database,CBM)等中英文數(shù)據(jù)庫,檢索髕周去神經(jīng)化處理在保留髕骨型初次全膝關(guān)節(jié)置換中療效的隨機對照試驗研究(Randomized Controlled Trial,RCT),結(jié)合Google學術(shù)進行補充檢索。由兩名獨立的研究人員對文獻進行篩查、質(zhì)量評價及數(shù)據(jù)提取。結(jié)局觀察指標包括:膝前痛(anterior knee pain,AKP)發(fā)生率、視覺模擬評分(Visual Analogue Scale,VAS)、Feller髕骨評分、美國膝關(guān)節(jié)社會評分(American Knee Society Scole,KSS)-臨床評分、KSS-功能評分、膝關(guān)節(jié)活動度(range of motion,ROM)、術(shù)后感染及并發(fā)癥情況。采用Cochrane協(xié)作網(wǎng)中的Jadad評分量表結(jié)合分配隱藏方法對納入文獻行質(zhì)量評價,同時應用Cochrane協(xié)作網(wǎng)提供的Revman 5.3軟件進行數(shù)據(jù)處理分析,其中連續(xù)變量資料用加權(quán)均數(shù)差(weight mean difference,WMD)及95%可信區(qū)間(confidence interval,CI)表達;二分類變量資料用相對危險度(relative risk,RR)和95%CI表達。對各研究資料行異質(zhì)性分析,根據(jù)I2定量分析異質(zhì)性大小:當I250%時,提示異質(zhì)性較低,選取固定效應模式合并數(shù)據(jù);當I2≥50%時,提示異質(zhì)性較高,選取隨機效應模式合并數(shù)據(jù)。結(jié)果:初步檢索得到453篇文獻,經(jīng)仔細篩查后6篇符合要求的RCT被納入本研究,共涉及723膝,其中試驗組(去神經(jīng)化組)362膝,對照組(非去神經(jīng)化組)361膝。納入文獻質(zhì)量評價較高,基線大致均衡。Meta分析結(jié)果:試驗組術(shù)后AKP發(fā)生率低于對照組,且在Feller髕骨評分、KSS-臨床評分、KSS-功能評分、活動度(ROM)等功能預后方面均優(yōu)于對照組,具有統(tǒng)計學差異;而在VAS評分、術(shù)后感染率等方面,兩組間無統(tǒng)計學差異。結(jié)論:Meta分析結(jié)果顯示:在保留髕骨型初次全膝關(guān)節(jié)置換中,髕周去神經(jīng)化處理能減少術(shù)后AKP發(fā)生率,改善功能預后,短期隨訪內(nèi)相對安全。
[Abstract]:Objective: to evaluate the efficacy of peripatellar denervation in primary total knee arthroplasty with patellar preservation by Meta analysis. Methods: according to the PICO principle, the inclusion exclusion criteria were established. The Chinese and English databases, such as MEDLINE EMBASE and Cochrane Library, (China National Knowledge Infrastructure and CNKI, and Wanfang data Resources (wanfang Data system), Chinese Journal Full-text Database, (VIP), Chinese Biomedical Literature Database, (China Biomedical Database, etc. A randomized controlled trial study of the efficacy of peripatellar denervation in patella preserving primary total knee arthroplasty (Randomized Controlled Trial RCT) was conducted. The literature was screened, evaluated, and extracted by two independent researchers. The outcome indexes included: the incidence of anterior knee pain (anterior knee pain), visual analogue score (Visual Analogue scale), American knee joint social score (American Knee Society score), clinical score (KSS-functional score, knee motion (range of), postoperative infection and complications. In this paper, the Jadad score scale in Cochrane cooperation network and the method of assignment and concealment are used to evaluate the quality of the literature, and the Revman 5.3 software provided by the Cochrane cooperation network is used to process and analyze the data. The data of continuous variables were expressed by weighted mean difference (weight mean difference (WMD) and 95% confidence interval (confidence CI), and the data of two-class variables were expressed by relative risk (RR) and 95%CI. According to the heterogeneity analysis of each research data, quantitative analysis of heterogeneity was made according to I2: when I250%, the heterogeneity was lower, fixed effect mode was selected to combine data, and when I2 鈮，

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