感染或外露全膝关节置换术中的软组织瓣重建:系统综述和网络荟萃分析。

IF 1.6 4区 医学 Q3 ORTHOPEDICS Knee Pub Date : 2024-11-07 DOI:10.1016/j.knee.2024.10.014
Mario Alessandri-Bonetti , Riccardo Giorgino , Andrea Costantino , Francesco Amendola , Armando De Virgilio , Laura Mangiavini , Giuseppe M. Peretti , Luca Vaienti , Saïd C. Azoury , Francesco M. Egro
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引用次数: 0

摘要

背景:与软组织缺损相关的全膝关节置换术(TKA)感染或外露对重建外科医生来说是一种挑战。本研究的目的是通过比较局部肌肉瓣(LMF)、局部筋膜皮瓣(LFF)和游离肌肉瓣(FMF),确定治疗感染或暴露的 TKA 最成功的重建方案:进行了一项系统性回顾和单臂网络荟萃分析(PRISMA),以比较需要用局部肌皮瓣、局部筋膜皮瓣和游离肌皮瓣覆盖软组织的复杂 TKA 的疗效。该研究方案已在 PROSPERO 上注册(CRD42023388731)。查询了 PubMed、Embase、Web of Science 和 Cochrane Library。采用 MINORS 标准进行偏倚评估。结果包括感染复发、TKA失败、膝上截肢和关节置换:共纳入 30 项研究和 555 个皮瓣。感染复发的汇总发生率为0.18(95% CI:0.11-0.26),关节成形术失败的发生率为0.18(95% CI:0.11-0.28),膝上截肢的发生率为0.10(95% CI:0.08-0.13),关节固定的发生率为0.10(95% CI:0.08-0.13)。局部筋膜瓣显示感染复发(LFF = 0.04 ± 0.037,LMF = 0.27 ± 0.043,FMF = 0.26 ± 0.092)、关节成形术失败(LFF = 0.11±0.068,LMF=0.28±0.045,FMF=0.22±0.094)和皮瓣覆盖感染性TKA后的膝关节固定术(LFF=0.03±0.027,LMF=0.14±0.03,FMF=0.08±0.06)。游离肌皮瓣与膝上截肢的最低风险相关(FMF = 0.08 ± 0.07,LFF = 0.10 ± 0.07,LMF = 0.11 ± 0.03)。MINORS评分的平均值为11.1(95% CI:11-12),主要缺点是缺乏前瞻性的患者招募:根据现有文献,在适当的情况下,LFF 似乎是复杂 TKA 软组织重建的最佳选择。
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Soft tissue flap reconstruction in infected or exposed total knee arthroplasty: A systematic review and network meta-analysis

Background

Total knee arthroplasty (TKA) infection or exposure associated with soft tissue deficiency represents a challenging scenario for the reconstructive surgeon. The aim of the study is to determine the most successful reconstructive option for infected or exposed TKA comparing local muscle flaps (LMF), local fasciocutaneous flaps (LFF), and free muscle flaps (FMF).

Methods

A systematic review and single-arm network meta-analysis (PRISMA) was conducted to compare outcomes of complicated TKA requiring soft tissue coverage with either LMF, LFF and FMF. The protocol was registered on PROSPERO (CRD42023388731). PubMed, Embase, Web of Science and Cochrane Library were queried. MINORS criteria were employed for bias assessment. Outcomes included infection recurrence, TKA failure, above-knee amputation, and arthrodesis.

Results

A total of 30 studies and 555 flaps were included. Pooled prevalence was 0.18 (95% CI: 0.11–0.26) for infection recurrence, 0.18 (95% CI: 0.11–0.28) for arthroplasty failure, 0.10 (95% CI: 0.08–0.13) for above-knee amputation and 0.10 (95% CI: 0.08–0.13) for arthrodesis. Local fasciocutaneous flaps demonstrated the lowest risk of infection recurrence (LFF = 0.04 ± 0.037, LMF = 0.27 ± 0.043, FMF = 0.26 ± 0.092), arthroplasty failure (LFF = 0.11 ± 0.068, LMF = 0.28 ± 0.045, FMF = 0.22 ± 0.094) and knee arthrodesis (LFF = 0.03 ± 0.027, LMF = 0.14 ± 0.03, FMF = 0.08 ± 0.06) after flap coverage of infected TKA. Free muscle flaps were associated with the lowest risk of above knee amputation (FMF = 0.08 ± 0.07, LFF = 0.10 ± 0.07, LMF = 0.11 ± 0.03). The mean MINORS score was 11.1 (95% CI: 11–12) with major weakness being the lack of prospective enrollment of the patients.

Conclusion

Based on the available literature, when appropriate, LFF appear to be the best reconstructive choice for soft tissue reconstruction in complicated TKA.
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来源期刊
Knee
Knee 医学-外科
CiteScore
3.80
自引率
5.30%
发文量
171
审稿时长
6 months
期刊介绍: The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.
期刊最新文献
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