改良全膝关节置换术中的椎体固定技术：系统回顾和荟萃分析。

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-01-09 DOI:10.1002/jeo2.70086

Francesco Onorato, Riccardo Giai Via, Francesco Bosco, Alessandro Dario Lavia, Luca Barberis, Marcello Capella, Alessandro Massè, Salvatore Risitano

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引用次数: 0

摘要

目的：本系统综述和荟萃分析旨在比较采用非骨水泥压合柄（混合固定）和骨水泥柄（骨水泥固定）行翻修全膝关节置换术（rTKA）患者的临床和影像学结果。研究还探讨了骨水泥固定是否在种植体存活、临床功能、影像学分析和并发症发生率方面优于混合固定。方法：根据PRISMA指南，对Pubmed、Scopus、Embase、Medline和Cochrane 5个数据库进行系统评价和meta分析。根据证据水平（LoE）对文章进行评价。回顾性研究分析了具有偏倚风险的非随机干预研究（robins - 1）和具有偏倚风险的随机对照试验（rob2）。该综述已在国际前瞻性系统评价注册数据库中注册。使用R软件进行meta分析，p值为p。结果：分析了来自12项比较研究的1303例患者（1352例rtka）的数据。混合固定和骨水泥固定的生存率相当，混合固定有明显的优势（p = 0.04）。感染和无菌性松动是最常见的失败原因。不同固定方法的x线摄影失败率无显著差异（p = 0.4）。meta分析显示混合固定效果更好，但无统计学意义(KSS功能p = 0.15；临床KSS p = 0.5)。由于患者特征和手术策略的差异，观察到高度异质性。结论：混合固定技术和骨水泥固定技术在rTKA中均获得满意的临床效果，混合固定总体失败率较低。固定方法的选择必须根据个别患者的特点和手术考虑而定。需要进一步的高质量随机试验来完善这些结果并优化固定策略以改善患者的预后。证据等级：四级。

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Stem fixation techniques in revision total knee arthroplasty: A systematic review and meta-analysis

Purpose

This systematic review and meta-analysis aimed to compare the clinical and radiological outcomes of patients undergoing revision total knee arthroplasty (rTKA) using uncemented press-fit stems (hybrid fixation) versus cemented stems (cemented fixation). It is also examined whether cemented fixation offers any superiority over hybrid fixation regarding implant survival, clinical function, imaging analysis and complication rates.

Methods

Following the PRISMA guidelines, a systematic review and meta-analysis were conducted on five databases (Pubmed, Scopus, Embase, Medline and Cochrane). Articles were evaluated according to levels of evidence (LoE). Retrospective studies were analysed with risk of bias in nonrandomised studies of interventions (Robins-I) and randomised controlled trials with risk of bias 2 (RoB-2). This review was registered in the International Prospective Register of Systematic Reviews database. Meta-analysis was performed using R software, with p < 0.05 considered statistically significant.

Results

Data from 12 comparative studies with 1303 patients (1352 rTKAs) were analysed. Survival rates of hybrid and cemented fixations were comparable, with a significant trend favouring hybrid fixation (p = 0.04). Infection and aseptic loosening were the most common causes of failure. Radiographic failure rates showed no significant differences between fixation methods (p = 0.4). Meta-analysis indicated better results with hybrid fixation, although not statistically significant (KSS functional p = 0.15; KSS clinical p = 0.5). High heterogeneity was observed due to variations in patient characteristics and surgical strategies.

Conclusion

Both hybrid and cemented fixation techniques achieve satisfactory clinical results in rTKA, with hybrid fixation demonstrating an overall lower failure rate. The choice of fixation method must be tailored to individual patient characteristics and surgical considerations. Further high-quality randomised trials are needed to refine these results and optimise fixation strategies to improve patient outcomes.