Nizard R S, Biau D, Porcher R, Ravaud P, Bizot P, Hannouche D, Sedel L
Lariboisière Hospital, Paris, France.
Clin Orthop Relat Res. 2005 Mar(432):196-203. doi: 10.1097/01.blo.0000150348.17123.7f.
From individual randomized studies it is unclear whether the patella should be replaced during total knee replacement. We did a meta-analysis to provide quantitative data to compare patellar resurfacing with nonresurfacing during total knee arthroplasty. Only randomized, controlled trials reported between January 1966 and August 2003 comparing patellar replacement with patella retention were included for a total of 12 studies. Two reviewers assessed trial quality and extracted data from papers. The outcomes identified were reoperations for patellar problems, anterior knee pain, knee scores, stair climbing, and patient satisfaction. The resurfaced patella performed better, and we found an increased relative risk (defined by the ratio of the risk of the event in the resurfaced group on the risk of the event in the nonresurfaced group) for reoperation, for significant anterior knee pain, and for significant pain during stair climbing when the patella was left unresurfaced. No differences were observed between the two groups for International Knee Society function score, Hospital for Special Surgery score, and for patient satisfaction. Despite these general findings, forming a definitive conclusion is difficult because many confounding factors, such as component design, surgeon experience, and technical aspects of the surgery, might influence the result in a patient.
从个体随机研究中尚不清楚在全膝关节置换术中是否应置换髌骨。我们进行了一项荟萃分析，以提供定量数据，比较全膝关节置换术中髌骨表面置换与未置换的情况。仅纳入了1966年1月至2003年8月间报告的比较髌骨置换与保留髌骨的随机对照试验，共12项研究。两名评审员评估试验质量并从论文中提取数据。确定的结果包括因髌骨问题进行的再次手术、膝前疼痛、膝关节评分、爬楼梯能力和患者满意度。髌骨表面置换组表现更好，我们发现当髌骨未进行表面置换时，再次手术、严重膝前疼痛以及爬楼梯时严重疼痛的相对风险增加（由表面置换组事件风险与未表面置换组事件风险之比定义）。两组在国际膝关节协会功能评分、特种外科医院评分以及患者满意度方面未观察到差异。尽管有这些总体发现，但由于许多混杂因素，如假体设计、外科医生经验和手术技术方面等，可能会影响患者的结果，因此很难得出明确的结论。
