Day Care Unit, The First Hospital of Jilin University, Changchun, China.
Department of Orthopaedics, The First Hospital of Jilin University, Changchun, China.
Orthop Surg. 2020 Dec;12(6):1859-1869. doi: 10.1111/os.12815. Epub 2020 Oct 28.
The aim of the present study was to evaluate the effect of patellar denervation (PD) in preventing anterior knee pain (AKP) and improving knee function after total knee arthroplasty (TKA) without patellar resurfacing, and to help surgeons decide whether or not to use PD in TKA.
The electronic databases of Pubmed, Embase, Cochrane, Web of Science, and Scopus were searched for all randomized controlled trials (RCT) comparing the outcomes of PD and no patellar denervation (NPD) in TKA without patellar resurfacing. Primary outcomes were incidence of AKP, visual analogue scale for pain (VAS), and patellar score (PS). Secondary outcomes were Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Knee Score (OKS), knee range of motion (ROM), and complications.
A total of nine RCT met the inclusion criteria. On meta-analysis, PD significantly reduced the incidence of AKP (odds ratio 0.49; 95% confidence interval [CI] 0.26 to 0.92), reduced the VAS (weighted mean difference [WMD] -0.57; 95% CI -1.02 to -0.11), and improved the WOMAC (WMD -4.63; 95% CI -6.49 to -2.77) and the ROM (WMD 9.60; 95% CI 0.39 to 18.81) during the follow-up within 12 months. In addition, PD improved the PS (WMD 1.01; 95% CI 0.65 to 1.38), KSS (WMD 1.12; 95% CI 0.10 to 2.14), and the WOMAC (WMD -1.41; 95% CI -2.74 to -0.08) during the follow-up after 12 months.
Patellar denervation could significantly reduce the VAS and the incidence of AKP in the early stages after TKA as well as improve the clinical outcomes in terms of the PS, the WOMAC, the KSS, and the ROM. This study demonstrates that PD is a safe and recommendable technique that could be routinely performed in TKA.
本研究旨在评估髌神经切断术（PD）在预防全膝关节置换术（TKA）后无髌骨表面置换的前膝痛（AKP）和改善膝关节功能方面的效果，并帮助外科医生决定是否在 TKA 中使用 PD。
检索 Pubmed、Embase、Cochrane、Web of Science 和 Scopus 电子数据库，以查找比较 PD 与无髌神经切断术（NPD）在无髌骨表面置换的 TKA 中的结果的所有随机对照试验（RCT）。主要结局为 AKP 发生率、疼痛视觉模拟量表（VAS）和髌骨评分（PS）。次要结局为膝关节学会评分（KSS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、牛津膝关节评分（OKS）、膝关节活动范围（ROM）和并发症。
共纳入 9 项 RCT。Meta 分析显示，PD 可显著降低 AKP 发生率（比值比 0.49；95%置信区间 [CI] 0.26 至 0.92），降低 VAS（加权均数差 [WMD] -0.57；95%CI -1.02 至 -0.11），并改善 WOMAC（WMD -4.63；95%CI -6.49 至 -2.77）和 ROM（WMD 9.60；95%CI 0.39 至 18.81）在 12 个月内的随访中。此外，PD 还改善了 PS（WMD 1.01；95%CI 0.65 至 1.38）、KSS（WMD 1.12；95%CI 0.10 至 2.14）和 WOMAC（WMD -1.41；95%CI -2.74 至 -0.08）在 12 个月后的随访中。
髌神经切断术可显著降低 TKA 后早期的 VAS 和 AKP 发生率，并在 PS、WOMAC、KSS 和 ROM 等方面改善临床结局。本研究表明，PD 是一种安全且推荐的技术，可在 TKA 中常规应用。
