非骨水泥固定与骨水泥固定单髁膝关节置换术后假体周围胫骨骨折发生率的比较：系统评价和荟萃分析。
Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis.
机构信息
Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St, New York, NY, 10021, USA.
Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2022 Mar;30(3):852-874. doi: 10.1007/s00167-021-06449-3. Epub 2021 Feb 2.
PURPOSE
(I) To determine the incidence of periprosthetic tibial fractures in cemented and cementless unicompartmental knee arthroplasty (UKA) and (II) to summarize the existing evidence on characteristics and risk factors of periprosthetic fractures in UKA.
METHODS
Pubmed, Cochrane and Embase databases were comprehensively searched. Any clinical, laboratory or case report study describing information on proportion, characteristics or risk factors of periprosthetic tibial fractures in UKA was included. Proportion meta-analysis was performed to estimate the incidence of fractures only using data from clinical studies. Information on characteristics and risk factors was evaluated and summarized.
RESULTS
A total of 81 studies were considered to be eligible for inclusion. Based on 41 clinical studies, incidences of fractures were 1.24% (95%CI 0.64-2.41) for cementless and 1.58% (95%CI 1.06-2.36) for cemented UKAs (9451 UKAs). The majority of fractures in the current literature occurred during surgery or presented within 3 months postoperatively (91 of 127; 72%) and were non-traumatic (95 of 113; 84%). Six different fracture types were observed in 21 available radiographs. Laboratory studies revealed that an excessive interference fit (press fit), excessive tibial bone resection, a sagittal cut too deep posteriorly and low bone mineral density (BMD) reduce the force required for a periprosthetic tibial fracture to occur. Clinical studies showed that periprosthetic tibial fractures were associated with increased body mass index and postoperative alignment angles, advanced age, decreased BMD, female gender, and a very overhanging medial tibial condyle.
CONCLUSION
Comparable low incidences of periprosthetic tibial fractures in cementless and cemented UKA can be achieved. However, surgeons should be aware that an excessive interference fit in cementless UKAs in combination with an impaction technique may introduce an additional risk, and could therefore be less forgiving to surgical errors and patients who are at higher risk of periprosthetic tibial fractures.
LEVEL OF EVIDENCE
V.
目的
（一）确定骨水泥型和非骨水泥型单髁膝关节置换术后（UKA）周围胫骨骨折的发生率，（二）总结 UKA 周围假体骨折的特征和危险因素的现有证据。
方法
全面检索 Pubmed、Cochrane 和 Embase 数据库。纳入任何描述 UKA 中假体周围胫骨骨折的比例、特征或危险因素的临床、实验室或病例报告研究。仅使用临床研究的数据进行骨折比例的荟萃分析。评估和总结特征和危险因素的信息。
结果
共有 81 项研究被认为符合纳入标准。基于 41 项临床研究，骨水泥型 UKA 的骨折发生率为 1.24%（95%CI 0.64-2.41），非骨水泥型 UKA 的骨折发生率为 1.58%（95%CI 1.06-2.36）（9451 例 UKA）。当前文献中的大多数骨折发生在手术期间或术后 3 个月内（127 例中有 91 例；72%），且为非外伤性（113 例中有 95 例；84%）。21 张可获得的 X 光片中观察到 6 种不同的骨折类型。实验室研究表明，过度的干扰配合（压配合）、过度的胫骨骨切除、后向太深的矢状切和低骨密度（BMD）会降低假体周围胫骨骨折所需的力。临床研究表明，假体周围胫骨骨折与体重指数和术后对线角度增加、年龄较大、BMD 降低、女性和内侧胫骨髁非常突出有关。
结论
骨水泥型和非骨水泥型 UKA 周围胫骨骨折的发生率相当低。然而，外科医生应该意识到，非骨水泥型 UKA 中的过度干扰配合结合冲击技术可能会带来额外的风险，因此对手术错误和假体周围胫骨骨折风险较高的患者的容忍度较低。
证据水平
V。
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