Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery), Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
Knee Surg Sports Traumatol Arthrosc. 2023 Mar;31(3):861-882. doi: 10.1007/s00167-022-06914-7. Epub 2022 Mar 2.
The purpose of this systematic review and metanalysis was to assess clinical and radiological outcomes of metaphyseal sleeves and cones and to identify their possible advantages and disadvantages.
A comprehensive search from the inception of the databases to March 2021 was performed on Medline, Scopus, CINAHL, Cochrane, Embase, Ovid, and Google scholar databases. Coleman Methodology Score was used for quality assessment. Author, year of publication, type of study, level of evidence, sample size, number of patients, number of knees treated, mean age, gender, mean follow-up, clinical outcomes, complications, the reason for revision and, type of prosthesis were extracted for analysis. Clinical studies providing data about patient's outcomes after the primary and Total Knee Arthroplasty revision with the usage of sleeves or cones and a minimum of 2 years of follow-up were included.
The literature search and cross-referencing resulted in a total of 93 articles, but only 30 articles were appropriate for the systematic review. Comparable clinical results were reported between cones and sleeves. The meta-analysis showed a greater incidence of intraoperative fractures in patients treated with sleeves (1.6%, [95% CI 0.7; 3.4] in cones and 4.6%, [95% CI 3.3; 6.4] in sleeves, p = 0.01), while the risk of postoperative fractures (4.3%, [95% CI 2.7; 7] in cones and 2.1%, [95% CI 1.2; 3.5] in sleeves, p = 0.04) and infections (8.5%, [95% CI 6; 12] in cones and 3.7%, [95% CI 2.1; 7.3] in sleeves, p = 0.03) was higher with cones.
A higher incidence of intraoperative fracture was reported in patients treated with sleeves, while a higher rate of postoperative fractures and infections was described in patients treated with cones. Nonetheless, complications were reported in both groups.
III.
本系统评价和荟萃分析的目的是评估干骺端袖套和锥体的临床和影像学结果，并确定其可能的优缺点。
从数据库创建开始到 2021 年 3 月，在 Medline、Scopus、CINAHL、Cochrane、Embase、Ovid 和 Google Scholar 数据库中进行了全面搜索。使用 Coleman 方法评分进行质量评估。提取分析内容包括作者、发表年份、研究类型、证据水平、样本量、患者数量、治疗的膝关节数量、平均年龄、性别、平均随访时间、临床结果、并发症、翻修原因和假体类型。纳入了提供关于初次和全膝关节置换术后使用袖套或锥体且至少 2 年随访的患者结局数据的临床研究。
文献检索和交叉引用共产生了 93 篇文章，但只有 30 篇文章适合进行系统评价。在使用锥体和袖套的患者中，报告了相似的临床结果。荟萃分析显示，袖套组患者术中骨折发生率更高（1.6%，[95%CI 0.7;3.4]；锥体组为 4.6%，[95%CI 3.3;6.4]，p=0.01），而术后骨折（4.3%，[95%CI 2.7;7]；锥体组为 2.1%，[95%CI 1.2;3.5]，p=0.04）和感染（8.5%，[95%CI 6;12]；锥体组为 3.7%，[95%CI 2.1;7.3]，p=0.03）的风险更高。
袖套治疗组患者报告的术中骨折发生率更高，而锥体治疗组患者术后骨折和感染的发生率更高。尽管如此，两组都报告了并发症。
III。
