Orthopedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China.
School of Foreign Languages, Qilu University of Technology, Qilu University of Technology, Jinan, China.
Z Orthop Unfall. 2024 Aug;162(4):391-402. doi: 10.1055/a-2050-7621. Epub 2023 May 23.
At present, the clinical efficacy of measured resection (MR) and gap balancing (GB) techniques in total knee arthroplasty (TKA) is still controversial. The objective of this study was to evaluate the clinical outcome indexes of the two surgical methods through a meta-analysis.
The literature was systematically searched on PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG, Weipu (VIP), and China Biomedical Literature (CBM) electronic databases inception until June 12, 2022. RevMan 5.3 software (the Nordic Cochrane Center, the Cochrane Collaboration, Copenhagen, Denmark) was used to analyze all data of this study. The Cochrane risk bias assessment tool is a risk bias evaluation criterion recommended by the Cochrane Handbook for systematic reviews.
Eleven studies involving 1268 knees in total were included. The main outcome indexes showed that the Knee Society Score (KSS) knee score (MD: -1.40; 95% CI: -2.57 to -0.22; p = 0.02) and KSS knee function score (MD: -3.11; 95% CI: -3.72 to -2.50; p < 0.001) in the GB group were higher 1 year after operation, while femoral component rotation angle (FCRA; MD: -0.75; 95% CI: -1.34 to -0.07; p = 0.03) and the osteotomy volume of the posterior medial femoral condyle (MD: -0.76; 95% CI; -1.13 to -0.38; p < 0.001) were greater in the GB group. In addition, there was no significant difference in the joint line change (MD: -0.03; 95% CI: -0.07 to 0.01; p = 0.16) between the two groups. Secondary outcome results showed that the knee joint range of motion (ROM) in 3 months, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score after 1 year were better in the GB group. However, the operation time of the MR group was shorter. In addition, this study revealed no significant differences in post-complications between these two groups.
Although the GB technique may not provide better radiographic results or reduce the complication rate, the recovery of joint function showed earlier improvement.
目前，测量截骨术（MR）和间隙平衡术（GB）在全膝关节置换术（TKA）中的临床疗效仍存在争议。本研究旨在通过荟萃分析评估两种手术方法的临床疗效指标。
系统检索 PubMed、EMBASE、Cochrane 图书馆、中国知网（CNKI）、万方、维普（VIP）和中国生物医学文献数据库（CBM）自成立至 2022 年 6 月 12 日的文献。采用 RevMan 5.3 软件（北欧 Cochrane 中心，Cochrane 协作网，丹麦哥本哈根）分析本研究的所有数据。Cochrane 风险偏倚评估工具是 Cochrane 系统评价手册推荐的风险偏倚评估标准。
共纳入 11 项研究，共计 1268 膝。主要结局指标显示，GB 组术后 1 年膝关节 Knee Society 评分（KSS）膝关节评分（MD：-1.40；95%CI：-2.57 至-0.22；p=0.02）和 KSS 膝关节功能评分（MD：-3.11；95%CI：-3.72 至-2.50；p<0.001）更高，而股骨组件旋转角度（FCRA；MD：-0.75；95%CI：-1.34 至-0.07；p=0.03）和后内侧股骨髁骨切开术体积（MD：-0.76；95%CI：-1.13 至-0.38；p<0.001）更大。此外，两组间关节线变化（MD：-0.03；95%CI：-0.07 至 0.01；p=0.16）无显著差异。次要结局结果显示，GB 组术后 3 个月膝关节活动度（ROM）和 1 年后 Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）评分更好，但 MR 组手术时间更短。此外，本研究未发现两组间术后并发症发生率存在显著差异。
尽管 GB 技术可能无法提供更好的影像学结果或降低并发症发生率，但关节功能的恢复更早得到改善。
