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膝关节镜手术后全膝关节置换治疗效果的荟萃分析。

A meta-analysis of the therapeutic effect of total knee replacement after knee arthroscopic surgery.

作者信息

Xu Yunwei, Wang Weidong

机构信息

Joint and Limbs Surgery Ward, The Affiliated Yangming Hospital Of Ningbo University, 800# Chengdong Road, Yuyao, Zhejiang, China.

出版信息

J Orthop Traumatol. 2025 May 22;26(1):31. doi: 10.1186/s10195-025-00848-9.

Abstract

PURPOSE

To appraise the influence of knee arthroscopic surgery on subsequent total knee arthroplasty (TKA) through meta-analysis.

METHODS

A computer search was implemented from the establishment of the database to August 2023 for literature on the influence of knee arthroscopic surgery on the efficacy of subsequent TKA in Web of Science, PubMed, CNKI, Embase, Cochrane Library, Wanfang, and other databases. Quality assessment, literature screening, and data extraction were enforced according to the exclusion and inclusion criteria, and the methodological quality of the involved literature was assessed using the risk-of-bias assessment method recommended by the Cochrane Assistance Network. RevMan 5.4 software was used to conduct a meta-analysis on the postoperative revision rate, periprosthetic infection rate, postoperative stiffness rate, postoperative venous thromboembolism (VTE) incidence rate, reoperation rate, and postoperative knee flexion range of motion after TKA.

RESULTS

Seven documents were finally involved, with a total of 42,642 cases, including 3405 cases in the knee arthroscopy group and 39,237 cases in the non-knee arthroscopy group. Meta-analysis results show that in the revision rate [95% confidence interval (CI) 0.97, 44.82] and reoperation rate [95% CI 1.66, 4.23] after TKA between the knee arthroscopy surgery group and the non-knee arthroscopy surgery group, there were statistically significant differences in postoperative stiffness rate [95% CI 0.86, 10.84] and periprosthetic infection rate [95% CI 0.86, 2.07], while in postoperative VTE incidence [95% CI 0.83, 1.35] and in postoperative knee flexion range of motion [95% CI -0.35, 0.10] there was no statistically significant difference.

CONCLUSIONS

Knee arthroscopic surgery hurts subsequent TKA surgery. Previous arthroscopic surgery increased the risk of postoperative stiffness, revision, periprosthetic infection, and reoperation after TKA, but there was no significant difference in the incidence of VTE and knee flexion range of motion after surgery.

摘要

目的

通过荟萃分析评估膝关节镜手术对后续全膝关节置换术(TKA)的影响。

方法

从数据库建立至2023年8月,在Web of Science、PubMed、CNKI、Embase、Cochrane Library、万方等数据库中进行计算机检索,查找关于膝关节镜手术对后续TKA疗效影响的文献。根据排除和纳入标准进行质量评估、文献筛选和数据提取,并采用Cochrane协作网推荐的偏倚风险评估方法评估所纳入文献的方法学质量。使用RevMan 5.4软件对TKA术后翻修率、假体周围感染率、术后僵硬率、术后静脉血栓栓塞(VTE)发生率、再次手术率以及术后膝关节屈曲活动度进行荟萃分析。

结果

最终纳入7篇文献,共42642例,其中膝关节镜组3405例,非膝关节镜组39237例。荟萃分析结果显示,膝关节镜手术组与非膝关节镜手术组TKA术后的翻修率[95%置信区间(CI)0.97,44.82]、再次手术率[95%CI 1.66,4.23]、术后僵硬率[95%CI 0.86,10.84]和假体周围感染率[95%CI 0.86,2.07]存在统计学差异,而术后VTE发生率[95%CI 0.83,1.35]和术后膝关节屈曲活动度[95%CI -0.35,0.10]无统计学差异。

结论

膝关节镜手术对后续TKA手术有不良影响。既往关节镜手术增加了TKA术后僵硬、翻修、假体周围感染及再次手术的风险,但术后VTE发生率及手术膝关节屈曲活动度无显著差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a833/12098253/334bc6f50051/10195_2025_848_Fig1_HTML.jpg

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