I期双侧膝关节置换安全性的Meta分析
Safety of Simultaneous Bilateral Total Knee Arthroplasty. A Meta-Analysis
同期双侧膝关节置换的安全性-Meta分析
Camilo Restrepo, Javad Parvizi, Thomas Dietrich, and Thomas A. Einhorn
J Bone Joint Surg Am. 2007;89:1220-1226.
Background: The safety of simultaneous bilateral total knee replacement remains controversial. Some studies have demonstrated a higher rate of serious complications, including death, following bilateral procedures, whereas others have suggested no increase in the complication rate. The objective of this meta-analysis was to compare the safety of simultaneous bilateral total knee replacement with that of staged bilateral and unilateral total knee replacements.
背景：同期双侧膝关节置换的安全性仍存在争议。一些研究表明在双侧手术过程中严重并发症发生率很高，包括死亡，而其他的研究表明并不增加并发症发生率。本荟萃分析的目的是比较同期双侧膝关节置换与分期双侧及单侧膝关节置换的安全性。
Methods: A computerized literature search was conducted to identify all citations, from 1966 to 2005, concerning bilateral total knee replacement. All of the English-language abstracts were obtained. A multistage assessment was then performed to identify articles fulfilling the inclusion criteria for the study. All randomized, prospective studies reporting the outcome of bilateral total knee replacement were included. The details of the reported data were extracted,and an extensive analysis of relevant variables was carried out.
方法：用计算机检索1966-2005年关于双侧膝关节置换的文献。收集所有英语语种的文摘。然后通过多级评估来确定文献符合研究准入标准。包括关于双侧膝关节置换的所有随机、前瞻性的研究报道结果。将报道数据的细节整理出，然后开始相关变量的多方面分析。
Results: One hundred and fifty published articles were identified, and eighteen that included a total of 27,807 patients (44,684 knees) were included in the meta-analysis. There were 10,930 unilateral total knee replacements,16,419 simultaneous bilateral total knee replacements, and 458 staged bilateral total knee replacements with at least three months between the operative procedures. The prevalences of pulmonary embolism (odds ratio = 1.8),cardiac complications (odds ratio = 2.49), and mortality (odds ratio = 2.2) were higher after simultaneous bilateral total knee replacement. The prevalence of deep venous thrombosis was lower after simultaneous bilateral total knee replacement, but this difference was not significant. The complication rates after the staged bilateral total knee replacements were similar to those in the patients who had undergone unilateral total knee replacement only.
结果：共标识150篇公开发表的文献，18篇包括共27807例患者（44684个膝）包含在本荟萃分析中。单侧膝关节置换共10930例，同期双侧膝关节置换16419例，458例分期双侧膝关节置换（手术间隔时间至少3个月）。同期双侧膝关节置换术后肺栓塞发病率（OR=1.8）、心脏疾患并发症（OR =2.49）、死亡率（OR =2.2）都比较高。而深静脉血栓的发生率则低，但差异不明显。分期双侧膝关节置换的并发症发生率与单侧膝关节置换的相近。
Conclusions: Compared with staged bilateral or unilateral total knee replacement, simultaneous bilateral total knee replacement carries a higher risk of serious cardiac complications, pulmonary complications, and mortality. The period of time between staged procedures that would eliminate these increased risks could not be determined from this study.
结论：与分期双侧膝关节置换和单侧膝关节置换相比，同期双侧膝关节置换术后心脏疾患并发症、肺部并发症、死亡率都比较高。本研究并不支持关于分期手术的间隔期可抵消增加的风险的这种说法。
[ 本帖最后由 daike_ren 于 2008-6-24 19:24 编辑 ]
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