赵传喜++卢岩岩++陈能++许光明++邱博凡

【摘 要】目的：系統评价滑膜切除对初次全膝关节置换术治疗膝骨关节炎临床疗效的影响。方法：计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、Cochrane Library、web of science等数据库收录的关于全膝关节置换术中是否同时行滑膜切除的临床随机对照研究，检索时间为建库至2016年12月12日。采用RevMan 5.3软件进行Meta分析。结果：共纳入6篇文献，1016例患者，518例予以滑膜切除，498例不予切除。Meta分析结果显示，与不切除组相比，滑膜切除组显著增加了手术时间（WMD = 8.40，95%CI = [0.90，15.90]，P < 0.05）、隐性失血量（WMD = 0.19，95%CI = [0.11，0.28]，P < 0.000 01）、引流量（WMD = 0.19，95%CI = [0.08，0.31]，P = 0.001）；2组间术后VAS评分（WMD = -1.23，95%CI = [-2.51，-0.05]，P = 0.06）、KSS评分（临床评分WMD = -0.48，95%CI = [-1.34，0.37]，P = 0.27）、功能评分（WMD = 0.14，95%CI = [-0.39，0.68]，P = 0.60）、术后关节活动度（WMD = -0.97，95%CI = [-4.92，2.97]，P = 0.63）、输血率（RR = 1.00，95%CI = [0.84，1.20]，P = 0.99）、术后浮髌试验阳性率（RR = 0.92，95%CI = [0.66，1.29]，P = 0.64），差异均无统计学意义。结论：基于有限的临床研究文献，本系统评价初步认为，全膝关节置换术中滑膜切除与不切除相比，无明显优势。

【关键词】 骨关节炎，膝；滑膜切除；全膝关节置换术；疗效；Meta分析

【ABSTRACT】Objective：To systematically evaluate the effect of synovectomy on the treatment of knee osteoarthritis with primary total knee arthroplasty.Methods：Databases such as CNKI，Wan Fang，VIP，CBMdisc，PubMed，Embase，Cochrane Library，Web of Science were retrieved for randomized control trials on whether total knee arthroplasty and synovectomy could be made at the same time（for the establishment of datebases to December 12th，2016）.Software RevMan 5.3 was used for Meta-analysis.Results：A total of 6 papers were collected，including 1016 patients，among which 518 cases had undergone synovectomy and 498 cases had not.Meta-analysis showed that synovectomy obviously increased operation time（WMD = 8.40，95%CI = [0.90，15.90]，

P < 0.05），implicit blood loss（WMD = 0.19，95% CI = [0.11，0.28]，P < 0.000 01），and volume of drainage（WMD = 0.19，95% CI = [0.08，0.31]，P = 0.001）.The differences of the following parameters before and after treatment had no statistical significance：VAS scores（WMD = -1.23，95% CI = [-2.51，-0.05]，P = 0.06），KSS scores（clinical scores WMD = -0.48，95% CI = [-1.34，0.37]，P = 0.27，function scores WMD = 0.14，95% CI = [-0.39，0.68]，P = 0.60），postoperative ROM of joint（WMD = -0.97，95%CI = [-4.92，2.97]，P = 0.63），blood transfusion rate（RR = 1.00，95%CI = [0.84，1.20]，P = 0.99），and positive rate of floating patella test after operation（RR = 0.92，95%CI = [0.66，1.29]，P = 0.64）.Conclusion：Based on limited clinical literatures，this systematic review has initially concluded that there is no significant advantage of synovectomy in total knee arthroplasty compared with that without synovectomy.

【Keywords】 osteoarthritis，knee；synovectomy；total knee arthroplasty；efficacy；Meta-analysis

随着我国步入老龄化社会，越来越多的人饱受膝骨关节炎（knee osteoarthritis，KOA）的困扰，据统计，我国65岁以上老年人罹患KOA的比例高达85%[1]。在本病的终末期，全膝关节置换往往成为最终的治疗手段。全膝关节置换术自应用于治疗本病以来，已经取得了巨大的成果[2]。但对于部分患者，术后仍遗留部分疼痛，大大影响了手术的疗效[3]。出现术后遗留疼痛的原因很多，比如术中假体的安放位置不当、髌骨轨迹不良、术后感染、滑膜的炎症反应等[4-7]。部分学者认为，滑膜炎症是造成膝关节疼痛的重要原因，并认为滑膜的炎性改变可能是KOA的超早期表现[8]。因此，李治国等[9]主张术中常规切除滑膜，Tanavalee等[10]

则持相反观点。目前，关于该问题的争议较大，国内尚未有相关的系统评价，本文试做Meta分析，系统比较滑膜切除与否对全膝关节置换术治疗KOA临床疗效的影响，为临床治疗提供循证学依据。……