摘要
目的比较单束前交叉韧带(ACL)重建联合前外侧结构(ALS)重建与单束前交叉韧带重建两种手术方式的临床效果。方法检索电子数据库PubMed、荷兰医学文摘(Embase)、Web of Science、万方数据库和中国知网(CNKI),并追溯纳入文献的相关参考文献,收集比较单束ACL重建联合ALS重建与单束ACL重建两种手术方式的临床研究,结局指标包括膝关节功能评分、国际膝关节文献委员会(IKDC)评分、Lysholm评分、Tegner评分、胫骨前位移等。排除术后随访时间小于1年、无对照组或非临床研究的相关文献。提取最终纳入的文献进行质量评价和资料,采用RevMan 5.3软件进行统计分析。结果最终纳入10项研究,共764例患者,其中单束ACL重建联合ALS重建的345例,单束ACL重建的419例。在胫骨前位移距离[均数差(MD)=-0.65,95%置信区间(CI)(-0.96,-0.33),P<0.01]、IKDC评分[MD=3.90,95%CI(1.96,5.84),P<0.01]、Lysholm评分[MD=2.65,95%CI(1.73,3.57),P<0.01]、Tegner评分[MD=0.31,95%CI(-0.13,0.75),P=0.17]、轴移试验[风险比(RR)=0.23,95%CI(0.12,0.44),P<0.01]、Lachman试验[RR=0.40,95%CI(0.21,0.77),P<0.01]、减少移植物再撕裂[RR=0.24,95%CI(0.10,0.54),P<0.01]等方面,单束ACL重建联合ALS重建均优于单束ACL重建,而在前抽屉试验[RR=0.67,95%CI(0.24,1.89),P=0.44]、重返运动[RR=1.18,95%CI(0.93,1.48),P=0.17]方面两组差异无统计学意义。结论单束ACL重建联合ALS重建在膝关节功能评分、稳定性、降低移植物再撕裂风险方面具有一定优势。
Objective To compare the clinical outcomes of single-bundle reconstruction combined with anterolateral structure(ALS)reconstruction of anterior cruciate ligament(ACL)and single-bundle ACL reconstruction only.Methods A literature search was conducted in PubMed,Excerpta Medical Database(Embase),Web of Science,Wanfang database and China National Knowledge Infrastructure(CNKI).The references in the included literature were tracked,and clinical studies comparing single-bundle ACL reconstruction combined with ALS reconstruction and single-bundle ACL reconstruction were collected and compared,and the outcome indices were knee function scores,International Knee Documentation Committee(IKDC)score,Lysholm score,Tegner score,anterior tibial shift,etc..The studies with a postoperative follow-up of less than one year,no controlled group or those that were not clinical studies,were excluded.The quality of the final included literatures was evaluated,the data were extracted and statistically analyzed using RevMan 5.3 software.Results Ten studies were included,with a total of 764 patients,including 419 patients with single-bundle ACL reconstruction and 345 patients with single-bundle reconstruction combined with ALS reconstruction of ACL.The single-bundle reconstruction combined with ALS reconstruction of ACL were superior than single-bundle ACL reconstruction in the results of anterior tibial shift[mean deviation(MD)=-0.65,95%confidence interval(CI)(-0.96,-0.33),P<0.01],IKDC score[MD=3.90,95%CI(1.96,5.84),P<0.01],Lysholm score[MD=2.65,95%CI(1.73,3.57),P<0.01],Tegner score[MD=0.31,95%CI(-0.13,0.75),P=0.17],pivot shift test[risk ratio(RR)=0.23,95%CI(0.12,0.44),P<0.01],Lachman test[RR=0.40,95%CI(0.21,0.77),P<0.01],and reducing the postoperative graft rerupture rate[RR=0.24,95%CI(0.10,0.54),P<0.01];the differences were statistically significant.There was no statistically significant difference in anterior drawer test[RR=0.67,95%CI(0.24,1.89),P=0.44],or return-to-sport rate[RR=1.18,95%CI(0.93,1.48),P=0.17].Conclusion Single-bundle reconstruction combined with ALS reconstruction of ACL present advantages in terms of knee joint function score,stability and reduction of graft re-rupture rate.
作者
邢阳
何爱珊
康焱
杨子波
孟繁钢
邬培慧
Xing Yang;He Aishan;Kang Yan;Yang Zibo;Meng Fangang;Wu Peihui(Department of Sports medicine,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)
出处
《中华关节外科杂志（电子版）》
CAS
CSCD
2023年第4期508-519,共12页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
国家自然科学基金面上项目(82272449)
作者简介
通信作者:邬培慧,Email:wupeihui3@mail.sysu.edu.cn
