摘要
目的通过Meta分析比较关节镜下初次修复术与重建术治疗前交叉韧带(ACL)近端损伤的疗效。方法计算机检索中国知网、万方数据库、PubMed、Web of Science和The Cochrane Library等数据库从建库到2023年8月关于关节镜下ACL初次修复术与重建术治疗ACL近端损伤的研究。检索后采用RevMan5.4软件通过Meta分析比较关节镜下ACL初次修复术与重建术治疗ACL近端损伤的手术失败率、国际膝关节文献委员会(IKDC)评分、Lysholm评分、患者满意度视觉模拟评分(VAS)、Lachman试验阳性率、双侧膝关节胫骨前移量差值。结果最终纳入8篇文献,4篇为随机对照试验,4篇为队列研究,共纳入217例ACL初次修复组患者和187例ACL重建组患者。文献中病例随访时间12~28个月。Meta分析结果显示初次修复组术后短期双侧膝关节胫骨前移量差值大于重建组(MD=0.75,95%CI:0.33~1.16,P<0.001),两组在IKDC评分、Lysholm评分、Lachman试验阳性率、患者满意度视觉模拟评分与手术失败率等方面差异均无统计学意义(P>0.05)。结论关节镜下ACL初次修复术后短期(1~2年)患者运动功能恢复、临床结果与ACL重建术相近,但在膝关节前向稳定性恢复上存在劣势,需提高警惕。
ObjectiveTo compare the arthroscopic primary repair versus reconstruction for proximal anterior cruciate ligament(ACL)tears by a meta analysis.MethodsA comprehensive computer search was performed in China National Knowledge Infrastructure,WanFang Data,Pubmed,Web of Since,The Cochrane Library for studies comparing primary ACL repair and ACL reconstruction published before August,2023.A meta-analysis was performed using RevMan 5.4 software to compare the surgical failure rate in repair of proximal ACL tears,International Knee Documentation Committee(IKDC)score,Lysholm score,patient satisfaction score of visual analogue scale(VAS),positive rate of Lachman test,and side-to-side difference in anterior tibial translation.ResultsIncluded in this meta analysis were 8 articles(4 randomized controlled trials and 4 cohort studies)involving 217 eligible patients undergoing primary ACL repair and 187 eligible patients undergoing ACL reconstruction.The follow-up duration for the cases in the literature ranged from 12 to 28 months.The meta analysis showed that the short-term side-to-side difference in anterior tibial translation in the primary ACL repair group was significantly larger than that in the ACL reconstruction group(MD=0.75,95%CI:0.33 to 1.16,P<0.001).However,there were no significant differences between the 2 groups in IKDC score,Lysholm score,positive rate in the Lachman test,VAS patient satisfaction score,or surgical failure rate(P>0.05).ConclusionsCompared with ACL reconstruction,arthroscopic primary ACL repair may lead to similar functional recovery and clinical outcomes in the early postoperative period(12 to 28 months).However,caution should be exercised against primary ACL repair because it is related to greater asymptomatic knee laxity.
作者
冯建豪
徐一宏
徐卫东
Feng Jianhao;Xu Yihong;Xu Weidong(Department of Orthopaedics,Tongji Hospital,Tongji University,Shanghai 200065,China;Department of Joint Surgery,Changhai Hospital,The Navy Medical University,Shanghai 200433,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2024年第7期626-631,共6页
Chinese Journal of Orthopaedic Trauma
基金
海军军医大学第一附属医院"234学科攀峰计划"项目(2020YXK002)
海军军医大学第一附属医院"深蓝123"军事医学研究专项重点攻关项目(2019YSL007)
海军军医大学第一附属医院"十四五"学科固海计划(GH145-16)。
关键词
膝关节
前交叉韧带
关节镜
修复术
重建术
META分析
Knee joint
Anterior cruciate ligament
Arthroscopy
Repair
Reconstruction
Meta-analysis
作者简介
通信作者:徐卫东,Email:xuwdshanghai@126.com。
