中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2011年
5期
411-417
,共7页
蔡喜雨%张鑫鑫%刘永刚%李方国%裴国献
蔡喜雨%張鑫鑫%劉永剛%李方國%裴國獻
채희우%장흠흠%류영강%리방국%배국헌
髌韧带%前交叉切带%Meta分析%腘绳肌
髕韌帶%前交扠切帶%Meta分析%腘繩肌
빈인대%전교차절대%Meta분석%객승기
Patella ligament%Anterior cruciate ligament%Meta-analysis%Hamstring
目的 评价自体髌腱与4股腘绳肌腱移植关节镜下单束重建前交叉韧带(ACL)的安全性.方法 计算机检索CENTRAL、PubMed、EMBASE、中国生物医学文献数据库等,获取自体髌腱与4股腘绳肌腱移植重建ACL的随机对照试验(RCT),根据Cochrane图书馆推荐的RCT偏倚评估标准对纳入研究的方法学质量进行评估,并使用RevMan 5.0统计学软件对结果进行Meta分析,比较自体髌腱与4股腘绳肌腱移植重建ACL的移植失败率、伸膝缺失度、膝前痛等的差异.结果共纳入14篇文献,包括1232例患者.自体髌腱组与自体4股腘绳肌腱组的移植失败率在平均随访2～3年(RR=0.69,95%CI 0.34～1.38,P=0.29)、5年(RR=0.37,95%CI0.09～1.55,P=0.18)、10年(P=0.94)及合并后(RR=0.71,95%CI 0.39～1.31,P=0.28)差异均无统计学意义.两组伸膝缺失度≥5°的例数比较差异无统计学意义(RR=1.63,95%CI0.85～3.16,P=0.14).两组膝前痛随访2年差异有统计学意义(RR=2.04,95%CI 1.34～3.09,P=0.0008),而随访5年(RR=3.00,95%CI 0.92～9.79,P=0.07)及随访10年(P=0.737)差异均无统计学意义.两组膝跪痛或不适随访2年差异有统计学意义(RR=1.97,95%CI 1.01～3.85,P=0.05),随访5年(RR=1.51,95%CI 0.95～2.39,P=0.08)及随访10年(P=0.342)差异无统计学意义.结论自体髌腱与4股腘绳肌腱移植失败率及膝关节被动伸直缺失的发生率相似.自体髌腱移植随访早期(平均随访2～3年)膝前痛、膝跪痛或不适的发生率较高,但随着时间的延长(5～10年),两者趋于一致.
目的 評價自體髕腱與4股腘繩肌腱移植關節鏡下單束重建前交扠韌帶(ACL)的安全性.方法 計算機檢索CENTRAL、PubMed、EMBASE、中國生物醫學文獻數據庫等,穫取自體髕腱與4股腘繩肌腱移植重建ACL的隨機對照試驗(RCT),根據Cochrane圖書館推薦的RCT偏倚評估標準對納入研究的方法學質量進行評估,併使用RevMan 5.0統計學軟件對結果進行Meta分析,比較自體髕腱與4股腘繩肌腱移植重建ACL的移植失敗率、伸膝缺失度、膝前痛等的差異.結果共納入14篇文獻,包括1232例患者.自體髕腱組與自體4股腘繩肌腱組的移植失敗率在平均隨訪2～3年(RR=0.69,95%CI 0.34～1.38,P=0.29)、5年(RR=0.37,95%CI0.09～1.55,P=0.18)、10年(P=0.94)及閤併後(RR=0.71,95%CI 0.39～1.31,P=0.28)差異均無統計學意義.兩組伸膝缺失度≥5°的例數比較差異無統計學意義(RR=1.63,95%CI0.85～3.16,P=0.14).兩組膝前痛隨訪2年差異有統計學意義(RR=2.04,95%CI 1.34～3.09,P=0.0008),而隨訪5年(RR=3.00,95%CI 0.92～9.79,P=0.07)及隨訪10年(P=0.737)差異均無統計學意義.兩組膝跪痛或不適隨訪2年差異有統計學意義(RR=1.97,95%CI 1.01～3.85,P=0.05),隨訪5年(RR=1.51,95%CI 0.95～2.39,P=0.08)及隨訪10年(P=0.342)差異無統計學意義.結論自體髕腱與4股腘繩肌腱移植失敗率及膝關節被動伸直缺失的髮生率相似.自體髕腱移植隨訪早期(平均隨訪2～3年)膝前痛、膝跪痛或不適的髮生率較高,但隨著時間的延長(5～10年),兩者趨于一緻.
목적 평개자체빈건여4고객승기건이식관절경하단속중건전교차인대(ACL)적안전성.방법 계산궤검색CENTRAL、PubMed、EMBASE、중국생물의학문헌수거고등,획취자체빈건여4고객승기건이식중건ACL적수궤대조시험(RCT),근거Cochrane도서관추천적RCT편의평고표준대납입연구적방법학질량진행평고,병사용RevMan 5.0통계학연건대결과진행Meta분석,비교자체빈건여4고객승기건이식중건ACL적이식실패솔、신슬결실도、슬전통등적차이.결과공납입14편문헌,포괄1232례환자.자체빈건조여자체4고객승기건조적이식실패솔재평균수방2～3년(RR=0.69,95%CI 0.34～1.38,P=0.29)、5년(RR=0.37,95%CI0.09～1.55,P=0.18)、10년(P=0.94)급합병후(RR=0.71,95%CI 0.39～1.31,P=0.28)차이균무통계학의의.량조신슬결실도≥5°적례수비교차이무통계학의의(RR=1.63,95%CI0.85～3.16,P=0.14).량조슬전통수방2년차이유통계학의의(RR=2.04,95%CI 1.34～3.09,P=0.0008),이수방5년(RR=3.00,95%CI 0.92～9.79,P=0.07)급수방10년(P=0.737)차이균무통계학의의.량조슬궤통혹불괄수방2년차이유통계학의의(RR=1.97,95%CI 1.01～3.85,P=0.05),수방5년(RR=1.51,95%CI 0.95～2.39,P=0.08)급수방10년(P=0.342)차이무통계학의의.결론자체빈건여4고객승기건이식실패솔급슬관절피동신직결실적발생솔상사.자체빈건이식수방조기(평균수방2～3년)슬전통、슬궤통혹불괄적발생솔교고,단수착시간적연장(5～10년),량자추우일치.
Objective To compare clinical outcomes of patellar tendon and 4-strand hamstring autografts in single-bundle endoscopic reconstruction of anterior cruciate ligament(ACL). Methods The digital databases(PubMed,Embase,Cochrane Central Register of Controlled Trials,CBM)were searched for randomized controlled trials (RCTs)comparing patellar tendon with hamstring autografts for reconstruction of ACL.In addition.the reference lists from related original studies and review articles were hand-searched.The Cochrane Collaboration's tool for assessing risk of bias and Cochrane collaboration's RevMan 5.0 software were used for assessing trial methodological quality and data analyses. Results Fourteen RCTs were included.There were 1232 participants who met inclusion criteria in all studies.Meta-analyses showed that no statisticallv significant differences were found in graft failure rate after single-bundle reconstruction of the ACL at mean follow-ups of 2 to 3 years (RR=0.69,95%C/0.34 to 1.38,P=0.29,of 5 years (RR=0.37,95%CI 0.09 to 1.55,P=0.18),of 10 years(P=0.94)or when 3 subgroups combined(RR=0.71,95%CI 0.39 t0 1.31.P=0.28).The diffe-rence in≥5°extensor deficit was not statistically significant between the 2 groups(RR=1.63.95%CI 0.85 to 3.16,P=0.14).Anterior knee pain and kneeling pain or discomfort showed significantlv differences between the 2 groups at a mean follow-up of 2 years(P<0.05),but did not at follow-ups of 5 years and 10 years(P>0.05). Conclusions In single-bundle endoscopic ACL reconstruction.patellar tendon and 4-strand hamstring autografts have similar rates of graft failure and knee motion deficits.The patellar tendon autograft may have higher rates of anterior knee pain and kneeling pain or discomfort at an early stage after operation than the 4-strand hamstring autografi,but there may be no such differences on a long-term basis.
