膝关节前交叉韧带损伤的早期手术和晚期手术的系统评价  

Efficacy of early versus late reconstruction for anterior cruciate ligament rupture:a systematic review

作　　者：岳勇 阿德力[2] 哈巴西 孙改生 帕哈提[3] 肖丽红 

机构地区：[1]新疆克拉玛依市人民医院,834000 [2]新疆医科大学第一附属医院骨科分院关节外科,乌鲁木齐831054 [3]新疆医科大学第一附属医院骨科分院创伤一科,乌鲁木齐831054

出　　处：《中国矫形外科杂志》2008年第12期900-903,共4页Orthopedic Journal of China

摘　　要：[目的]系统评价膝关节前交叉韧带损伤的早期手术和晚期手术的疗效。[方法]计算机检索数据库MEDLINE（1950～2007．4）、OVID数据库（1950-2007．6）、PUBMED（1950-2007．7）中国生物医学文献数据CBM（1978-2007．6），万方数据库（1981-2007．6），手工检索《中华骨科杂志》、《中华创伤骨科杂志》、《中国矫形外科杂志》、《骨与关节损伤》、《实用骨科杂志》等5种中文骨科核心杂志（截自2007年6月），由2名评价员独立选择试验、提取资料并交叉核对，按Cochrane系统评价的方法，评价纳入文献的方法学质量并提取有效数据进行Meta分析。共查到相关文献120篇。109篇因研究目的与本系统评价不符被排除。1篇文章系RCT文章，9篇临床对照试验（CCT）。9个CCT均可能存在选择性偏倚、实施偏倚和测量偏倚的高度可能性。[结果]Meta分析结果显示：膝关节前交叉韧带损伤的早期手术和晚期手术，手术中发现半月板损伤的情况、术后膝关节伸膝范围的缺陷、术后膝关节的Lysholm评分，各研究间有很大异质性。手术中关节面软骨面损伤情况、手术后Lachmantest比较、手术后Pivot test比较，两组差异无统计学意义；手术后并发症一关节内的纤维化、手术后膝关节屈膝范围的缺陷方面，晚期手术优于早期手术。[结论]膝关节前交叉韧带损伤的早期手术和晚期手术，手术中发现半月板损伤的情况、手术后膝关节伸膝范围的缺陷、手术后膝关节的Lysholm评分，各研究间有很大异质性，未对其进行合并分析，以上两组之间尚不能得出肯定结论。手术中关节面软骨面损伤情况、手术后Lachman test比较、手术后pivot test比较，两组无差异；手术后并发症-关节内的纤维化、手术后膝关节屈膝范围的缺陷方面，晚期手术优于早期手术。由于纳入研究均为CCT，存在偏倚的高度可能性，故本[ Objective] To determine the efficacy of early versus late reconstruction for anterior cruciate ligament rupture. [ Method] The author searched MEDLINE （ 1950-2007.4 ）, OVID （ 1950-2007.6 ）, PUBMED （ 1950-2007.7 ）, the CBM （ 1978- 2007.6 ）, WanFang （ 1981-2007.6 ）, and hand-searched several related journals for randomized controlled trials （RCTs） and quasirandomized controlled trials （quasi-RCTs）involving the efficacy of early versus late reconstruction for anterior cruciate ligament rupture,the quality of the included trials was assessed. RevMan 4.2.8 software was used for statistical analysis. [ Result] Ten studies were included （ 1RCT,9 CCT）. The results of meta-analysis indicated that the huge heterogeneity consist in as follows：intraarticular meniscus tears of the knee,extension deficit of the knee, comparison of lysholm of the knee after the operation. No statistically significant differences between the two operative procedures were observed as follows ： including the result of incidence of intraarticular chondral damage of the knee, comparison of Lachman test of the knee found after the operation as well as the result of incidence of comparison of Pivot test of the knee found after the operation. Statistically significant differences were more observed in the late reconstruction in the clinical outcome of both intraarticular arthofibrosis and flexion deficit of the knee found after the operation than that of early reconstruction. [ Conclusion ] Although result obtained on the basis of CCT with a lager bias and one RCT,the author still conclude that statistically significant differences are more observed in the late reconstruction in the clinical outcome of both intraarticular arthofibrosis and flexion deficit of the knee found after the operation than that of early reconstruction. More high quality ,large-scale randomized controlled trials are required for the accurate conclusion in treating it.

关 键 词：前交叉韧带 损伤 早期手术 晚期手术 疗效 系统评价 

分 类 号：R687.2[医药卫生—骨科学]