自体髌腱与四股腘绳肌腱移植重建前交叉韧带安全性的Meta分析  

Patellar tendon autograft versus 4-strand hamstring autograft for endoscopic reconstructionof anterior cruciate ligament： a Meta-analysis

作　　者：蔡喜雨[1] 张鑫鑫[1] 刘永刚[1] 李方国[1] 裴国献[2] 

机构地区：[1]南方医科大学南方医院创伤骨科,广州510515 [2]第四军医大学西京医院骨科

出　　处：《中华创伤骨科杂志》2011年第5期411-417,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 评价白体髌腱与4股胭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股胭绳肌腱移植重建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RevMan5．0统计学软件对结果进行Meta分析，比较自体髌腱与4股胴绳肌腱移植重建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股胭绳肌腱组的移植失败率在平均随访2～3年（RR：0．69，95％C10．34～1．38，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％CI0．39～1．31，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％CI1．34～3．09，P=0．0008），而随访5年（RR=3．00，95％CI0．92～9．79，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％CI1．01～3．85，P=0．05），随访5年（RR=1．51，95％CI0．95～2．39，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股胭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。Objective To compare clinical outcomes of patellar tendon and 4-strand hamstring au- tografts 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 autografls for reconstruction of ACL. In addition, the reference lists from related original studies and review articles were hand-searched. The Coehrane 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 statistically 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% CI O. 34 to 1.38, P = 0. 29, of 5 years （ RR = 0. 37, 95% C]0.09 to 1,55, P=0. 18）, of 10 years （P=0.94） or when 3 subgroups combined （RR=0.71, 95% CI O. 39 to 1.31, P =0.28） . The difference in ~〉 5~ extensor deficit was not statistically significant between the 2 groups （ RR = 1.63, 95% CI O. 85 to 3.16, P = 0. 14）. Anterior knee pain and kneeling pain or discomfort showed significantly 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 autograft, but there may be no such differences on a long-term basis.

关 键 词：髌韧带 前交叉韧带 META分析 腘绳肌 

分 类 号：R687[医药卫生—骨科学]