自体与非放射线处理同种异体肌腱重建前交叉韧带的荟萃分析  

Autograft versus non-irradiated allograft for anterior cruciate ligament reconstruction: a meta-analysis

作　　者：王伊伦 谢东兴 李辉[1] 杨拓[1] 邓桢翰[1] 杨烨[1] 张屹[1] 丁翔[1] 雷光华[1] 

机构地区：[1]中南大学湘雅医院骨科,湖南省长沙市410008

出　　处：《中国组织工程研究》2014年第42期6863-6870,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金项目(81272034);湖南省发改委项目([2013]1199);湖南省科技厅科研项目(2013SK2018);教育部博士点基金(20120162110036)~~

摘　　要：背景:当今,前交叉韧带重建是修复膝关节前交叉韧带损伤的常用方法,但就重建移植物的选择问题尚存在不少争议。目的:比较自体与非放射线处理的同种异体肌腱移植重建前交叉韧带临床疗效的差异。方法:计算机检索PubMed/Medline数据库以及手工检索国内外公开发表的有关自体与非放射线处理的同种异体肌腱移植重建前交叉韧带的随机对照试验,所有文献检索截止至2014年7月12日。应用RevMan5.2软件进行数据统计分析,输入数据时采取双人核对以确保准确无误。结果与结论:共纳入6项随机对照试验,累计858例受试对象,其中自体肌腱组441例,非放射线处理的同种异体肌腱组417例。荟萃分析结果显示,自体与非放射性处理的同种异体肌腱移植重建前交叉韧带的总IKDC评分[相对危险度=1.02,95%置信区间(0.99-1.06),P=0.21];松弛度[均数差=-0.13,95%置信区间(-0.29至-0.02),P=0.09];Lachman试验[相对危险度=1.04,95%置信区间(0.95-1.13),P=0.37];pivot shift试验[相对危险度=1.00,95%置信区间(0.95-1.05),P=0.96];one-leg hop试验[相对危险度=1.01,95%置信区间(0.96-1.06),P=0.77];Lysholm评分[均数差=-0.64,95%置信区间(-1.45-0.17),P=0.12];Tegner评分[均数差=0.16,95%置信区间(-0.16-0.47),P=0.34]以及并发症发生率[相对危险度=1.42,95%置信区间(0.67-3.04),P=0.36]的差异无显著性意义。以上结果表明,自体与非放射线处理的同种异体肌腱移植重建前交叉韧带的临床疗效并无明显差异,但鉴于此研究存在一定局限性,此结论有待更多更高质量的随机对照试验进一步证实。BACKGROUND：Reconstruction of the anterior cruciate ligament has become the gold-standard treatment for an anterior cruciate ligament rupture. Despite the popularity of the procedure, there remains a considerable amount of controversies over whether an autograft or anal ograft should be used for primary anterior cruciate ligament reconstruction. OBJECTIVE：To compare the clinical outcomes of al ograft and autograft in primary anterior cruciate ligament reconstruction. METHODS：Randomized control ed trials concerning autograft versus non-irradiated al ograft for anterior cruciate ligament reconstruction were identified from the PubMed/Medline database conducted up to July 12, 2014. These studies were selected independently by two reviewers according to the inclusion and exclusion criteria. Meta-analysis was performed using Revman5.2 software. RESULTS AND CONCLUSION：A total of 6 randomized control ed trials consisting of 858 cases were included,＆amp;nbsp;441 cases in autograft group and 417 cases in non-irradiated al ograft. The results of the meta-analysis indicate no significant difference between autografts and non-irradiated al ografts in overal IKDC [relative risk （RR）=1.02, 95%confidence interval （CI） （0.99 to 1.06）, P=0.21], degree of laxity [mean difference （MD）=-0.13, 95%CI （-0.29 to-0.02）, P=0.09], Lachman test [RR=1.04, 95%CI （0.95 to 1.13）, P=0.37], pivot shift test [RR=1.00, 95%CI （0.95 to 1.05）, P=0.96], one-leg hop test [RR=1.01, 95%CI （0.96 to 1.06）, P=0.77], Lysholm score [MD=-0.64, 95%CI （-1.45 to 0.17）, P=0.12], Tegner score [MD=0.16, 95%CI （-0.16 to 0.47）, P=0.34] and rate of postoperative complications [RR=1.42, 95%CI （0.67 to 3.04）, P=0.36]. Therefore, in the meta-analysis, there is no significant difference between autograft and non-irradiated al ograft in clinical outcomes. However due to the limitations of our study, further work is needed to determine this conclusion.

关 键 词：组织构建 组织工程 前交叉韧带重建 自体肌腱 异体肌腱 非放射线处理 荟萃分析 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]