自体与同种异体肌腱移植单束重建后交叉韧带疗效的Meta分析  

Autograft versus Allograft Tendon for Posterior Cruciate Ligament Single-bundle Reconstruction:A Meta-analysis

作　　者：熊为[1] 刘家国[1] 罗斌[1] 张劲松[1] 赵猛[1] 张超[2] 

机构地区：[1]十堰市太和医院(湖北医药学院附属医院)创伤骨科,湖北十堰442000 [2]湖北医药学院附属太和医院循证医学与临床研究中心,湖北十堰442000

出　　处：《中国循证医学杂志》2016年第5期579-584,共6页Chinese Journal of Evidence-based Medicine

基　　金：湖北医药学院附属太和医院2014年循证医学"苗圃基金"项目(编号:EBM2014020)

摘　　要：目的系统评价自体肌腱与同种异体肌腱移植单束重建后交叉韧带(PCL)的疗效。方法计算机检索Pub Med、The Cochrane Library(2015年3期)、EMbase、CBM、CNKI、VIP和WanFang Data数据库,搜集有关自体肌腱与同种异体肌腱移植单束重建后交叉韧带疗效对比的随机对照试验、非随机的临床对照试验和队列研究,检索时限均为从建库至2015年8月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan5.3软件进行Meta分析。结果共纳入7个队列研究,共376例成年单侧肢体PCL损伤患者,患者均在关节镜下经胫骨骨道完成单束PCL重建。Meta分析结果显示:在Lysholm评分[MD=–0.54,95%CI(–2.36,1.27),P=0.56]、Tegner评分[MD=–0.04,95%CI(–0.88,0.80),P=0.93]、IKDC客观评分[OR=1.31,95%CI(0.68,2.53),P=0.41]及膝关节后向稳定性[SMD=–0.15,95%CI(–0.37,0.07),P=0.18]方面,关节镜下自体肌腱与同种异体肌腱移植单束重建后交叉韧带的疗效无明显差异,但同种异体肌腱组较自体肌腱组术后发热时间长[MD=–3.55,95%CI(–5.61,–1.49),P=0.000 7]。结论当前证据显示,关节镜下自体与同种异体肌腱移植单束重建后交叉韧带的疗效相当,但采用同种异体肌腱术后发热时间较自体肌腱长。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。Objective To systematically review the effects of autograft versus allograft tendon for posterior cruciate ligament single-bundle reconstruction. Methods Databases including PubMed, The Cochrane Library （Issue 3, 2015）, EMbase, CBM, CNKI, VIP and WanFang Data were searched from inception to August 2015, to collect randomized controlled trials, clinical controlled trials and cohort studies of autograft tendon versus allograft tendon for posterior cruciate ligament single-bundle reconstruction. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed using RevMan 5.3 software. Results A total of 7 cohort studies involving 376 patients who had undergone the arthroscopic transtibial single-bundle PCL reconstruction were included. The results of meta-analysis indicated that no significant differences were found between the autograft group and the allograft group in Lysholm score （MD= -0.54, 95%CI -2.36 to 1.27, P=0.56）, Tegner score （MD-- -0.04, 95%CI -0.88 to 0.80, P=0.93）, IKDC objective score （OR=l.31, 95%CI 0.68 to 2.53, P=0.41） and posterior translation side-to-side difference （SMD= -0.15, 95%CI -0.37 to 0.07, P--0.18）. However, patients in the allograft group had a longer duration of fever when compared with the autograft group patients （MD= -3.55, 95%CI -5.61 to -1.49, P=0.000 7）. Conclusion Current evidence shows that autograft tendon and allograft tendon tibial have similar effects in PCL singlebundle reconstruction, though there is a longer duration of fever in patients with allograft. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

关 键 词：后交叉韧带 重建 自体肌腱 同种异体肌腱 META分析 

分 类 号：R687.2[医药卫生—骨科学]