关节镜下保留残端重建前交叉韧带与不保留残端重建的Meta分析  

Preserving-remnant versus removing-remnant for arthroscopic anterior cruciate ligament reconstruction: a Meta-analysis

作　　者：张磊[1] 谢崇新 白靖平[1] 

机构地区：[1]新疆医科大学附属肿瘤医院骨与软组织科,新疆维吾尔自治区乌鲁木齐市830011 [2]武警兵团指挥部医院外一科,新疆维吾尔自治区乌鲁木齐市830002

出　　处：《中国组织工程研究》2016年第20期3032-3040,共9页Chinese Journal of Tissue Engineering Research

基　　金：新疆生产建设兵团自然科学基金(2015AD004)~~

摘　　要：背景:对于前交叉韧带重建过程中是否保留原韧带残端仍存在不同观点。很多学者认为保留残端重建前交叉韧带术后疗效更满意,但也有学者认为保留残端重建与普通手术无显著差异,并不赞同保留残端重建前交叉韧带。目的:通过Meta分析对保留残端重建前交叉韧带与不保留残端重建的有效性和安全性进行比较。方法:按照Cochrane系统评价的方法,计算机检索Medline、荷兰医学文摘、Cochrane图书馆、Cochrane协作网专业试验数据库、中国生物医学文献数据库,CNKI等数据库1995年至2015年7月的相关文献,英文检索词:anterior cruciate ligament AND remnant(OR stump)AND randomized controlled trial(RCT)OR quasi-RCT;中文检索词:前交叉韧带重建、保残、不保残。采用Review Manager 5.3.软件进行Meta分析。结果与结论:共纳入13个研究,Meta分析结果显示:保留残端重建前交叉韧带与不保残重建在KT1000/2000评分[OR=-0.28,95%CI:-0.76-0.20,P=0.25]、滑膜覆盖优良率[OR=-0.30,95%CI:-0.30-0.90,P=0.32]及Cyclops病变发生率[OR=0.87,95%CI:0.63-2.90,P=0.44]方面差异无显著性意义。在术后Lysholm评分[OR=2.45,95%CI:0.52-4.39,P=0.01]、本体感觉[OR=-1.72,95%CI:-3.32至-0.13,P=0.03]、骨道扩大[OR=-0.66,95%CI:-1.08至-0.23,P=0.002]方面,保留残端重建前交叉韧带组较优。结果说明,保留残端重建前交叉韧带与不保残重建均能取得较好的膝关节前后稳定性,而在膝关节术后评分、本体感觉及防止骨道扩大方面,保留残端组更具有优势。由于部分文献质量不高,可能存在各种偏倚,未来需要更多高质量的随机对照试验来得出更可靠的结论。BACKGROUND： There are controversies about preserving the remnant in the anterior cruciate ligament reconstruction procedure because of its uncertain therapeutic effects. OBJECTIVE： To compare the efficacy and safety of preserving-remnant with removing-remnant for arthroscopic anterior cruciate ligament reconstruction using a meta-analysis. METHODS： A computer-based online search was conducted in Pub Med, Embase, the Cochrane Library, CDSR, CBM, and CNKI databases by using the English key words of ＂anterior cruciate ligament AND remnant（OR stump） AND randomized controlled trial（RCT） OR quasi-RCT＂ and the Chinese key words of ＂anterior cruciate ligament reconstruction, preserving-remnant, removing-remnant＂ to screen the relevant articles published from 1995 to July 2015. Meta-analysis was performed using Review Manager 5.3 software. RESULTS AND CONCLUSION： A total of 13 randomized controlled trials were included. The meta-analysis results showed that there were no statistically significant differences in KT1000/2000 scores（OR=-0.28, 95%CI：-0.76-0.20, P=0.25）, the good rate of synoveal coverage（OR =-0.30, 95%CI：-0.30-0.90, P=0.32）, and the incidence of cyclops leions（OR=0.87, 95%CI： 0.63-2.90, P=0.44）. Postoperative Lysholm scores（OR=2.45, 95%CI： 0.52-4.39, P=0.01）, proprioceptive function（OR=-1.72, 95%CI：-3.32 to 0.13, P=0.03）, tunnel enlargement（OR=-0.66, 95%CI：-1.08 to-0.23, P=0.002） in preserving-remnant were superior to removing-remnant for arthroscopic anterior cruciate ligament reconstruction. These results suggest that both preserving-remnant and removing-remnant for arthroscopic anterior cruciate ligament reconstruction can obtain satisfactory antero-posterior stability of the knee. Preserving-remnant exhibits superiority in post-operative scores of the knee, proprioceptive function, tunnel enlargement. Further high-quality randomized controlled trials are warranted because of some low-quality studies and the existing biases.

关 键 词：组织工程 前交叉韧带 META分析 组织构建 肌肉肌腱韧带 保留残端 不保留残端 重建 随机对照 本体感觉 Cyclops病变 骨道扩大 膝关节稳定性 

分 类 号：R318[医药卫生—生物医学工程]