微骨折术与自体软骨细胞移植术在膝关节软骨缺损疗效比较的Meta分析  

Effectiveness of Microfracture Versus Autologous Chondrocyte Implantation for Treatment of Cartilage Defects: A Meta-Analysis

作　　者：庄腾丰 王华军[1] 郑小飞 吴文锐[1] 罗斯敏[1] 陈均源[1] 查振刚[1] ZHUANG Teng-feng;WANG Hua-jun;ZHENG Xiao-fei;WU Wen-rui;LUO Si-min;CHEN Jun-yuan;ZHA Zhen-gang(Department of Bone and Joint Surgery, The First Affilated Hospital of Ji＇an University , Guangzhou 510630, China)

机构地区：[1]暨南大学附属第一医院骨关节科,广州510630

出　　处：《循证医学》2018年第2期99-105,共7页The Journal of Evidence-Based Medicine

基　　金：国家自然科学基金资助项目(81601219)

摘　　要：目的 系统评价微骨折术与自体软骨细胞移植术治疗膝关节软骨缺损的有效性。方法 计算机检索电子数据库PubMed、EMBASE、Cochrane图书馆(2017年第5期)、CBM、中国知网、万方数据库,搜集微骨折术与自体软骨细胞移植术治疗膝关节软骨缺损临床疗效比较的随机对照试验,检索时间均为自建库至2017年5月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,运用RevMan5.3软件进行Meta分析。结果 共纳入7篇随机对照试验,555例患者。Meta分析结果显示:在最终比较随访的膝关节运动评分(Tegner)(均数差-0.13,95%可信区间-0.82~0.56,P=0.72),Lysholm评分(均数差-7.21,95%可信区间-20.19~5.77,P=0.28),膝关节损伤和骨关节炎评分(均数差-4.23,95%可信区间-8.39^-0.06,P=0.05)和2年随访的各项评分(标准化均数差-0.50,95%可信区间-1.05~0.05,P=0.08)的对比中,自体软骨移植术仅在膝关节损伤和骨关节炎评分(KOOS)上优于微骨折术,且差异有统计学意义。结论 微骨折术与自体软骨移植术疗效相当,患者术后在关节活动、疼痛、稳定性方面无明显差异。但是否在更加长的时间跨度下仍有相同的疗效需要更多长时间随访的临床研究来支持。Objective To systematically review the efficacy of microfracture versus autologous chondrocyte implantation for treatment of cartilage defects. Methods Databases including PubMed,EMBASE, the Cochrane library（Issue 5,2017）, CBM, CNKI and Wanfang data were electronically searched to collect randomized controlled trials（RCTs）about microfracture versus autologous chondrocyte implantation for treatment of cartilage defects from inception to May 2017. Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using Rev Man 5.3 software. Results A total of 7 RCTs involing 555 patients were included. The results of meta-analysis showed that KOOS scores at final follow-up in the microfracture group is less than that of autologous chondrocyte implantation group with significant difference（MD=-4.23,95%CI-8.39^-0.06,P=0.05）. There were no significant difference between both groups in Tegner scores at final follow-up（MD=-0.13,95%CI=-0.82~0.56,P=0.72）,Lysholm scores at final follow-up（MD=-7.21,95%CI-20.19~5.77,P=0.28）and available scores at 2-years follow-up（SMD=-0.50,95%CI-1.05~0.05,P=0.08）. Conclusion These findings demonstrate that microfracture result in same outcome with autologous chondrocyte implantation. However,whether microfracture owns a same long-term outcome with autologous chondrocyte implantation in general needs more research.

关 键 词：关节软骨缺损 微骨折术 自体软骨细胞移植术 随机对照试验 META分析 

分 类 号：R687.3[医药卫生—骨科学]