膝关节多发韧带损伤不同手术时机与疗效相关性的Meta分析  

Association of surgical timing and operative outcomes in multiple ligaments knee injuries: a meta-analysis

作　　者：毛云鹤 唐婕晞 李箭[1] 付维力[1] 郑峻[3] 杨渊[3] 熊燕[1] 李棋[1] 陈刚[1] 唐新[1] MAO Yunhe;TANG Jiexi;LI Jian;FU Weili;ZHENG Jun;YANG Yuan;XIONG Yan;LI Qi;CHEN Gang;TANG Xin(Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;West China School of Medicine, Sichuan University, Chengdu, 610207, P.R. China;Neurosurgery Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China)

机构地区：[1]四川大学华西医院运动医学中心,成都610041 [2]四川大学华西临床医学院,成都610207 [3]四川大学华西医院神经外科医疗中心,成都610041

出　　处：《中国循证医学杂志》2019年第4期418-423,共6页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金项目(编号:31741046;81871826);中央高校基本科研业务费(编号:2015SCU04A40);四川省卫计委项目(编号:18ZD017);四川省科技厅项目(编号:2017SZ0017);四川大学创新火花项目库(编号:2018SCUH0034);四川大学华西医院"135"工程项目(编号:ZY2017301)

摘　　要：目的 系统评价膝关节多发韧带损伤(MLIK)早期、延期手术效果的差异,为MLIK最佳手术时机的选择提供依据。方法 计算机检索PubMed、The Cochrane Library、EMbase、CNKI、CBM、WanFang Data和VIP数据库,搜集MLIK不同手术时机疗效的队列研究,检索时限均从建库至2018年9月23日。由2名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,采用RevMan 5.3软件进行Meta分析。结果 共纳入8个队列研究,包括153例早期手术患者和90例延期手术患者。Meta分析结果显示:与延期手术相比,早期手术患者术后膝关节Lysholm评分[MD=7.52,95%CI(2.00,13.04),P=0.008]更优;术后IKDC评分优良率[OR=2.97,95%CI(1.51,5.84),P=0.002]更高,差异均有统计学意义。但两组患者在术后Tegner评分[MD=–0.08,95%CI(–1.07,0.92),P=0.88]和术后膝关节活动度[MD=4.08,95%CI(–2.38,10.55),P=0.22]方面差异无统计学意义。MLIK手术治疗的主要不良反应包括神经血管损伤、下肢深静脉血栓形成、腓总神经损伤、止血带麻痹、关节活动受限等。早期手术的并发症发生率更低(7.1%vs. 30%)。结论 当前证据表明,早期手术治疗MLIK能够获得更高的Lysholm评分及IKDC优良率,且手术并发症更少。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。Objectives To systematically review the differences of operative outcomes between early surgery and delayed surgery in multiple ligament injury of knee joint(MLIK)patients.Methods PubMed,The Cochrane Library,EMbase,CNKI,CBM,WanFang Data and VIP databases were searched to collect cohort studies about operative outcomes of different surgery times in MLIK patients from inception to September23rd,2018.Two reviewers independently screened literature,extracted data and assessed risk of bias of included studies.Meta-analysis was then performed using RevMan5.3software.Results A total of8cohort studies involving153early and90delayed operatively treated patients were included.The results of meta-analysis showed that:compared with delayed surgery,early surgery received higher Lysholm score(MD=7.52,95%CI2.00to13.04,P=0.008)and superior IKDC score rate(OR=2.97,95%CI1.51to5.84,P=0.002).There were no significant differences in Tegner score(MD=–0.08,95%CI–1.07to0.92,P=0.88)and ROM(MD=4.08,95%CI–2.38to10.55,P=0.22)between two groups.The main adverse reactions of MLIK included neurovascular injury,deep venous thrombosis of lower extremities,common peroneal nerve injury,tourniquet paralysis and limited joint activity.Early surgery had a lower incidence of complications than delayed surgery(7.1%vs.30%).Conclusion The current evidence shows that early surgery can receive higher Lysholm score and superior IKDC score rate in treatment of MLIK,and have a lower incidence of complications.Due to limited quality and quantity of the included studies,more high-quality studies are required to verify above conclusions.

关 键 词：膝关节多发韧带损伤 早期手术 延期手术 效果 系统评价 META分析 队列研究 

分 类 号：R687.4[医药卫生—骨科学]