自体腘绳肌重建前交叉韧带中可吸收螺钉和金属螺钉胫骨固定效果比较的Meta分析  

Meta-analysis of comparison of the effect of tibial fixation using absorbable screws and metal screws in anterior cruciate ligament reconstruction with autologous hamstrings

作　　者：熊小龙[1] 王广积[1] 方业汉 杜秀藩 黄晖[1] 叶志方 Xiong Xiaolong;Wang Guangji;Fang Yehan;Du Xiufan;Hang Hui;Ye Zhifang(Department of Sports Medicine,Hainan General Hospital,Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,Hainan Province,China)

机构地区：[1]海南省人民医院,海南医学院附属海南医院运动医学科,海南省海口市570311

出　　处：《中国组织工程研究》2021年第21期3438-3444,共7页Chinese Journal of Tissue Engineering Research

基　　金：海南省科技项目资助(ZDYF2019180),项目负责人:王广积。

摘　　要：目的:近年有报道比较了可吸收螺钉和金属螺钉固定在自体腘绳肌移植重建前交叉韧带中的疗效,都能取得满意的临床疗效,有必要对2种螺钉固定方式进行Meta分析。文章观察比较了可吸收螺钉和金属螺钉固定在自体腘绳肌重建前交叉韧带中应用的临床效果。方法:检索PubMed、The Cochrane Library、EMbase、MEDLINE(Ovid)、CBM、中国知网、维普、百度学术及万方医学数据库,并手工检索相关的中英文骨科杂志。收集所有相关可吸收螺钉和金属螺钉固定在自体腘绳肌重建前交叉韧带中应用的随机对照试验,检索时限均从建库至2020年8月。通过筛选文献、文献评价、提取数据,采用Cochrane协作组推荐的偏倚风险评估工具和Jadad评分表评估随机对照试验,并在RevMan 5.3软件进行Meta分析。结果:①最终纳入了8个随机对照试验,共472例患者,其中采用可吸收螺钉固定237例,采用金属螺钉固定235例,研究偏倚风险评估为低风险,改良Jadad评分均在4分以上,均为高质量研究;②Meta分析显示:可吸收螺钉组和金属螺钉组在术后前交叉韧带再断裂、Lysholm评分、IKDC正常分级、KT-1000、Lanchman试验、Pivot试验和术后感染方面比较差异无显著性意义(P>0.05),但金属螺钉组在术后骨长入方面优于可吸收螺钉组(RR=0.16,95%CI:0.03-0.84,P=0.03)。结论:采用可吸收螺钉和金属螺钉在自体腘绳肌移植重建前交叉韧带胫骨端固定的术后膝关节稳定和功能恢复上疗效相当,金属螺钉固定比可吸收螺钉在术后更利于骨长入。临床上可推荐金属螺钉代替可吸收螺钉固定,但纳入研究较少,需要更多随机对照试验研究的证据。OBJECTIVE:In recent years,it has been reported that both absorbable screws and metal screws can achieve satisfa ctory clinical efficacy in the tibial fixation with autologous hamstring reconstruction for anterior cruciate ligament.It is necessary to conduct a meta-analysis on the two screw fixation methods.This study observed and compared the clinical outcomes of absorbable versus metal screws in the autologous hamstring tendon reconstruction of anterior cruciate ligament.METHODS:The PubMed,The Cochrane Library,EMbase,MEDLINE(Ovid),CBM,CNKI,VIP,Baidu Scholar,and Wanfang medical databases were searched,and relevant Chinese and English orthopedic journals were sea rched manually.All relevant randomized control trials of absorbable versus metal screws fixation in the autologous hamstring tendon reconstruction for anterior cruciate ligament were collected.The searched period was from database inception to August 2020.Thro ugh literature screening,literature evaluation and data extraction,randomized controlled trials were assessed using the Cochrane Collaboration’s recommended risk assessment tool for bias and the Jadad scale,and meta-analysis was conducted in RevMan 5.3 software.RESULTS:(1)Eight randomized controlled trials were included,with 472 patients,including 237 cases fixed with absorbable screws and 235 cases fixed with metal screws.The risk of study bias was assessed as low risk,and the modified Jadad score was above 4,indicating high-quality studies.(2)The results of metaanalysis showed there were no statistically significant differences in postoperative anterior cruciate ligament rerupture,Lysholm score,IKDC normal gra ding,KT-1000,Lanchman test,Pivot test and postoperative infection between the absorbable screw group and the metal screw group(P>0.05).However,the metal screw group had an advantage in bone ingrowth compared to the absorbable screw group(RR=0.16,95%CI:0.03-0.84,P=0.03).CONCLUSION:The effects of stability and function recovery of the knee after operation between the absorbable screw group a

关 键 词：软组织 骨 韧带 前交叉韧带 腘绳肌 可吸收螺钉 金属螺钉 META分析 

分 类 号：R459.9[医药卫生—治疗学] R605[医药卫生—临床医学]