全内技术与全胫骨隧道技术重建前十字韧带的临床疗效meta分析  

All-inside versus full-tibial tunnel techniques of anterior cruciate ligament reconstruction:a systematic review and meta-analysis

作　　者：冯建豪 徐一宏 徐卫东 Feng Jianhao;Xu Yihong;Xu Weidong(Department of Orthopaedics,Tongji Hospital,Tongji University,Shanghai 200065,China;Department of Joint Surgery,the First Affiliated Hospital of Naval Medical University(Shanghai Changhai Hospital),Shanghai 200433,China)

机构地区：[1]同济大学附属同济医院骨科,上海200065 [2]海军军医大学第一附属医院(上海长海医院)关节骨病外科,上海200433

出　　处：《中华骨科杂志》2023年第16期1104-1114,共11页Chinese Journal of Orthopaedics

基　　金：海军军医大学第一附属医院"十四五"学科固海计划(GH145-16)。

摘　　要：目的比较关节镜下全内技术与全胫骨隧道技术重建前十字韧带(anterior cruciate ligament,ACL)的临床疗效。方法检索中国知网、万方数据库、中华医学期刊全文数据库、PubMed、Web of Science和Cochrane Library等数据库关于全内技术与全胫骨隧道技术重建ACL的文献。检索时间为各数据库建立至2023年2月。对纳入文献进行meta分析。若组间异质性较大采用随机效应模型进行分析,组间异质性较小则采用固定效应模型进行分析。结果共13篇文献纳入meta分析,全内重建组患者511例,全胫骨隧道技术重建组465例,平均随访时间6~25.8个月。Meta分析结果显示全内重建的移植物直径[MD=0.42,95%CI(0.11,0.73),P=0.007]和术后国际膝关节文献委员会(International Knee Documentation Committee,IKDC)主观评分[MD=1.11,95%CI(0.36,1.86),P=0.004]均大于全胫骨隧道技术重建,胫骨隧道增宽量小于全胫骨隧道技术重建[MD=-1.70,95%CI(-2.38,-1.01),P<0.001]。两组IKDC客观评分[OR=1.09,95%CI(0.67,1.78),P=0.730]、Lysholm评分[MD=0.99,95%CI(-0.08,2.05),P=0.070]、Tegner膝关节运动评分[MD=-0.01,95%CI(-0.48,0.45),P=0.950]、双侧膝关节前向松弛度差值[MD=0.32,95%CI(-0.22,0.86),P=0.250]、轴移试验阴性率[OR=0.80,95%CI(0.33,1.91),P=0.610]、移植物再断裂率[OR=0.76,95%CI(0.34,1.74),P=0.524]和重返运动率[OR=1.56,95%CI(0.85,2.86),P=0.150]的差异无统计学意义。结论全内技术重建ACL疗效满意,与全胫骨隧道技术重建ACL相比具有移植物直径粗、胫骨隧道增宽小的优势,两者术后2年内的关节功能无差异。Objective To compare the clinical efficacy of arthroscopic all-inside technique versus full-tibial tunnel technique for anterior cruciate ligament(ACL)reconstruction.MethodsLiterature on all-inside versus full-tibial tunnel for ACL reconstruction was retrieved from databases including China National Knowledge Infrastructure(CNKI),Wanfang Data,Full-text Database of Chinese Medical Journals,PubMed,Web of Science,and Cochrane Library from their establishment to February 2023.Meta-analysis was performed on the included studies.Random effects model was used if heterogeneity was large,while fixed effects model was used if heterogeneity was small.ResultsA total of 13 studies with 511 cases in the all-inside group and 465 cases in the full-tibial tunnel group were included in the meta-analysis,with a mean follow-up of 6-25.8 months.Meta-analysis showed that the graft diameter[MD=0.42,95%CI(0.11,0.73),P=0.007]and International Knee Documentation Committee(IKDC)subjective score[MD=1.11,95%CI(0.36,1.86),P=0.004]of the all-inside group was larger than full-tibial tunnel group,and the tibial tunnel widening of the all-inside group was less than full-tibial tunnel group[MD=-1.70,95%CI(-2.38,-1.01),P<0.001].There were no significant differences in IKDC objective score[OR=1.09,95%CI(0.67,1.78),P=0.730],Lysholm score[MD=0.99,95%CI(-0.08,2.05),P=0.070],Tegner activity score[MD=-0.01,95%CI(-0.48,0.45),P=0.950],bilateral knee anterior laxity difference[MD=0.32,95%CI(-0.22,0.86),P=0.250],negative rate of pivot shift test[OR=0.80,95%CI(0.33,1.91),P=0.610],graft re-rupture rate[OR=0.76,95%CI(0.34,1.74),P=0.524]and return to sport rate[OR=1.56,95%CI(0.85,2.86),P=0.150].ConclusionAll-inside ACL reconstruction provides satisfactory efficacy.Compared with full-tibial tunnel technique,it has the advantages of larger graft diameter and less tibial tunnel widening,with no difference in joint function within 2 years postoperatively.

关 键 词：膝关节 前交叉韧带重建 关节镜检查 META分析 

分 类 号：R686.5[医药卫生—骨科学]