关节镜下全内技术与传统技术重建前交叉韧带:疗效和放射学结果的Meta分析  

All-inside versus traditional techniques of anterior cruciate ligament reconstruction:meta-analysis of therapeutic efficacy and radiological outcomes

作　　者：王锋 曹春风[1] 何超[1] 张涛[1] 周子弦 朱凤臣[1] Wang Feng;Cao Chunfeng;He Chao;Zhang Tao;Zhou Zixian;Zhu Fengchen(Yongchuan Hospital,Chongqing Medical University,Chongqing 402160,China)

机构地区：[1]重庆医科大学附属永川医院,重庆市402160

出　　处：《中国组织工程研究》2025年第35期7629-7638,共10页Chinese Journal of Tissue Engineering Research

基　　金：云南省科技厅科技计划项目(202301AY070001-214),项目参与人:王锋;重庆市永川区自然科学基金项目(2023yc-jckx20059),项目负责人:曹春风。

摘　　要：目的:比较关节镜下全内技术与传统技术重建前交叉韧带的临床疗效和放射学结果。方法:检索PubMed、Web of Science、Embase和Cochrane Library、CNKI、万方以及维普数据库关于全内技术与传统技术重建前交叉韧带的文献。检索时限为各数据库建立至2024年9月。对纳入文献进行Meta分析。结果:①共17篇文献纳入Meta分析,全内技术重建组患者631例,传统技术重建组患者626例,末次随访时间最早为术后半年,最晚术后5年,大多数随访时间为2年。②Meta分析结果显示:与传统技术重建前交叉韧带相比,全内技术重建前交叉韧带术中移植物更粗[MD=0.20,95%CI(0.09,0.31),P=0.0005],术后胫骨侧骨道最大直径[SMD=-3.64,95%CI(-6.00,-1.28),P=0.002]和体积[SMD=-3.69,95%CI(-5.37,-2.00),P<0.0001]更小,术后2年的国际膝关节文献委员会主观评分[MD=2.41,95%CI(0.49,4.32),P=0.01]和Lysholm评分[MD=1.11,95%CI(0.42,1.8),P=0.002]更高,但手术时间相对较长[MD=10.06,95%CI(4.71,15.4),P=0.0002],且2年以后膝关节稳定性较差[SMD=0.3,95%CI(0.04,0.55),P=0.02]。两组术后半年和术后1年的国际膝关节文献委员会主观评分[MD=-0.05,95%CI(-1.96,1.83),P=0.96]、[MD=0.51,95%CI(-1.17,2.19),P=0.55]、术后半年至1年双侧膝关节前向松弛度差值[SMD=-0.02,95%CI(-0.3,0.27),P=0.9]、术后半年Lysholm评分[MD=0.87,95%CI(-0.15,1.89),P=0.09]、末次随访国际膝关节文献委员会客观评分[RR=0.95,95%CI(0.86,1.06),P=0.37]、末次随访美国膝关节协会评分[MD=0.33,95%CI(-0.55,1.21),P=0.47]、末次随访Tegner评分[MD=0.05,95%CI(-0.11,0.22),P=0.53]、末次随访轴移试验阴性率[RR=0.92,95%CI(0.83,1.01),P=0.09]、末次随访术后翻修率[RR=2.2,95%CI(0.98,4.92),P=0.05]和单腿跳跃测试结果[MD=-0.06,95%CI(-4.99,4.86),P=0.98]均无统计学差异。结论:全内技术与传统技术重建前交叉韧带术后,大多数功能结局评分以及胫骨侧隧道位置并无明显差异。从术后2年的国际膝关节文献委�OBJECTIVE:To compare the clinical efficacy and radiological results of arthroscopic all-inside technique and traditional technique in anterior cruciate ligament reconstruction.METHODS:Databases such as CNKI,WanFang,VIP,PubMed,Web of Science,Embase,and Cochrane Library were searched for literature on all-inside technique and traditional technique in anterior cruciate ligament reconstruction.The search time was from the establishment of each database to September 2024.Meta-analysis was conducted on the included literature.RESULTS:(1)A total of 17 articles were included in the meta-analysis,with 631 patients in the all-inside technique reconstruction group and 626 patients in the traditional technique reconstruction group.The earliest time for the last follow-up was half a year after surgery,and the latest was 5 years after surgery.Most follow-up period was 2 years.(2)Meta-analysis results showed that compared with traditional anterior cruciate ligament reconstruction,the all-inside technique had a thicker graft during anterior cruciate ligament reconstruction[mean difference(MD)=0.20,95%confidence interval(CI)(0.09,0.31),P=0.0005],smaller postoperative maximum diameter[standardized mean difference(SMD)=-3.64,95%CI(-6.00,-1.28),P=0.002]and volume[SMD=-3.69,95%CI(-5.37,-2.00),P<0.0001]of the tibial tunnel,and higher International Knee Documentation Committee subjective scores[MD=2.41,95%CI(0.49,4.32),P=0.01]and Lysholm scores[MD=1.11,95%CI(0.42,1.8),P=0.002]2 years after surgery.However,the operation time was relatively longer[MD=10.06,95%CI(4.71,15.4),P=0.0002],and the knee stability was poorer after 2 years[SMD=0.3,95%CI(0.04,0.55),P=0.02].No significant differences were found between the two groups in the following aspects:the subjective scores of the International Knee Documentation Committee at 6 months and 1 year postoperatively[MD=-0.05,95%CI(-1.96,1.83),P=0.96;MD=0.51,95%CI(-1.17,2.19),P=0.55];the difference in anterior laxity of bilateral knees at 1 year postoperatively[SMD=-0.02,95%CI(-0.3,0.27),P=0.9];the

关 键 词：前交叉韧带 前交叉韧带损伤 全内技术 悬吊固定 全胫骨隧道技术 前交叉韧带重建 关节镜 META分析 随机对照试验 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R686.5