中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (32): 5227-5231.doi: 10.12307/2021.229

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    下一篇

关节镜下保留残端与不保留残端重建前交叉韧带：前瞻性、随机、对照研究的Meta分析

黄泓慧1，潘华山1，赖春柏2   

  1. 1广州中医药大学，广东省广州市    510006；2赣州市中医院，江西省赣州市    341000

  • 收稿日期:2019-10-21 修回日期:2019-10-26 接受日期:2020-01-17 出版日期:2021-11-18 发布日期:2021-07-26
  • 通讯作者: 黄泓慧，硕士，广州中医药大学，广东省广州市 510006
  • 作者简介:黄泓慧，女，1990年生，广州中医药大学毕业，硕士，主要从事运动医学研究。

Arthroscopic reconstruction of anterior cruciate ligament with and without remnant preservation: a Meta-analysis of prospective, randomized, and controlled studies

Huang Honghui1, Pan Huashan1, Lai Chunbai2   

  1. 1Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China; 2Ganzhou Municipal Hospital of Traditional Chinese Medicine, Ganzhou 341000, Jiangxi Province, China
  • Received:2019-10-21 Revised:2019-10-26 Accepted:2020-01-17 Online:2021-11-18 Published:2021-07-26
  • Contact: Huang Honghui, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
  • About author:Huang Honghui, Master, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China

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摘要：

文题释义：
本体感觉：是指肌、腱、关节等运动器官本身在不同状态(运动或静止)时产生的感觉(例如，人在闭眼时能感知身体各部的位置)，因位置较深，又称深部感觉。此外，在本体感觉传导通路中，还传导皮肤的精细触觉(如辨别两点距离和物体的纹理粗细等)。主要涉及躯干和四肢的本体感觉传导通路(属于顶叶功能)。
保留韧带残端在前交叉韧带重建术中的价值：为了在前交叉韧带重建手术中清晰显露前交叉韧带股骨止点及胫骨的足迹，前交叉韧带重建术通常将前交叉韧带残端进行清扫。研究证实，此类韧带残端具有维持膝关节本体感觉、促进移植物血管再生、有助于预防膝关节前向再松弛的作用，故前交叉韧带断裂患者术中保留韧带残端逐渐被临床医生认可，并在术后康复中取得了较满意的结果。
目的：关节镜下重建前交叉韧带已经成为当前前交叉韧带损伤的首选治疗方法，但对于是否保留前交叉韧带胫骨残端重建存在较大争议。文章系统评价关节镜下保留残端与不保留残端重建前交叉韧带的临床效果。
方法：通过计算机检索PubMed、EMbase、The Cochrane Library、CBM、WanFang Data、CNKI和VIP数据库，搜集所有关于关节镜下保留残端与不保留残端重建前交叉韧带的临床对照研究，检索时限均从建库至2019年9月。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：①保留残端组的Lysholm评分明显高于不保留残端组[MD=2.20，95%CI(0.82，3.58)，P=0.001]；②保留残端组的IKDC评分明显高于不保留残端组[MD=2.28, 95%CI(1.20，3.37)，P < 0.001]；③保留残端组的KT1000/KT2000评分明显低于不保留残端组[MD=-0.29，95%CI(-0.52，-0.06)，P=0.01]；④保留残端组与不保留残端组的轴移试验无明显差异；⑤保留残端组与不保留残端组的Lachman试验无明显差异；⑤保留残端组与不保留残端组的本体感觉差异明显[MD=0.41，95%CI(0.13，0.69)，P=0.004]；⑥保留残端组与不保留残端组的胫骨隧道直径无明显差异。
结论：现有证据表明保留残端重建前交叉韧带可以提高膝关节术后功能评分、本体感觉和客观稳定性，但无证据表明其对主观稳定性和胫骨骨隧道保护有益。

关键词: 保留残端, 不保留残端, 前交叉韧带, 系统评价, 临床疗效

Abstract: OBJECTIVE: Arthroscopic reconstruction of the anterior cruciate ligament has become the preferred choice for anterior cruciate ligament injuries, but there is still a big controversy about whether to preserve the tibial remnant of the anterior cruciate ligament. Here, we attempt to systematically evaluate the clinical effect of anterior cruciate ligament reconstruction with and without remnant preservation under arthroscopy.
METHODS: PubMed, EMbase, the Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were searched for clinical controlled studies regarding arthroscopic anterior cruciate ligament reconstruction with or without remnant preservation. The retrieval time was from inception of the databases to September 2019. Two researchers independently screened the literature, extracted data and evaluated the risk of bias in the included studies. Revman 5.3 software was then used for Meta-analysis.
RESULTS: Compared with the reconstruction without remnant preservation, there was higher Lysholm score [mean difference (MD)=2.20, 95% confidence interval (CI) (0.82, 3.58), P=0.001], higher International Knee Documentation Committee score (MD=2.28, 95% CI (1.20, 3.37), P < 0.001), lower KT1000/KT2000 score [MD =-0.29, 95% CI (-0.52, -0.06), P=0.01] after remnant-preserved reconstruction. There were no significant differences in the axial displacement test, Lachman test and the diameter of the tibial tunnel between the reconstruction with or without remnant preservation. Compared with the reconstruction without remnant preservation, the reconstruction with remnant preservation led to a better proprioception [MD=0.41, 95%CI (0.13, 0.69), P=0.004]. 
CONCLUSION: Existing evidence has shown that remnant-preserved reconstruction of the anterior cruciate ligament can improve the functional score, proprioception and objective stability of the knee joint after surgery, but there is no evidence that it is beneficial to subjective stability and to protecting the tibial tunnel.


Key words: remnant preservation, no remnant preservation, anterior cruciate ligament, systematic review, clinical efficacy

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