中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (20): 3032-3040.doi: 10.3969/j.issn.2095-4344.2016.20.019

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

关节镜下保留残端重建前交叉韧带与不保留残端重建的Meta分析

张  磊1，谢崇新2，白靖平1   

  1. 1新疆医科大学附属肿瘤医院骨与软组织科，新疆维吾尔自治区乌鲁木齐市  830011；2武警兵团指挥部医院外一科，新疆维吾尔自治区乌鲁木齐市  830002
  • 出版日期:2016-05-13 发布日期:2016-05-13
  • 通讯作者: 白靖平，博士，主任医师，博士生导师，新疆医科大学附属肿瘤医院骨与软组织科，新疆维吾尔自治区乌鲁木齐市 830011
  • 作者简介:张磊，男，1979年生，汉族，新疆医科大学附属肿瘤医院在读博士，新疆维吾尔自治区阿勒泰市人，主要从事骨与关节损伤研究。
  • 基金资助:

    新疆生产建设兵团自然科学基金(2015AD004)

Preserving-remnant versus removing-remnant for arthroscopic anterior cruciate ligament reconstruction: a Meta-analysis

Zhang Lei1, Xie Chong-xin2, Bai Jing-ping1   

  1. 1Deparment of Bone and Soft Tissue, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, Xinjiang Uyghur Autonomous Region, China; 2the First Department of Surgery, Hospital Affiliated to Xinjiang Production and Construction Corps Headquarters of Chinese People’s Armed Police Forces, Urumqi 830002, Xinjiang Uyghur Autonomous Region, China
  • Online:2016-05-13 Published:2016-05-13
  • Contact: Bai Jing-ping, M.D., Chief physician, Doctoral supervisor, Deparment of Bone and Soft Tissue, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, Xinjiang Uyghur Autonomous Region, China
  • About author:Zhang Lei, Studying for doctorate, Deparment of Bone and Soft Tissue, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, Xinjiang Uyghur Autonomous Region, China
  • Supported by:

    the Natural Science Foundation of Xinjiang Production and Construction Corps, China, No. 2015AD004

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被引次数

2

摘要：

文章快速阅读：

文题释义：
关节镜技术：是骨科最早使用的微创技术，自应用于临床以来，极大地提高了关节疾病的确诊率，并且完成了很多常规手术很难执行的关节内病变手术，它不但已经从初创时单纯的膝关节扩展到肩、肘、腕、髋、踝甚至指间关节，而且从原先简单的处理半月板损伤和滑膜疾病发展到能够做半月板移植，前后交叉韧带重建和软骨缺损移植。
膝关节前交叉韧带损伤：是最常见而严重的运动创伤之一，前交叉韧带撕裂引起膝关节不稳，治疗不当将引起膝关节功能严重障碍。前交叉韧带损伤的修复重建一直是骨科和运动创伤领域的重要研究课题。

摘要
背景：对于前交叉韧带重建过程中是否保留原韧带残端仍存在不同观点。很多学者认为保留残端重建前交叉韧带术后疗效更满意，但也有学者认为保留残端重建与普通手术无显著差异，并不赞同保留残端重建前交叉韧带。
目的：通过Meta分析对保留残端重建前交叉韧带与不保留残端重建的有效性和安全性进行比较。
方法：按照Cochrane系统评价的方法，计算机检索Medline、荷兰医学文摘、Cochrane图书馆、Cochrane协作网专业试验数据库、中国生物医学文献数据库，CNKI等数据库1995年至2015年7月的相关文献，英文检索词：anterior cruciate ligament AND remnant (OR stump) AND randomized controlled trial (RCT) OR quasi-RCT；中文检索词：前交叉韧带重建、保残、不保残。采用Review Manager 5.3.软件进行Meta分析。
结果与结论：共纳入13个研究，Meta分析结果显示：保留残端重建前交叉韧带与不保残重建在KT1000/2000评分[OR=-0.28，95%CI：-0.76-0.20，P=0.25]、滑膜覆盖优良率[OR =-0.30，95%CI：-0.30-0.90，P=0.32]及Cyclops病变发生率[OR= 0.87，95%CI：0.63-2.90，P=0.44]方面差异无显著性意义。在术后Lysholm评分[OR =2.45，95%CI：0.52-4.39，P=0.01]、本体感觉[OR=-1.72，95%CI：-3.32至-0.13，P=0.03]、骨道扩大[OR= -0.66，95%CI：-1.08至-0.23，P=0.002]方面，保留残端重建前交叉韧带组较优。结果说明，保留残端重建前交叉韧带与不保残重建均能取得较好的膝关节前后稳定性，而在膝关节术后评分、本体感觉及防止骨道扩大方面，保留残端组更具有优势。由于部分文献质量不高，可能存在各种偏倚，未来需要更多高质量的随机对照试验来得出更可靠的结论。

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程
ORCID: 0000-0002-0667-727X(张磊)

关键词: 组织构建, 组织工程, 肌肉肌腱韧带, 前交叉韧带, 保留残端, 不保留残端, 重建, 随机对照, 本体感觉, Cyclops病变, 骨道扩大, 膝关节稳定性, Meta分析

Abstract:

BACKGROUND: There are controversies about preserving the remnant in the anterior cruciate ligament reconstruction procedure because of its uncertain therapeutic effects.
OBJECTIVE: To compare the efficacy and safety of preserving-remnant with removing-remnant for arthroscopic anterior cruciate ligament reconstruction using a meta-analysis.
METHODS: A computer-based online search was conducted in PubMed, Embase, the Cochrane Library, CDSR, CBM, and CNKI databases by using the English key words of “anterior cruciate ligament AND remnant (OR stump) AND randomized controlled trial (RCT) OR quasi-RCT” and the Chinese key words of “anterior cruciate ligament reconstruction, preserving-remnant, removing-remnant” to screen the relevant articles published from 1995 to July 2015. Meta-analysis was performed using Review Manager 5.3 software.
RESULTS AND CONCLUSION: A total of 13 randomized controlled trials were included. The meta-analysis results showed that there were no statistically significant differences in KT1000/2000 scores (OR=-0.28, 95%CI: -0.76-0.20, P=0.25), the good rate of synoveal coverage (OR =-0.30, 95%CI: -0.30-0.90, P=0.32), and the incidence of cyclops leions (OR=0.87, 95%CI: 0.63-2.90, P=0.44). Postoperative Lysholm scores (OR=2.45, 95%CI: 0.52-4.39, P=0.01), proprioceptive function (OR=-1.72, 95%CI: -3.32 to 0.13, P=0.03), tunnel enlargement (OR=-0.66, 95%CI: -1.08 to -0.23, P=0.002) in preserving-remnant were superior to removing-remnant for arthroscopic anterior cruciate ligament reconstruction. These results suggest that both preserving-remnant and removing-remnant for arthroscopic anterior cruciate ligament reconstruction can obtain satisfactory antero-posterior stability of the knee. Preserving-remnant exhibits superiority in post-operative scores of the knee, proprioceptive function, tunnel enlargement. Further high-quality randomized controlled trials are warranted because of some low-quality studies and the existing biases.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Tissue Engineering, Anterior Cruciate Ligament, Meta-Analysis

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