中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (12): 1943-1948.doi: 10.3969/j.issn.2095-4344.1027

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

儿童和青少年前交叉韧带断裂早期与延迟重建继发半月板和软骨损伤风险的Meta分析

顾晓东1，2，赵瑞鹏1，2，车先达1，2，李鹏翠1，2，卫小春1，2   

  1. 1山西医科大学第二医院骨科，山西省太原市 030001；2骨与软组织损伤修复山西省重点实验室，山西省太原市 030001
  • 出版日期:2019-04-28 发布日期:2019-04-28
  • 通讯作者: 卫小春，博士，主任医师，教授，博士生导师，山西医科大学第二医院骨科，山西省太原市 030001；骨与软组织损伤修复山西省重点实验室，山西省太原市 030001
  • 作者简介:顾晓东，男，1984年生，黑龙江省齐齐哈尔市人，在读博士，主治医师，主要从事骨关节炎及关节软骨损伤修复方面的研究。
  • 基金资助:

    国家国际科技合作专项项目(2015DFA33050)，项目负责人：卫小春；国家自然科学基金青年项目(81601949)，项目负责人：李鹏翠；山西省骨关节炎生物学样本资源共享服务平台建设项目(201705D121010)，项目负责人：李鹏翠

Early versus delayed reconstruction of anterior cruciate ligament injuries in children and adolescents is associated with the risks of meniscus and articular cartilage injury: a meta-analysis  

Gu Xiaodong1, 2, Zhao Ruipeng1, 2, Che Xianda1, 2, Li Pengcui1, 2, Wei Xiaochun1, 2   

  1. 1Department of Orthopedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; 2Shanxi Provincial Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan 030001, Shanxi Province, China
  • Online:2019-04-28 Published:2019-04-28
  • Contact: Wei Xiaochun, MD, Chief physician, Professor, Doctoral supervisor, Department of Orthopedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; Shanxi Provincial Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan 030001, Shanxi Province, China
  • About author:Gu Xiaodong, Doctoral candidate, Attending physician, Department of Orthopedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; Shanxi Provincial Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan 030001, Shanxi Province, China
  • Supported by:

    the National International Science and Technology Cooperation Project, No. 2015DFA33050 (to WXC); the National Natural Science Foundation of China for the Youth, No. 81601949 (to LPC); the Osteoarthritis Biological Sample Resource Sharing Service Platform Construction Project of Shanxi Province, No. 201705D121010 (to LPC)

PDF

100

摘要：

文章快速阅读：

 
 
文题释义：
儿童前交叉韧带重建：临床医生在对骨骼发育不成熟的前交叉韧带断裂患者选择治疗方法时经常面临进退两难的境地，早期行韧带重建可能会导致肢体成角及短缩畸形，而保守治疗或者待骨骺闭合后手术，又会出现膝关节持续不稳定及继发半月板或关节软骨损伤。
对儿童和青少年前交叉韧带重建手术的认识：近年来，有Meta分析结果指出，儿童前交叉韧带损伤行韧带重建，肢体不等长及成角畸形的发生率非常低。另文献指出：早期行韧带重建可以更好的恢复膝关节的稳定性，关节功能恢复更好，对于青少年运动员来说，有超过90%的韧带重建患者可以重返运动。早期行前交叉韧带重建，有较高的IKDC膝关节功能评分。由此，在过去的20多年中，儿童和青少年前交叉韧带重建的手术量在逐年增加。
 
摘要
背景：儿童和青少年前交叉韧带损伤，目前多主张手术治疗，但手术时机选择及不同手术时机对继发性半月板和软骨损伤风险的影响仍有争议。
目的：评价儿童和青少年前交叉韧带断裂早期或延迟行韧带重建对继发性膝关节半月板和关节软骨损伤风险的影响。
方法：检索2018年3月前Medline、EMbase、Cochrane图书馆、中国知网(CNKI)、万方数据库中，有关儿童或者青少年(<19岁)前交叉韧带断裂行韧带重建手术，不同手术时机以及继发半月板和膝关节软骨损伤的文章，严格按照纳入和排除标准及文献质量评分标准收集数据，运用Review Manager 5.3 统计学软件对所提取的文献数据进行Meta分析。
结果与结论：共纳入5篇文献，849例患者。Meta分析结果显示：儿童和青少年前交叉韧带断裂后，早期行前交叉韧带重建可以显著降低内侧半月板损伤的风险(OR=0.40，95% CI 0.25-0.67，P=0.000 4)；同时，早期韧带重建继发性外侧半月板损伤风险也会降低(OR=0.70，95%CI 0.53-0.93，P=0.01)。在关节软骨损伤方面，和延迟重建相比，早期重建可以降低股骨髁软骨(OR=0.25，95% CI 0.12-0.53，P=0.000 3)、胫骨平台软骨(OR=0.41，95%CI 0.25-0.67，P=0.000 4)及髌股关节软骨(OR=0.35，95%CI 0.16-0.77，P=0.009)损伤的发生率。提示：对于儿童和青少年前交叉韧带断裂患者，早期行前交叉韧带重建可以降低继发性内外侧半月板、股骨髁软骨、胫骨平台软骨及髌股关节软骨损伤的发生率。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0003-2515-8050(顾晓东)

关键词: 儿童, 青少年, 前交叉韧带, 前交叉韧带断裂, 手术时机, 早期韧带重建, 延迟韧带重建, 半月板损伤, 软骨损伤

Abstract:

BACKGROUND: Surgical treatment is mostly advocated in children and adolescents with anterior cruciate ligament injury, but the impact of surgical timing and different surgical timing on the risk of secondary meniscus and cartilage injury is still controversial.

OBJECTIVE: To evaluate the effects of early or delayed anterior cruciate ligament reconstruction on the risk of secondary meniscus and articular cartilage injury in children and adolescents.
METHODS: A computer-based online search was conducted in Medline, Embase, Cochrane Library, WanFang, and CNKI databases until March 2018. The articles about anterior cruciate ligament rupture in children or adolescents (< 19 years old) undergoing ligamentous reconstruction, and injuries of meniscus and knee cartilage at different operation times were collected in accordance with the inclusion and exclusion criteria. Meta-analysis was performed using Review Manager 5.3 software.
RESULTS AND CONCLUSION: Five articles involving 849 patients were included. Meta-analysis showed that early anterior cruciate ligament reconstruction after anterior cruciate ligament rupture in children and adolescents could significantly reduce the risk of medial meniscus injury (OR=0.40, 95%CI 0.25-0.67, P=0.000 4). At the same time, the risk of secondary lateral meniscus injury in early ligament reconstruction was reduced (OR=0.70, 95%CI 0.53-0.93, P=0.01). In terms of articular cartilage injury, compared with delayed reconstruction, early reconstruction could reduce the incidence of injuries of femoral condyle cartilage (OR=0.25, 95%CI 0.12-0.53, P=0.000 3), tibial plateau cartilage (OR=0.41, 95%CI 0.25-0.67, P=0.000 4) and patellofemoral joint cartilage (OR=0.35, 95%CI 0.16-0.77, P=0.009). In summary, for children and adolescents with anterior cruciate ligament rupture, early anterior cruciate ligament reconstruction can reduce the incidence of secondary medial and lateral meniscus, femoral condyle cartilage, tibial plateau cartilage and patellofemoral cartilage injuries. 

Key words: Anterior Cruciate Ligament, Adolescent, Child, Meta-Analysis

中图分类号: