中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (35): 7629-7638.doi: 10.12307/2025.938

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

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

王  锋，曹春风，何  超，张  涛，周子弦，朱凤臣   

  1. 重庆医科大学附属永川医院，重庆市  402160
  • 收稿日期:2024-10-16 接受日期:2024-12-06 出版日期:2025-12-18 发布日期:2025-05-07
  • 通讯作者: 朱凤臣，副主任医师，硕士生导师，重庆医科大学附属永川医院，重庆市 402160
  • 作者简介:王锋，男，1997年生，安徽省全椒县人，汉族，2024年昆明理工大学毕业，硕士，医师，主要从事关节骨科以及运动损伤修复研究。
  • 基金资助:
    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

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

Wang Feng, Cao Chunfeng, He Chao, Zhang Tao, Zhou Zixian, Zhu Fengchen   

  1. Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, China
  • Received:2024-10-16 Accepted:2024-12-06 Online:2025-12-18 Published:2025-05-07
  • Contact: Zhu Fengchen, Associate chief physician, Master’s supervisor, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, China
  • About author:Wang Feng, Master, Physician, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, China
  • Supported by:
    Science and Technology Plan Project of Yunnan Provincial Science and Technology Department, No. 202301AY070001-214 (to WF [project participant]); Natural Science Foundation of Yongchuan District of Chongqing, No. 2023yc-jckx20059 (to CCF)

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摘要：


文题释义：
全内技术重建前交叉韧带：该技术仅需取半腱肌，通过四股折叠后便能达到移植物直径要求，借助倒打钻头制备胫骨侧半骨道，利用可调式皮质悬吊装置进行股骨端和胫骨端固定，整个重建过程在关节腔内完成。
传统技术重建前交叉韧带：即全长胫骨隧道前交叉韧带重建，取自身股薄肌和半腱肌2条肌腱作为移植物(直径通常为7.0-8.0 mm)，制做胫骨全长骨道以及股骨半长骨道，然后将移植物引入并固定，最后切掉多余的韧带尾端，胫骨侧移植物通常使用干涉螺钉挤压固定。

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=0.000 5]，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 < 0.000 1]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=0.000 2]，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员会主观评分和Lysholm评分来看，全内技术更为有利。从膝关节稳定性来看，传统技术在术后2年表现得更为稳定。此外还发现，全内技术使用的移植物更粗，术后胫骨侧骨隧道的直径与体积更小，能保留更多骨组织，但手术所需时间相对较长。
https://orcid.org/0000-0002-7618-1368(王锋)

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

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

Abstract: 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=0.000 5], 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 < 0.000 1] 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=0.000 2], 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 Lysholm score at 6 months postoperatively [MD=0.87, 95% CI (-0.15, 1.89), P=0.09]; the objective score of the International Knee Documentation Committee at the last follow-up [RR=0.95, 95% CI (0.86, 1.06), P=0.37]; the American Knee Society Score at the last follow-up [MD=0.33, 95% CI (-0.55, 1.21), P=0.47]; the Tegner score at the last follow-up [MD=0.05, 95% CI (-0.11, 0.22), P=0.53]; the negative rate of the pivot shift test at the last follow-up [RR=0.92, 95% CI (0.83, 1.01), P=0.09]; the postoperative revision rate at the last follow-up [RR=2.2, 95% CI (0.98, 4.92), P=0.05]; and the result of the single-leg hop test at the last follow-up [MD=-0.06, 95% CI (-4.99, 4.86), P=0.98]. 
CONCLUSION: There were no significant differences in most functional outcome scores and the position of the tibial tunnel between the all-inside technique and the traditional technique after anterior cruciate ligament reconstruction. The all-inside technique was more favorable in terms of subjective International Knee Documentation Committee scores and Lysholm scores at 2 years postoperatively. Meanwhile, the knee joint was more stable 2 years after anterior cruciate ligament reconstruction using the traditional technique. In addition, it was found that the graft was thicker during the all-inside technique, while the diameter and volume of the tibial tunnel were smaller postoperatively, with more bone tissue preserved. Nevertheless, the operation time of the all-inside technique was longer.

Key words: anterior cruciate ligament, anterior cruciate ligament injury, all-inside technique, suspension fixation, transtibial tunnel technique, anterior cruciate ligament reconstruction, arthroscope, Meta-analysis, randomized controlled trial

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