摘要
背景:同种异体骨软骨移植治疗膝关节软骨缺损是临床应用最久的方法之一。虽然该方法在临床中应用广泛且深受骨科医师信赖,但仍缺乏循证医学方面的支持。目的:分析同种异体骨软骨在膝关节移植术中的疗效,对所有已获得的数据进行系统综述和Meta分析,评价同种异体骨软骨在膝关节移植过程中作为移植替代物的有效性及安全性。方法:在PubMed/Medline、EMBASE、Cochrane协作网图书馆、中国知网(CNKI)以及万方数据库中进行文献检索。检索同种异体骨软骨在膝关节移植术中的应用,根据文献纳入标准进行选择,重点选择数据可以被提取以及能够进行Meta分析的文章。结果与结论:①25项研究符合纳入标准,均为病例系列研究,患者报道的结果是同种异体骨软骨可以作为修复膝关节缺损的移植材料;共1081例患者(1111膝)纳入研究,发病年龄11-75岁,平均年龄约为34.41岁,女性比例约为40.81%,随访时间4-384个月,平均76.8个月;②在这些研究中,接受的供者年龄为10-65岁,而根据供者年龄范围与研究数目进行统计发现,15-45岁的供者为主要的获取目标;③术后总体的成功率为74%,总体二次手术率17%;单极移植成功率74.44%(501/673),双极移植成功率50.94%(27/53),单极移植成功率明显高于双极移植(χ2=13.679,P<0.05);④67例(13.14%,67/510)出现治疗并发症,常见并发症为手术部位持续疼痛(15例)和移植物骨折或碎裂(12例);⑤提示同种异体骨软骨是膝关节移植中一种有效且安全的移植替代物,整体成功率74%,二次手术率17%,是一种成功率高、再次手术风险低的治疗方式。
BACKGROUND:Osteochondral allograft transplantation for the treatment of knee articular cartilage defects is one of the longest clinical methods.Although this method is widely used in clinical practice and is trusted by orthopedic surgeons,it still lacks evidence-based medicine support.OBJECTIVE:To investigate the efficacy of osteochondral allograft transplantation in the knee joint,systematic review and meta-analysis of all available data,and evaluate the efficacy and safety of osteochondral allograft as a transplant substitute in knee joint surgery.METHODS:Literature search was conducted in PubMed/Medline,EMBASE,Cochrane Collaboration Library,China National Knowledge Infrastructure and Wanfang Database.The application of osteochondral allograft in knee joint transplantation was searched and selected according to the literature inclusion criteria.Articles whose data can be extracted and meta-analyzable were mainly selected.RESULTS AND CONCLUSION:(1)Twenty-five studies met the inclusion criteria and were all case series studies.The patient reported that osteochondral allograft can be used as a graft material to repair knee joint defects.A total of 1081 patients(1111 knees)were included in the study.The age of onset was 11-75 years old,with an average age of 34.41 years.The proportion of women was about 40.81%.The follow-up period was 4-384 months,with an average of 76.8 months.(2)In these studies,donors received a minimum age of 10 years and a maximum of 65 years.According to the donor age range and number of studies,donors aged 15-45 were the primary targets.(3)The overall success rate after surgery was 74%,and the overall secondary operation rate was 17%.The success rate of unipolar surgery was 74.44%(501/673);the success rate of bipolar surgery was 50.94%(27/53).The success rate of unipolar surgery was significantly higher than that of bipolar surgery(χ2=13.679,P<0.05).(4)Treatment complications occurred in 67 patients(13.14%,67/510).Common complications were persistent pain at the surgical site(15 cases),graft fracture or fragmentation(12 cases).(5)These results indicate that osteochondral allograft is an effective and safe substitute for knee joint transplantation.The overall success rate is 74%and the secondary operation rate is 17%.It is a treatment with high success rate and low risk of reoperation.
作者
华堃池
冯江涛
胡永成
Hua Kunchi;Feng Jiangtao;Hu Yongcheng(Department of Bone Tumor,Tianjin Hospital,Tianjin 300211,China)
出处
《中国组织工程研究》
CAS
北大核心
2020年第27期4406-4413,共8页
Chinese Journal of Tissue Engineering Research
关键词
同种异体骨软骨
膝关节移植
移植材料
二次手术
META分析
osteochondral allograft
knee transplantation
transplantation material
secondary operation
meta-analysis
