摘要
目的:系统评价关节镜与传统切开手术治疗前交叉韧带(anterior cruciate ligament,ACL)胫骨止点撕脱骨折的临床疗效。方法:计算机检索2010年7月至2020年7月Embase,Pubmed,Central,Cinahl,学位论文和论文(ProQuest dissertations and theses,PQDT),中国知网,维普,万方,Cochrane Library,中国生物医学文献数据库(China Biology Medicine,CBM)已发表的关于关节镜与传统切开手术治疗ACL胫骨止点撕脱骨折的临床对照研究类文章。按照纳入和排除标准进行文献筛选及数据提取,并采用改良Jadad评分和渥太华纽卡斯尔量表(Newcastle-Ottawa Scale,NOS)对纳入文献进行质量评价。采用Review Manager 5.3软件对两种术式的手术时间、住院时间、骨折愈合时间、膝关节活动度、术后优良率、并发症发生率、Lysholm评分、国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评分和Tegner评分进行统计分析。结果:最终纳入16篇文献,其中1篇为随机对照试验,15篇为非随机对照试验,共822例患者(关节镜组405例,传统切开手术组417例)。Meta分析显示,关节镜组手术时间[MD=-9.03,95%CI(-14.36,-3.70),P<0.001],住院时间[MD=-5.81,95%CI(-9.32,-2.31),P=0.001]和骨折愈合时间[MD=-14.61,95%CI(-17.93,-11.28),P<0.001]优于传统切开手术组。关节镜组并发症发生率低于传统切开手术组[OR=0.15,95%CI(0.07,0.33),P<0.001]。关节镜组术后优良率[OR=4.39,95%CI(1.96,9.82),P<0.001],膝关节活动度[MD=6.78,95%CI(2.79,10.77),P<0.001],Lysholm评分[MD=11.63,95%CI(4.91,18.36),P<0.001],IKDC评分[MD=7.83,95%CI(6.09,9.57),P<0.001]和Tegner评分[MD=0.60,95%CI(0.31,0.89),P<0.001]高于传统切开手术组。结论:与传统手术切开复位内固定相比,ACL胫骨止点撕脱骨折患者采用关节镜下手术能缩短手术时间、住院时间和骨折愈合时间,降低术后并发症发生率,获得良好的膝关节功能,可推荐作为ACL胫骨止点撕脱骨折的首选术式之一。
Objective:To systematically evaluate the clinical efficacy of arthroscopy and traditional incision in the treatment of tibial avulsion fracture of anterior cruciate ligament(ACL).Methods:From July 2010 to July 2020,clinical comparative trial about arthroscopy and traditional incision in the treatment of ACL tibial avulsion fracture was conducted by using computer-based databases,including Embase,Pubmed,Central,Cinahl,PQDT,CNKI,Weipu,Wanfang,Cochrane Library,CBM.Literature screening and data extraction were carried out according to the inclusion and exclusion criteria,and the quality of the included literature was evaluated by improved Jadad score and Ottawa Newcastle scale(NOS).The operation time,hospital stay,fracture healing time,knee range of motion,postoperative excellent and good rate,complication rate,Lysholm score,International Knee Documentation Committee(IKDC)score and Tegner score were statistically analyzed by Review Manager 5.3 software.Results:Finally,16 literatures were included,including 1 randomized controlled trial and 15 non randomized controlled trials,with a total of 822 patients(405 in arthroscopy group and 417 in traditional incision group).Meta analysis showed that the operation time[MD=-9.03,95%CI(-14.36,-3.70),P<0.001],hospital stay[MD=-5.81,95%CI(-9.32,-2.31),P=0.001]and fracture healing time[MD=-14.61,95%CI(-17.93,-11.28),P<0.001]in the arthroscopy group were better than those in the traditional incision group.The incidence of complications in arthroscopy group was lower than that in traditional incision group[OR=0.15,95%CI(0.07,0.33),P<0.001].The postoperative excellent and good rate[OR=4.39,95%CI(1.96,9.82),P<0.001],knee mobility[MD=6.78,95%CI(2.79,10.77),P<0.001],Lysholm score[MD=11.63,95%CI(4.91,18.36),P<0.001],IKDC score[MD=7.83,95%CI(6.09,9.57),P<0.001]and Tegner score[MD=0.60,95%CI(0.31,0.89),P<0.001]in the arthroscopic group were higher than those in the traditional incision group.Conclusion:Compared with the traditional open reduction and internal fixation,arthroscopic surgery in patients with ACL tibial avulsion fracture can shorten the operation time,hospital stay and fracture healing time,reduce the incidence of postoperative complications,and obtain good postoperative knee function.It can be recommended as one of the first choice for patients with ACL tibial avulsion fracture.
作者
牛文杰
黄凌岸
周新
杨彦飞
梁浩然
宋文杰
刘洋
段王平
NIU Wen-jie;HUANG Ling-an;ZHOU Xin;YANG Yan-fei;LIANG Hao-ran;SONG Wen-jie;LIU Yang;DUAN Wang-ping(不详;Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair,the Second Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi,China)
出处
《中国骨伤》
CAS
CSCD
2022年第3期292-299,共8页
China Journal of Orthopaedics and Traumatology
关键词
关节镜
前交叉韧带
胫骨骨折
META分析
Arthroscopes
Anterior cruciate ligament
Tibial fractures
Meta analysis
