自体软骨细胞移植和微骨折术修复膝关节软骨缺损的Meta分析

摘要

BACKGROUND:A few studies have reported that autologous chondrocyte implantation is better than microfracture for treating cartilage defects of the knee. But there are few meta-analyses on the clinical outcomes of autologous chondrocyte implantation versus microfracture. OBJECTIVE:To evaluate the effects of autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee based on existing clinical data. METHODS:A systematic search for control ed clinical trials or control ed prospective observational studies published from 1979 to January 2015 was done in electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Central Register, Wanfang, CNKI and VIP. The literatures about the effects of autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee were retrieved. We screened the retrieved literature according to the inclusion and exclusion criteria and performed a Meta-analysis with the software RevMan 5.2 after identification of the relevant data. RESULTS AND CONCLUSION:Eight studies were enrol ed according to the selection criteria, which revealed a statistical y significant difference, representing a clinical y relevant superiority of autologous chondrocyte implantation over microfracture, in IKDC scores at final fol ow-up [weighted mean difference (WMD),-9.93;95%confidence interval (CI):-13.16 to-5.43;P<0.000 01] and available scores at 5-year fol ow-up [standard mean difference (SMD),-0.30;95%CI: -0.55 to-0.05;P=0.02). In contrast, there were no significant differences, thus representing no clinical relevant superiority of microfracture versus autologous chondrocyte implantation, in Tegner scores at final fol ow-up (WMD=0.44;95%CI:0.04 to 0.84;P=0.03), Lysholm scores at final fol ow-up (WMD=-10.21;95%CI:-33.68 to 13.26;P=0.39), and available scores at 2-year fol ow-up (SMD=-0.25;95%CI:-0.92 to 0.43;P=0.47). These findings demonstrate that autologous chondrocyte implantation can result in a better long-term outcome than microfracgure. However, whether autologous chondrocyte implantation has a better treatment effect than microfracture in general needs more research.%背景：现有一些文献报道证实，自体软骨细胞移植治疗膝关节软骨缺损在某些方面较微骨折术好，但关于两种术式优劣比较，尚缺乏循证医学方面证据。目的：整合现有临床研究的数据进行系统和科学的分析，明确自体软骨细胞移植是否在提高临床功能方面优越于微骨折术。方法：文章检索了电子数据库MEDLINE，EMBASE，CINAHL和 Cochrane Register数据库，万方数据库、中国知识资源总库和维普数据库，检索时间从1979年到2015年1月。收集自体软骨细胞移植和微骨折术治疗膝关节软骨缺损疗效的相关文献，按纳入与排除标准筛选文献并对其进行质量评价，运用 RevMan 5.2软件进行Meta分析。结果与结论：共纳入8篇文献。在比较最终随访的 IKDC 评分(WMD=-9.93；95%CI：-13.16至-5.43；P<0.00001)和5年随访的各项评分(SMD=-0.30；95%CI：-0.55至-0.05；P=0.02)方面，自体软骨细胞移植比微骨折术能更好的改善患者的临床功能。在最终随访的Tegner评分(WMD=0.44；95%CI：0.04至0.84；P=0.03)，最终随访的Lysholm评分(WMD=-10.21；95%CI：-33.68至13.26；P=0.39)和2年随访的各项评分(SMD=-0.25；95%CI：-0.92至0.43；P=0.47)的对比中，未发现微骨折术的优越性。结果证实，自体软骨细胞移植能带来更稳定更长久的临床功能，并且在一定程度上比微骨折术更能达到缓解疼痛、提高功能的目的。但是在一般情况下，自体软骨细胞移植是否都优越于微骨折术需要更多的临床研究来支持。