自体腘绳肌腱双束与单束重建前交叉韧带效果的Meta分析★

摘要

背景：选择双束还是单束自体腘绳肌腱重建前交叉韧带，目前仍存在很大争议。目的：系统评价自体腘绳肌腱双束与单束重建前交叉韧带的临床疗效。方法：计算机检索 PubMed、Cochrane library、Springerlink、CNKI、CBM 等数据库，收集自体腘绳肌腱双束对比单束重建前交叉韧带的临床随机对照试验，采用 Jadad 量表对所纳入研究的方法学质量进行评价，并提取数据资料，使用 RevMan 5.0软件对数据进行 Meta 分析。结果与结论：纳入临床随机对照试验15篇，共1008例患者符合纳入标准，Meta 分析结果显示：双束重建与单束重建后 KT 测量值的差异有显著性意义[WMD=-0.51，95%CI(-0.74，-0.28)，P <0.0001]；重建后轴移试验阴性的差异有显著性意义[RR=1.27，95%CI(1.11，1.45)，P=0.0003]；重建后 Lysholm膝关节评分的差异有显著性意义[WMD=-2.10，95%CI(-3.65，-0.55)，P=0.008]；重建后 IKDC 分级评分的差异无显著性意义[RR=1.04，95%CI(0.99，1.06)，P=0.10]。双束自体腘绳肌腱重建前交叉韧带对于恢复膝关节稳定性优于单束重建，而对于恢复膝关节功能两者疗效差异不大。%BACKGROUND: Doctors often use autoal ergic hamstring double-bundle and single-bundle for the reconstruction of anterior cruciate ligament, but there is a controversy on which method is better. OBJECTIVE: To evaluate the clinical outcome of double-bundle versus single-bundle autoal ergic hamstring for the reconstruction of anterior cruciate ligament. METHODS: Randomized control ed trials about comparing double-bundle with single-bundle autoal ergic hamstring for the reconstruction of anterior cruciate ligament were col ected from PubMed database, Cochrane library, Springerlink database, CNKI database and CBM database. The Jadad’s scale was used to assess the methodological quality of the randomized control ed trials and Cochrane col aboration’s RevMan 5.0 software was used to perform the Meta analysis. RESULTS AND CONCLUSION: Fifteen randomized control ed trials total y 1 008 patients met the inclusion criteria and included. Meta-analysis results showed that there was statistical difference of postoperative KT-1000 or KT-2000 arthrometer mesurement between double-bundle and single-bundle reconstruction [weighted mean difference (WMD)=-0.51, 95% confidence interval (CI) (-0.74, -0.28), P < 0.000 1], there was significant difference of the negative pivot-shift testing [relative risk (RR)=1.27,95%CI(1.11,1.45), P=0.000 3], as wel as the postoperative Lysholm scores [WMD=-2.10, 95%CI(-3.65, -0.55), P=0.008]. But there was no statistical differences of IKDC final score [RR=1.04,95%CI(0.99, 1.06), P=0.10]. The double-bundle autoal ergic hamstring is superior to single-bundle for anterior cruciate ligament reconstruction on recovering stability of knee joint, but they are similar in recovering the functions of knee joint.