自体骨软骨移植与微骨折术临床疗效的Meta分析

Meta-analysis on clinical efficacy of osteochondral autograft transfer and microfracture surgery

目的通过Meta分析比较自体骨软骨移植与微骨折对膝关节软骨缺损修复手术疗效的影响。方法通过计算机检索建库至2020年8月PubMed,荷兰医学文摘数据库(EMbase),Cochrane图书馆,万方数据库、维普中文科技期刊数据库和中国知网发表的比较自体骨软骨移植与微骨折术的相关研究文献,根据纳入标准如国内外公开发表的自体骨软骨移植与微骨折直接比较的随机病例对照研究与排除标准如无法获取全文及缺乏原始数据的研究等进行文献筛选,质量评价及数据提取,采用Review Manager 5.4统计学软件对患者术后Lysholm评分,术后患者恢复活动情况,以及术后优良率,失败率和骨关节炎患病数等方面进行Meta分析。结果共纳入7篇文献,345例患者,其中自体骨软骨移植171例,微骨折174例。Meta分析结果显示:自体骨软骨移植与微骨折术在术后Lyshlom评分[均数差(MD)=-10.19;95%置信区间(CI)(-19.28,-1.10);P=0.03],术后优良率[比值比(OR)=0.24;95%CI(0.08,0.72);P=0.01],失败率[OR=5.96;95%CI(2.58,13.75);P<0.0001],术后患者恢复活动数[OR=0.15;95%CI(0.08,0.28);P<0.0001],骨关节炎患者数[OR=2.76;95%CI(1.07,7.10);P=0.03]等方面比较,差异存在统计学意义;在这些方面,自体骨软骨移植均优于微骨折。结论结果证实,自体骨软骨移植在术后患骨关节炎患者数、临床评分及术后恢复活动等方面均优于微骨折。对于膝关节软骨缺损修复患者,自体骨软骨移植可作为优先选择的一线手术方式。

Objective To compare the effects of osteochondral autograft transfer(OAT)and microfracture on the surgical treatment of articular cartilage defect(ACD)by meta-analysis.Methods The related research literature comparing OAT and microfracture published by PubMed,Excerpta Medica Database(EMbase),Cochrane Library,Wanfang Database,China Science and Technology Journal Database and China National Knowledge Infrastructure(CNKI)until August 2020 was searched by computer.Literature screening,quality evaluation and data extraction were conducted according to inclusion criteria such as randomized case-control studies of direct comparison between OAT and microfracture published at home and abroad,and exclusion criteria such as studies that could not obtain full text and lacked original data.The Lysholm score,recovery activity,excellent and good rate,failure rate and incidence of osteoarthritis were analyzed by meta analysis using Review Manager 5.4 statistical software.Results A total of 345 patients with OAT were included in seven articles,including 171 cases and 174 cases of microfracture.Meta-analysis showed that between OAT and microfracture surgery,the postoperative Lyshlom score[mean difference(MD)=-10.19,95%confidence interval(CI)(-19.28,-1.10),P=0.03],excellent and good rate after operation[odds ratio(OR)=0.24,95%CI(0.08,0.72),P=0.01],failure rate[OR=5.96,95%CI(2.58,13.75),P<0.0001],the number of postoperative recovery activities[OR=0.15,95%CI(0.08,0.28),P<0.0001],the number of patients with osteoarthritis[OR=2.76,95%CI(1.07,7.10),P=0.03],the differences of all these were statistically significant.In these aspects,OAT was superior to microfracture.Conclusions OAT is superior to microfracture in the number of patients with osteoarthritis,clinical score and postoperative recovery activity.OAT is the preferred first-line operation for patients with ACD repair.