前交叉韧带双束重建术与单束重建术对恢复膝关节稳定性的系统评价

Knee Stability after Double-bundle and Single-bundle Anterior Cruciate Ligament Reconstruction:A Systematic Review

目的系统评价前交叉韧带双束重建术与单束重建术在恢复膝关节前交叉韧带的前直向稳定性和旋转稳定性方面的临床疗效,为前交叉韧带重建方法的选择提供依据。方法按Cochrane系统评价方法,计算机检索MEDLINE(1966～2007.10),OVID(1950～2007.10),Cochrane图书馆(2007年第4期),中国期刊全文数据库(1979～2007.10),收集所有相关随机和半随机对照试验。采用Juni评价法评价文献质量并提取有效数据后,利用RevMan4.2.10软件进行Meta分析。结果共纳入随机和半随机对照试验6篇。文献质量B级1篇,C级5篇。Meta分析结果显示:双束重建组术后前交叉韧带的前直向稳定性[WMD=?–0.75(–1.14,–0.37),P=0.0001]和旋转稳定性[RR=1.38,95%CI(1.17,1.61),P<0.0001]均优于单束重建组,其差异有统计学意义。结论前交叉韧带双束重建术在恢复膝关节的前直向稳定性和旋转稳定性方面优于单束重建术。由于纳入文献数量较少,质量不高,上述结论尚需开展大样本高质量的临床研究来证实。

Objective To evaluate knee stability after double-bundle and single-bundle anterior cruciate ligament reconstruction. Methods Randomized controlled trials （RCTs） and quasi-randomized controlled trials （quasi- RCTs） were collected from MEDLINE （1966 to October 2007）, OVID （1950 to October 2007）, The Cochrane Library （issue 4, 2007） and China Academic Journals Full-text Database （1979 to October 2007）. The quality of included trials was assessed. Data analyses were performed with The Cochrane Collaboration＇s RevMan 4.2.10 software. Results One RCT （quality B） and 5 quasi-RCTs （quality C） involving 426 patients met the inclusion criteria. Meta-analyses showed significant differences between the two operative procedures in terms of anterior stability （WMD -0.75, 95%CI -1.14 to -0.37, P=0.000 1） and rotational stability [RR 1.38, 95%CI 1.17 to 1.61, P〈0.000 1]. Conclusion The double-bundle anterior cruciate liagament is superior to single-bundle anterior cruciate ligament in terms of anterior stability and rotational stability. Since the included trials were small and of poor quality, more high-quality, large-scale randomized controlled trials are required.