自体骨髌腱骨和腘绳肌腱重建前交叉韧带疗效的Meta分析

Bone-patellar Tendon-bone Autograft Versus Hamstring Autograft for the Reconstruction of Anterior Cruciate Ligament:A Meta-analysis

目的通过Meta分析来比较自体骨髌腱骨和腘绳肌腱重建前交叉韧带的疗效。方法资料来源Medline,Cochrane图书馆和中国知网,检索1999年至2009年关于前交叉韧带断裂使用自体骨髌腱骨和腘绳肌腱治疗的文献,采用Meta分析的方法,运用RevMan4.2软件进行数据处理,对术后膝关节的体格检查和膝关节功能进行综合分析。结果 15篇文献入选本研究,轴移试验阳性的OR值为1.39[95%C(I0.82～2.36),P=0.23],Lachman试验阳性的OR值为1.30[95%C(I0.90～1.88),P=0.17],膝前疼痛的OR值为0.43[95%C(I0.30～0.61),P=0.000],伸膝受限(>5°)的OR值为0.44[95%CI(0.24～0.79),P=0.007]。结论腘绳肌腱重建前交叉韧带术后膝关节出现疼痛和伸膝受限的发病率低于骨髌腱骨,而膝关节稳定性方面二者没有显著的差别。

Objective To compare the therapeutic efficacy of bone-patellar tendon-bone autograft with that of hamstring autograft for the reconstruction of anterior cruciate ligament by Meta-analysis.Methods We retrieved the articles about the reconstruction of anterior cruciate ligament with bone-patellar tendon-bone autograft or hamstring autograft which were published between 1999 and 2009 in MEDLINE,Cochrane Library,and CNKI.The data were analyzed by using RevMan4.2 software.The results of body examination and knee joint function were included in the analysis.Results A total of 15 articles were eligible in this study.The odds ratios of a positive pivot shift test,a positive Lachman test,anterior knee pain,and loss of extension（5°）were 1.39（95%CI 0.82 to 2.36,P =0.23）,1.30（95%CI 0.90 to 1.88,P =0.17）,0.43（95%CI 0.30 to 0.61,P =0.000）,and 0.44（95%CI 0.24 to 0.79,P =0.007）,respectively.Conclusion The incidences of anterior knee pain and loss of extension after the reconstruction of anterior cruciate ligament are lower for hamstring autograft than for patellar tendon autograft,without significant difference in stability of the knee joint.