手术和保守治疗急性髌骨脱位的Meta分析

Meta analysis on the treatment of acute patellar dislocation by surgical versus conservative treatment

背景:急性髌骨脱位在临床中多见,对于其手术治疗和保守治疗尚存在争议。目的:系统评价手术和保守治疗急性髌骨脱位的临床疗效,从而指导临床治疗方案的选择。方法:计算机检索Cochrane图书馆(2012年第4期)、MEDLINE(1966年至2012年4月)、EMBase(1966年至2012年4月)、中国生物医学文献数据库(1979年1月至2012年4月)、PubMed(1966年6月至2012年4月)、万方数据库和维普数据库(建库至2012年4月),手工检索中文骨科期刊中的相关文献。筛选出比较手术和保守治疗急性髌骨脱位的随机对照研究,对其进行严格的质量评价后应用RevMan5.1软件进行Meta分析。观察两种方法治疗急性髌骨脱位的复发率、术后膝关节Kujala评分、基于Kujala评分的优良率以及随访期间再次手术等情况。结果与结论:共纳入6个随机对照研究,包含380例患者,其中手术组203例,保守组177例。Meta分析结果显示:对于急性髌骨脱位患者,手术治疗与保守治疗在术后复发率(RR=0.54,95%CI:0.28-1.07)、膝关节功能的Kujala评分(WMD=5.50,95%CI:-4.46-15.45)、基于Kujala评价优良率(RR=2.53,95%CI:0.47-13.56)及随访期间再次手术情况(RR=1.09,95%CI:0.72-1.65)方面差异均无显著性意义(P>0.05)。进一步对随访2-5年的短期随访组及随访5-7年的长期随访组进行亚组分析,发现仅在短期随访组的膝关节Kujala评分方面手术治疗优于保守治疗(WMD=15.52,95%CI:5.67-25.38,P<0.05)。说明对于急性髌骨脱位,手术和保守治疗效果相当,但手术治疗后患者短期内膝关节功能恢复优于保守治疗。

BACKGROUND： Acute patellar dislocation is more common in clinic, but there is controversial about surgical treatment and conservative treatment. OBJECTIVE： To compare the clinical therapeutic effects of surgical versus conservative treatment method for acute patellar dislocation and to guide the selection of clinical treatment options. METHODS： The Coehrane Library （Issue 4, 2012）, MEDLINE （from 1966 to April 2012）, EMBase （from 1966 to April 2012）, CBM database （from January 1979 to April 2012）, PubMed database （from June 1966 to 2012） and Wangfang database （from beginning to April 2012） were searched with computer and the Chinese orthopedic journals were searched by hand for the randomized controlled trials and clinical trials on comparison of surgical versus conservative treatment method for acute patellar dislocation. Meta analysis was conducted using the Cachrane Collaboration＇s RevMan 5.1 software. The risk of recurrent dislocation, Kujala scores after operation, the excellent and good rate based on Kujala scores and re-operation rate during follow-up were observed after treated with surgical and conservative treatment methods. RESULTS AND CONCLUSION： Only six randomized controlled trials were included involving 380 patients （203 patients in surgical group and 117 patients in conservative group） met the criteria of the present study. Meta analysis results showed that there was no significant difference between surgical and conservative group of acute patellar dislocation in the risk of recurrent dislocation [relative risk （RR）=0.54, 95% confidence interval （CI）： 0.28 1.07], Kujaia scores [weighted mean difference （WMD）=5.50, 95%C1： 4.46-15.45], excellent and good rate based on Kujala scores （RR=2.53, 95%C1： 0.47-13.56） and re-operation rate during follow-up （RR=I.09, 95%C/： 0.72 1.65） （P 〉 0.05）.