关节镜下后交叉韧带双束与单束重建疗效的Meta分析

Arthroscopic Double-bundle versus Single-bundle Posterior Cruciate Ligament Reconstruction:A Meta-analysis

目的系统评价关节镜下经胫骨隧道后交叉韧带(PCL)单束与双束重建的临床疗效。方法计算机检索Pub Med、The Cochrane Library、EMbase、VIP和Wan Fang Data数据库,纳入所有关于关节镜下经胫骨隧道PCL单束与双束重建疗效对比的随机对照试验(RCT),检索时限均为从建库至2014年11月27日。由2位研究者按照纳入与排除标准筛选文献、提取资料,并评价纳入研究的方法学质量后,采用Rev Man 5.3软件进行Meta分析。结果共纳入4个RCT,186例单纯PCL损伤患者。Meta分析结果显示:PCL双束重建在Lysholm评分[MD=2.17,95%CI(0.29,4.05),P=0.02]、Tegner评分[MD=0.62,95%CI(0.09,1.16),P=0.02]、IKDC客观评分[A级:RR=1.57,95%CI(1.09,2.26),P=0.02;A+B级:RR=1.15,95%CI(1.01,1.32),P=0.04]方面优于单束重建;而在KT-1000测量膝关节稳定性方面,单、双束重建差异无统计学意义[MD=-0.65,95%CI(-3.29,1.99),P=0.63]。结论当前证据显示,关节镜下经胫骨隧道PCL双束重建优于单束重建。受纳入研究数量和质量的限制,本研究结论尚需更多大样本、高质量的试验结果来验证。

Objective To systematically review the effectiveness of double-bundle versus single-bundle for arthroscopic transtibial reconstruction of posterior cruciate ligament （PCL）. Methods We searched PubMed, The Cochrane Library, EMbase, VIP and WanFang Data to collect randomized controlled trials （RCTs） of PCL reconstruction treated with double-bundle versus single-bundle arthroscopic transtibial technique. Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies, and then meta-analysis was performed by using RevMan 5.3 software. Results A total of 4 RCTs involving 186 patients were included. The results of meta-analysis showed that double-bundle was superior to single-bundle in Lysholm score （MD=2.17, 95%CI 0.29 to 4.05, P=0.02）, Tegner score （MD=0.62, 95%CI 0.09 to 1.16, P=0.02）, IKDC objective score （A： RR=1.57, 95%CI 1.09 to 2.26, P=0.02; A＋B： RR=1.15, 95%CI 1.01 to 1.32, P=0.04）. However, there was no significant difference in the KT-1000 posterior between both groups （MD= -0.65, 95%CI -3.29 to 1.99, P=0.63）. Conclusion The current evidence shows that the double bundle arthroscopic transtibial is superior to the single bundle PCL reconstruction. Due to the limited quality and quantity of the included studies, more high quality studies with large sample-size are needed to validate the conclusion.