关节镜下自体腘绳肌腱与同种异体肌腱移植重建前交叉韧带效果的系统评价

Hamstring Tendon Autograft versus Hamstring Tendon Allograft in Anterior Cruciate Ligament Reconstruction by Arthroscopy: A Systematic Review

目的系统评价自体腘绳肌腱移植与同种异体肌腱移植重建前交叉韧带的效果。方法计算机检索PubMed、EMbase、The Cochrane Library(2015年第2期)、CNKI、VIP和WanFang Data数据库,搜集自体腘绳肌腱与同种异体肌腱移植重建前交叉韧带效果比较的随机对照试验(RCT),检索时限均为从建库至2015年2月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.2软件进行Meta分析。结果共纳入6个RCT,535例膝关节。Meta分析结果显示:1术后物理指标:自体腘绳肌腱移植组与同种异体肌腱移植组的术后1年前后抽屉试验(Lachman test)阳性率[RR=1.25,95%CI(0.92,1.71),P=0.15]和术后1年轴移试验(Pivot shift test)阳性率[RR=1.04,95%CI(0.93,1.17),P=0.47]差异无统计学意义;2术后功能康复指标:两组术后1年KT-1000/2000测量结果[MD=0.79,95%CI(–1.78,0.20),P=0.12]、术后1年IKDC评分异常率[RR=1.03,95%CI(0.96,1.10),P=0.42]以及术后1年Lysholm评分[MD=0.23,95%CI(–1.86,2.33),P=0.83]差异也均无统计学意义。结论关节镜下采用自体腘绳肌腱或同种异体肌腱移植进行前交叉韧带重建的效果相当。受纳入研究数量和质量所限,上述结论尚需开展更多大样本高质量的研究进行验证。

Objective To systematically review the efficacy of hamstring tendon autograft versus hamstring tendon allograft in anterior cruciate ligament reconstruction by arthroscopy. Methods Databases including PubMed, EMbase,The Cochrane Library（Issue 2, 2015）, CNKI, VIP, WanFang Data were electronically searched to collect randomized controlled trials（RCTs） about hamstring tendon autograft versus hamstring tendon allograft in anterior cruciate ligament reconstruction by arthroscopy from inception to February 2015. Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2software. Results A total of 6 RCTs involving 535 knees were included. The results of meta-analysis showed that：（1）Postoperative physical outcomes： There were no significant differences between the hamstring tendon autograft group and the hamstring tendon allograft group in positive rate of Lachman test（RR=1.25, 95%CI 0.92 to 1.71, P=0.15） and positive rate of Pivot shift test（RR=1.04, 95%CI 0.93 to 1.17, P=0.47） at 1 year postoperatively.（2） Postoperative functional recovery outcomes： There were no significant differences between both groups in KT-1000/2000 measurement（MD=–0.79, 95%CI –1.78 to 1.20, P=0.12）, abnormal rate of IKDC scores（RR=1.03, 95%CI 0.90 to 1.1, P=0.42） and Lysholm scores（MD= 0.23, 95%CI –1.86 to 2.33, P=0.83） at 1 year postoperatively. Conclusion Hamstring tendon autograft and hamstring tendon allograft have similar efficacy in anterior cruciate ligament reconstruction by arthroscopy. Due to limited quality and quantity of the included studies, more large-scale and high quality studies are needed to verify the above conclusion.