非手术治疗与关节镜手术治疗对退行性半月板撕裂患者治疗效果的系统评价

Arthroscopic Debridement versus Non-operative Treatment for Degenerative Meniscal Tear:A Systematic Review and Meta-analysis

目的系统评价关节镜手术治疗退行性半月板撕裂患者的有效性及安全性,以期为临床退行性半月板撕裂治疗方式的选择提供证据。方法计算机检索Pub Med、EMbase、The Cochrane Library(2015年7期)、Wan Fang Data、CBM和CNKI数据库,搜集有关非手术治疗与关节镜手术比较治疗退行性半月板撕裂患者的随机对照试验(RCT)。检索时限均为从建库至2015年7月。由2位作者严格按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的偏倚风险,并相互交叉核对结果,如遇分歧则讨论解决或交由第三位作者裁定。然后,采用Rev Man 5.3软件进行Meta分析。结果最终纳入9个RCT,共计1 023例患者。Meta分析结果显示:非手术治疗组与关节镜手术组患者各随访时间点关节功能评分差异无统计学意义[≤6个月:SMD=0.12,95%CI(–0.11,0.35),P=0.30;1年:SMD=–0.03,95%CI(–0.18,0.11),P=0.65;2年:SMD=–0.07,95%CI(–0.32,0.19),P=0.61]。非手术治疗组与关节镜手术组患者各随访时间点疼痛评分差异均无统计学意义[≤6个月:MD=0.30,95%CI(–0.10,0.70),P=0.14;1年:MD=0.10,95%CI(–0.40,0.60),P=0.70;2年:MD=0.02,95%CI(–0.52,0.92),P=0.90]。结论与非手术治疗相比,关节镜手术并未明显改善退行性半月板撕裂患者膝关节活动功能。但受纳入研究随访时间限制,该结论的可靠性尚需更多远期随访的大样本高质量研究证实或证伪。

Objective To systematically evaluate the effectiveness of arthroscopic debridement versus non-operative treatment for degenerative meniscal tear. Methods Databases including PubMed, EMbase, The Cochrane Library （Issue 7, 2015）, WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials （RCTs） about arthroscopic debridement versus non-operative treatment for degenerative meniscal tear from inception to July 2015. The meta-analysis was conducted using RevMan 5,3 software. Results A total of nine RCTs involving 1 023 patients were included. The results of meta-analysis showed that： there were no significant differences between two groups at different follow-up time points in knee scoring scale （less than 6 months： SMD--0.12, 95%CI -0.11 to 0.35, P=0.30; 1 year： SMD= -0.03, 95%CI -0.18 to 0.11, P=0.65; 2 years： SMD= -0.07, 95%CI -0.32 to 0.19, P=0.61） and pain score （less than 6 months： MD=0.30, 95%CI -0.10 to 0.70, P=0.14; 1 year： MD=0.10, 95%CI -0.40 to 0.60, P=0.70; 2 years： MD=0.02, 95%CI -0.52 to 0.92, P=0.90）. Conclusion Current evidence suggests that arthroscopic debridement hasn＇t better effective than non-operative treatment for degenerative meniscal tear, however, due to the limited quantity of the included studies, the above condusion still need more high quality research to be verified.