关节镜手术改善半月板退行性撕裂伤疼痛的荟萃分析

The Effect of Arthroscopic Surgery for Degenerative Meniscus Tears: A Meta-analysis

目的运用META分析软件分析关节镜治疗半月板退行性损伤的效果。方法通过检索MEDLINE、PUBMED、EMBASE、WOS收录的2007~2014年相关文献,选取Jadad评分>4关节镜手术治疗半月板退行性损伤的研究,获得其样本数(N)、均值(M)、方差(S),对患者膝关节的30分钟无障碍行走,行走及静息疼痛感进行短期(术后6个月)和长期(术后24个月)效果评价。结果共9个高质量符合标准的研究进入分析。关节镜手术改善半月板退行性撕裂伤疼痛评分分析:(1)短期(6个月)评分:SMD=0.32,95%CI(0.19-0.45),P=0.000,差异有统计学意义;欧洲人群分析SMD=0.31,95%CI(0.11-0.52),P=0.003,差异有统计学意义;亚洲人群分析SMD=0.32,95%CI(0.15-0.49),P=0.000,差异有统计学意义。(2)长期(24个月)评分:SMD=0.10,95%CI(-0.03-0.24),P=0.125,差异无统计学意义;欧洲人群分析SMD=0.22,95%CI(0.03-0.41),P=0.021,差异有统计学意义;亚洲人群分析SMD=-0.01,95%CI(-0.20-0.17),P=0.880,差异无统计学意义。结论关节镜手术治疗半月板退行性损伤能短期改善关节功能及疼痛,长期来看并不能改善关节功能及疼痛。

Objective To evaluate the effect of arthroscopic surgery for degenerative meniscus tears. Methods The correlated literatures of cohort study and prospective control study on the arthroscopic surgery for treating the degenerative meniscus tears with Jadad scored 4 above were retrieved in MEDLINE, PUBMED, EMBASE and WOS database from 2007 to 2014. The effect （pain score） of short-term （6-mon after surgery） and long-term （24-mon after surgery） were evaluated by meta-analysis. Results There were 9 studies adopted in the meta-analysis. The knee joint function was evaluated after the arthroscopic surgery for degenerative meniscus tears ： （1）The functional outcomes of short-term showed SMD = 0.32, 95% CI（0.19 - 0. 45 ） , P = 0. 000, and there was significant difference ; In the stratification analysis of European cases, there was SMD = 0.31, 95 % CI （0.11 - 0.52 ）, P = 0. 003, and the difference was statistical significance ; In the stratification analysis of Asian cases, there was SMD = 0.32, 95 % CI （0.15 -0.49）, P = 0. 000, and the difference was statistical significance. （2）The functional outcomes of long-term revealed SMD = 0.10, 95% CI（ -0. 03- 0. 24）, P = 0. 125, and there was no statistical difference; In the European patients, there wasSMD =0.22, 95% CI（0.03 -0.41 ）, P =0. 021, and the difference was statistical significance; In the Asian patients, there was SMD = - 0.01,95% CI（ - 0.20 - 0.17） , P = 0. 880, and the difference was not statistical significance. Conclusion The arthroscopic surgery can improve the knee joint function and pain for degenerative meniscus tears in short-term, but not in long-term.