前交叉韧带重建术后再损伤危险因素的meta分析

Risk of Secondary Injury After Anterior Cruciate Ligament Reconstruction:A Meta-analysis

目的:通过Meta分析,探讨年龄、运动、性别因素对前交叉韧带重建术( ACLR)后前交叉韧带再损伤的影响.方法:在PubMed、EBSCO、CNKI、VIP、CBM数据库(截止2018年12月)中检索前交叉韧带重建术后再损伤危险因素的文章.使用Rev-Man 5.3软件进行Meta分析,评价年龄、运动、性别因素对前交叉韧带重建术后前交叉韧带再损伤的影响,并计算总样本及年轻患者、术后恢复运动患者、年轻恢复运动患者和年轻女性患者恢复运动的前交叉韧带再损伤发病率.结果:最终纳入15篇文献.年龄<25岁的患者相比于对照组更容易出现ACL再损伤,差异有统计学意义(OR=2.86,95% CI:1.85-4.41,P<0.05);术后恢复运动的患者相比于对照组更容易出现ACL再损伤,差异有统计学意义( OR=4.89,95% CI:1.45-16.47,P<0.05);女性相比于男性ACL再损伤的差异没有统计学意义(OR=1.12,95% CI:0.74-1.68,P>0.05),但女性相比于男性在术后恢复运动后更容易出现ACL再损伤,其差异有统计学意义( OR=2.32,95% CI:1.18 -4.58,P=0.61);ACLR 术后 ACL再损伤的发病率为15%,年龄<20-25岁的患者ACL再损伤的发病率为20%,术后恢复运动的患者ACL再损伤的发病率也为20%,当年龄<25岁的患者术后恢复运动时ACL再损伤的发病率为22%,而当年轻女性术后恢复运动时ACL再损伤的发病率为26%.结论:年龄<25岁和术后恢复运动是前交叉韧带重建术后前交叉韧带再损伤的危险因素,在术后恢复运动的过程中女性是前交叉韧带再损伤的危险因素,但对于全部人群女性不是再损伤的危险因素.在ACLR术后恢复运动特别是在早期,几乎每4个年轻的恢复高强度运动的人就有1个发生ACL再损伤,而其中女性受伤的可能性要更大.

Objective: The purpose of this review was to assess the risk factors, which are age, sport, and sex, to the reinjures after anterior cruciate ligament reconstruction. Methods: We searched the PubMed, EBSCO, CNKI, VIP, CBM( from beginning to December 2018) for the literatures about the risk factors to the reinjures after anterior cruciate ligament reconstruction. Meta analysis was conducted using the RevMan5 .3 softwar to conduct the total population data as well as the following subsets : young age, return to sport, young age return to sport, and young female return to sport. Results: Eventually 15 studies were included, a total of 37912 patients joined. Patients <25 years old experience further ACL reinjury to the control group, with a statistically significant difference (OR =2.86, 95% CI:1.85-4. 41, P<0.05). Patients returning to play experience further ACL reinjury to the control group, with a statistically significant difference ( OR =1.12,95% CI:0.74-1.68, P>0.05 ). There was no statistically significant difference between male and female( OR=1.12, 95% CI:0.74-1.68, P >0.05 ), while female returning to play experience further ACL reinjury to the control group with a statistically significant difference( OR =2.32, 95% CI :1. 18-4.58 , P =0.61). The second ACL totally reinjury rate was 15%. The secondary ACL injury rate for patients younger than 25 years was 20%. The secondary ACL injury rate of athletes returning to sport was 20%. The secondary ACL injury rate for Athletes younger than 25 years who return to sport was 22%. The secondary ACL injury rate for female Athletes younger than 25 years who return to sport was 26%. Conclusion: This review demonstrates that both younger age and return to high level of sport are risk factors of secondary ACL injury, and female is one of risk factor of secondary ACL injury during returning to play. However, female is not a risk factor in the overall population. It suggested nearly one of four young athletic patients who return to high-risk sport after ACLR will go on to sustain another ACL injury, especially female patients,the earlier in the return-to-play period.,the more dangerous.