关节镜下腘窝囊肿切除术与传统开放手术治疗腘窝囊肿临床疗效比较的Meta分析

A Meta-analysis of the clinical efficacy of arthroscopic popliteal cyst resection versus conventional open surgery for the treatment of popliteal cyst

目的系统评价关节镜下腘窝囊肿切除术与传统开放手术治疗腘窝囊肿的效果,为临床医生选择腘窝囊肿切除术式时提供更佳的循证医学依据。方法纳入对照组为传统开放切除手术,观察组为关节镜下切除腘窝囊肿联合关节清理术的随机对照试验与回顾性队列研究。通过检索中国知网(CNKI)、万方、维普(VIP)、PubMed、The CochraneLibrary和Web ofScience数据库近十年的相关文献941篇,排除重复文献、数据无法提取的文献、未设置对照组的文献和质量较差的文献,最后纳入文献24篇(中文文献23篇,英文文献1篇),选取手术有效率、术后复发率、并发症率、视觉模拟评分(VAS)、Lysholm功能评分、术中出血量、手术切口长度作为分析指标。使用Cochrane协作网提供的Review Manager 5.3软件进行系统评价与Meta分析。结果纳入的24篇文章中包含1559例病例,关节镜手术组有效率(OR=0.24,95%CI:0.14~0.41,P=0.000)和Lysholm功能评分(SMD=-2.75,95%CI:-3.64~-1.85,P=0.000)较传统手术组高,并发症发生率(O R^=4.01,95%CI:1.55~10.40,P=0.004)、VAS评分(MD=1.55,95%CI:1.36~1.75,P=0.000)和术后复发率(OR=6.33,95%CI:3.70~10.84,P=0.000)较传统手术组低,术中出血量较传统手术组少(SMD=7.67,95%CI:5.64~9.70,P=0.000),手术切口长度较传统手术组短(SMD=6.16,95%CI:4.94~7.37,P=0.000)。结论关节镜下腘窝囊肿切除术与传统开放手术具有手术有效率高、术后复发率低、并发症少、术后疼痛轻、膝关节功能评分好、术中出血量少和手术切口小等优势。

Objective To systematically evaluate the efficacy of arthroscopic popliteal cyst resection versus traditional open surgery for the treatment of popliteal cyst.It provides a higher evidence-based medical basis for clinicians to choose the surgical method of popliteal cyst resection in the future.Methods Randomized controlled trials and retrospective cohort studies were conducted in which traditional open resection of the popliteal cyst was performed in the control group and arthroscopic resection of the popliteal cyst combined with joint debridement was performed in the observation group.By retrieving the CNKI,WANFANG database,VIP,PubMed,the Cochrane Library,Web of Science nearly a decade of literature,a total of 941 to retrieve relevant literature,eliminate duplicate documents and data to extract the literature,is not set in the control group literature,as well as the poor quality of literature,the participants included 24 references.Selecting operation of efficient and postoperative recurrence rate and complication rate,visual analogue scale(VAS),Lysholm score,intraoperative blood loss,surgical incision length as analysis indicators.Review Manager 5.3 software provided by the Cochrane Collaboration was used for system evaluation and Meta-analysis.Results In a Meta-analysis of 1559 patients in the 24 included articles,the effective rate(OR=0.24,95%CI:0.14~0.41,P=0.000)and Lysholm function score(SMD=-2.75,95%CI=-3.64~-1.85,P=0.000)in the arthroscopic operation group were higher than those of traditional operation group,the complication rate(OR=4.01,95%CI:1.55~10.40,P=0.004),VAS score(MD=1.55,95%CI:1.36~1.75,P=0.000)and postoperative recurrence rate(OR=6.33,95%CI:3.70~10.84,P=0.000)were lower than those of traditional operation group,the amount of intraoperative bleeding was less than that of traditional operation group(SMD=7.67,95%CI:5.64~9.70,P=0.000),the incision length was shorter than that of traditional operation group(SMD=6.16,95%CI:4.94~7.37,P=0.000).Conclusion Compared with traditional open surgery,arthroscopic popliteal cyst resection has the advantages of high efficiency,low postoperative recurrence rate,less complications,less postoperative pain,better knee function score,less intraoperative blood loss and small surgical incision.