自体骨骨软骨移植术与关节镜下微骨折术修复距骨骨软骨损伤疗效差异的系统评价

A systematic evaluation on the difference between autologous osteochondral transplantation and arthroscopic microfracture surgery in repairing talus osteochondral injury

目的:系统评价自体骨骨软骨移植术(Autologous Osteochondral Transplantation,AOT)与关节镜下微骨折术(Arthroscopic Microfracture Surgery,AMS)修复距骨骨软骨损伤(Talus Osteochondral Lesions,TOL)的临床疗效的差异。方法:计算机检索PubMed、Web of science、Cochrane、CBM、中国知网、维普、万方数据库中公开发表的AOT与AMS治疗TOL的临床对照试验。由2名研究人员独立检索、筛选文献,并对纳入的文献依据文献类型采用不同的质量评价工具进行质量评价,随机对照研究文献采用改良Jadad量表,病例对照(Case Control,CC)文献采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS),使用WPS Office进行数据提取及RevMan 5.3软件进行Meta分析。结果:共6篇文献符合纳入标准,384例患者,其中AOT组186例、AMS组198例。Meta分析表明:AOT在改善疼痛视觉模拟评分法(Visual Analog Scales,VAS)评分上优于AMS,亚组分析显示随机对照试验组(P <0.001)与CC组(P=0.002)结果均与其一致;AOT在改善美国足与踝关节协会(American Orthopedic Foot Andankle Society,AOFAS)评分上优于AMS;不能判断AOT与AMS治疗TOL在临床有效率方面的优劣,亚组分析显示随机对照试验组与其结果一致,但CC组显示AOT治疗TOL在临床有效率优于AMS组;在不良反应方面,不能判断AOT与AMS的优劣,亚组分析显示随机对照试验组(P=0.35)与CC组(P=0.22)均一致。结论:AOT与AMS均能改善踝关节功能及疼痛症状,提高临床有效率;AOT在改善VAS评分及AOFAS评分上优于AMS;尚不能确定AOT与AMS临床有效率及安全性的优劣。以上结论仍需大量高质量研究的循证依据。

Objective: To systematically evaluate the difference of clinical efficacy between autologous osteochondral transplantation and arthroscopic microfracture surgery in repairing talus osteochondral injury. Methods: The clinical randomized controlled trials of treating talus osteochondral injury by autologous osteochondral transplantation and arthroscopic microfracture in PubMed, Web of science,Cochrane, CBM, CNKI, VIP and Wanfang databases were searched by computer. Two researchers searched and screened the literature independently, and evaluated the quality of the included literature by different quality evaluation tools according to the literature types.RCT literature was evaluated by the improved Jadad scale, CC literature was evaluated by NOS, WPS Office was used for data extraction,and RevMan 5.3 software was used for a meta-analysis. Results: A total of 6 articles met the inclusion criteria, including 384 cases, with 186 cases in AOT group and 198 cases in AMS group. The meta-analysis showed that AOT was superior to AMS in ameliorating VAS score, and the subgroup analysis showed that the results in RCT group(P<0.001) and CC group(P=0.002) were consistent. AOT is superior to AMS in ameliorating AOFAS score. It can not be judged whether AOT and AMS are effective in treating TOL. The subgroup analysis showed that its results was consistent with the results in RCT group, but CC group showed that the clinical efficacy of AOT is better than AMS in treating TOL. In terms of adverse reactions, the advantages and disadvantages of AOT and AMS can not be judged. The subgroup analysis showed that RCT group(P=0.35) and CC group(P=0.22) were consistent. Conclusion: AOT and AMS both can ameliorate ankle function and pain symptoms, and improve clinical efficiency. AOT is superior to AMS in ameliorating VAS score and AOFAS score. The clinical efficiency and safety of AOT and AMS are still uncertain. The above conclusions still need to be verified by a lot of high-quality evidence-based evidence.