自体与同种异体肌腱重建距腓前韧带效果的Meta分析

Meta-analysis of the effect of reconstruction of the anterior talofibular ligament by autograft and allograft

目的比较自体肌腱与同种异体肌腱在重建外踝副韧带治疗慢性踝关节不稳定中的临床疗效性和安全性。方法计算机检索PubMed、Embase、Cochrane library、中国知网(CNKI)、万方数据库和维普数据库(VIP),纳入自体肌腱与同种异体肌腱在重建外踝副韧带治疗慢性踝关节不稳定的相关研究。检索时限从建库起至2022年3月,手工检索相关的已发表文献。由两位研究者独立进行文献筛选、资料提取和方法学质量评价后,采用Revman5.4软件进行Meta分析。结果共纳入6篇文献332例患者,在疗效性方面,自体肌腱和异体肌腱术后在AOFAS踝-后足评分、视觉模拟评分、距骨倾斜角度、距骨前移距离等指标上,无明显差异;自体肌腱的手术时间长于异体肌腱[均数差(mean difference,MD)=26.73,95%置信区间(confidence interval,CI):24.27~29.19,P<0.001];异体肌腱的术后持续发热时间长于自体肌腱组[MD=-2.76,95%CI:(-3.05~-2.48),P<0.001]。结论两种移植物在重建外踝副韧带治疗慢性踝关节不稳的术后功能评分上疗效相当,在手术时间上,同种异体肌腱组所需时间较短,而在术后持续发热时间上持续时间更长,需要进一步的研究探索两种移植物的长期临床疗效。

Objective To compare the clinical efficacy and safety of autogenous tendons and allograft tendons in the reconstruction of the external collateral ligament in the treatment of chronic ankle instability.Methods Relevant studies on autograft versus allograft in the reconstruction of external ankle collateral ligaments for chronic ankle instability were included by computer searches of PubMed,Embase,Cochrane library,China Knowledge Network(CNKI),Wanfang database and Vipers database(VIP).The search time frame was from database creation to March 2022,and relevant published literature was hand-searched.Meta-analysis was performed using Revman 5.4 software after independent literature screening,data extraction and methodological quality evaluation by two investigators.Results A total of 332 patients were included in six publications,and in terms of efficacy,there were no significant differences between autologous and allograft tendons after surgery in terms of AOFAS ankle-hindfoot score,visual analogue score,talar tilt angle,and talar anterior distance;the duration of surgery was longer for autologous tendons than for allograft tendons[(mean difference(MD)=26.73,95%confidence interval(CI):24.27-29.19,P<0.001)].The duration of postoperative fever was longer in the allograft tendon than in the autologous tendon group[(MD=-2.76,95%CI:-3.05--2.48,P<0.001)].Conclusion Both grafts are comparable in efficacy in terms of postoperative functional scores for reconstruction of the external collateral ankle ligament for chronic ankle instability,with shorter time required in the allograft tendon group in terms of operative time and longer duration in terms of duration of postoperative fever,further studies are needed to explore the long-term clinical efficacy of both grafts.