关节镜下两种固定方式治疗ACL胫骨止点撕脱骨折疗效的Meta分析

A meta-analysis of two fixation methods for the treatment of ACL avulsion fracture of tibial junction under arthroscopy

目的通过Meta分析比较关节镜下空心螺钉和不可吸收缝线固定治疗ACL胫骨止点撕脱骨折的疗效差异。方法检索并收集2008年—2018年期间公开发表于Embase、Pubmed、Cochrane、中国知网(CNKI)、中文科技期刊全文数据库(VIP)及万方数据库,关于关节镜下空心螺钉与不可吸收缝线固定治疗ACL胫骨止点撕脱骨折临床对照研究的文章,严格按照纳入和排除标准及文献质量评分标准收集数据,运用Review Manager 5.3软件对数据进行Meta分析。结果共纳入9篇文献,总计446例膝关节ACL胫骨止点撕脱骨折患者,其中空心螺钉治疗组222例,缝线治疗组224例。研究发现:关节镜下空心螺钉组手术时间[95%CI(-11.00,-5.50),P<0.01]明显短于不可吸收缝线组;膝关节活动度(ROM)[95%CI(-2.16,1.29),P=0.62]、Lysholm评分[95%CI(-0.64,4.16),P=0.15]、KT-1000/2000测量[95%CI(-0.06,0.16),P=0.38]、IKDC评分[95%CI(-8.72,4.73),P=0.52]、骨折愈合时间[95%CI(-0.59,0.69),P=0.88]等方面提示两种固定方式差异均无统计学意义。结论尚无充分证据证明两种固定方式的优劣,空心螺钉和不可吸收缝线固定ACL胫骨止点撕脱骨折均可取得满意的临床效果,空心螺钉固定手术时间更短。临床医师可根据患者的具体情况进行选择。

Objective To compare the efficacy of arthroscopic hollowscrews and non-absorbable suture fixation in the treatment of anterior cruciate ligament(ACL)tibial avulsion fractures by meta-analysis.Methods Published studies about the arthroscopic hollowscrewfixation and non-absorbable suture fixation for the treatment of ACL tibial avulsion fracture from 2008 to 2018 were retrieved and collected on Embase,Pubmed,Cochrane Library,CNKI,VIP and Wanfang Database.After strict methodological quality of the trials'included criteria and exclusion criteria was critically assessed,Review management 5.3 software is utilized to conduct meta-analysis of data.Results A total of 446 cases of knee ACL avulsion fracture of tibia were included in 9 literatures,among which 222 cases were treated with hollowscrewand 224 cases were treated with suture.The study found that the operation time of the hollowscrewgroup under arthroscopy[95%CI(-11.00,-5.50),P<0.01]was significantly shorter than that of the non-absorbable suture group.However there were no significant difference in Knee Range of motion(ROM)[95%CI(2.16,1.29),P=0.62]、Lysholm score[95%CI(-0.64,4.16),P=0.15]、KT-1000/2000[95%CI(0.06,0.16),P=0.38]、IKDC score[95%CI(-8.72,4.73),P=0.52]and Fracture healing time[95%CI(-0.59,0.69),P=0.88]between the two fixation methods.Conclusions The results showed that there was no sufficient evidence to prove the advantages and disadvantages of the two fixation methods.Both hollowscrewfixation and non-absorbable suture fixation could achieve satisfactory clinical effects,and the operation time of hollow screw fixation was shorter.The clinician can choose according to the specific situation of the patient.