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
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摘要
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 hollow screw fixation 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 hollow screw and 224 cases were treated with suture.The study found that the operation time of the hollow screw group 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 hollow screw fixation 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.
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 hollow screw fixation 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 hollow screw and 224 cases were treated with suture.The study found that the operation time of the hollow screw group 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 hollow screw fixation 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.
引文
[1]HAYES J M,MASEAR V R.Avulsion fracture of the tibial eminence associated with severe medial ligamentous injury in an adolescent.A case report and literature review[J].American Journal of Sports Medicine,1984,12(4):330-333.
[2]陆振飞,赵金忠.前交叉韧带胫骨止点撕脱骨折的治疗进展[J].中华创伤骨科杂志,2008,10(2):186-188.
[3]李锋,周利武,赵建宁.膝关节前交叉韧带损伤的诊断与治疗进展[J].中华解剖与临床杂志,2011,16(5):437-440.
[4]KENDALL N S,HSU S Y,CHAN K M.Fracture of the tibial spine in adults and children.A review of 31 cases[J].Journal of Bone&Joint Surgery-british Volume,1992,74(6):848-852.
[5]YOO J H,CHONG B C,LEE T S,et al.Delayed recurrent hemarthrosis after staple fixation of tibial avulsion fracture of the posterior cruciate ligament:a case report.[J].Knee Surgery Sports Traumatology Arthroscopy Official Journal of the Esska,2006,14(9):854.
[6]KIMS J,SHIN S J,CHOI N H,et al.Arthroscopically Assisted Treatment of Avulsion Fractures of the Posterior Cruciate Ligament from the Tibia[J].Journal ofBone&Joint SurgeryAmerican Volume,2001,83-A(5):698.
[7]高彦平,吴宇峰,邱桂春,等.前交叉韧带胫骨棘止点撕脱骨折的现状与思考[J].中华创伤骨科杂志,2005,7(3):272-274.
[8]GAN Y,XU D,DING J,et al.Tension band wire fixation for anterior cruciate ligament avulsion fracture:biomechanical comparison of four fixation techniques[J].Knee Surgery Sports Traumatology Arthroscopy Official Journal of the Esska,2012,20(5):909-915.
[9]PALYS K E,BERGER V W.A Note on the Jadad Score as an Efficient Tool for Measuring Trial Quality[J].Journal of Gastrointestinal Surgery Official Journal of the Society for Surgery of the Alimentary Tract,2013,17(6):1170-1171.
[10]犹怀勇,邵明,邱伟.关节镜下前交叉韧带胫骨止点撕脱骨折固定方案的研究[J].中国内镜杂志,2015,21(12):1302-1306.
[11]褚青波,邢雅昶,刘大旭.3种方式治疗ⅡⅢ型前交叉韧带胫骨止点撕脱骨折的疗效比较[J].安徽医学,2018,39(1):95-98.
[12]李小磊,魏鹏,邱忠鹏.关节镜下两种固定方式治疗前交叉韧带胫骨止点撕脱骨折的临床研究[J].中国内镜杂志,2018(2):38-42.
[13]PAN R Y,YANG J J,CHANG J H,et al.Clinical outcome of arthroscopic fixation of anterior tibial eminence avulsion fractures in skeletally mature patients:a comparison of suture and screwfixation technique[J].Journal of Trauma&Acute Care Surgery,2012,72(2):E88.
[14]SEON J K,PARK S J,LEE K B,et al.A clinical comparison of screw and suture fixation of anterior cruciate ligament tibial avulsion fractures[J].American Journal of Sports Medicine,2009,37(12):2334-2339.
[15]王庆,黄华扬,张涛,等.关节镜下螺钉与缝线固定前交叉韧带胫骨止点撕脱骨折的疗效比较[J].中华创伤骨科杂志,2015,17(4):309-313.
[16]李桓毅,吴海山,吴宇黎,等.关节镜下两种固定方式治疗前交叉韧带止点撕脱骨折的疗效比较[J].中国修复重建外科杂志,2011(8):899-902.
[17]陈永田,张振兴,姜景尧,等.关节镜下两种固定方式治疗前交叉韧带止点撕脱骨折的比较分析[J].中外医学研究,2016,14(32):23-25.
[18]刁天月,杨挺,李健华,等.全关节镜下复位固定前交叉韧带止点撕脱骨折的效果观察[J].临床合理用药杂志,2016,9(25):142-143.
[19]DI CF,BUDAR,GHERMANDI R,et al.Combined arthroscopic treatment oftibial plateau and intercondylar eminence avulsion fractures[J].Journal of Bone&JointSurgeryAmerican Volume,2010,92 Suppl2(Suppl2):161.
[20]刘云鹏,杨柳,陈光兴,等.关节镜下胫骨髁间棘骨折的治疗[J].中华创伤骨科杂志,2006,8(4):330-333.
[21]LEEBERG V,LEKDORF J,WONG C,et al.Tibial eminentia avulsion fracture in children-a systematic reviewofthe current literature[J].Danish Medical Journal,2014,61(3):A4792.
[22]杨冬发,侯之启,彭昌贵,等.关节镜下应用可吸收界面螺钉固定自体4股腘绳肌腱重建前交叉韧带[J].中华解剖与临床杂志,2010,15(4):253-256.
[23]石青,杨建平,龚仁钰,等.手法复位空心螺钉固定治疗儿童胫骨远端三平面骨折[J].中华骨科杂志,2010,30(9):876-881.
[24]胡勇,程松苗,唐杰.应用改良的关节镜下带垫片的空心螺钉内固定技术治疗儿童前交叉韧带胫骨止点撕脱性骨折[J].第三军医大学学报,2008,30(15):1424-1426.
[25]DE W M,SCHOLES C J,PATEL S,et al.Tibial fixation in anterior cruciate ligament reconstruction:a prospective randomized study comparing metal interference screw and staples with a centrally placed polyethylene screwand sheath[J].American Journal of Sports Medicine,2017,39(9):1858.
[26]王靖,翁晓军,李晶,等.关节镜下ULTRA-Braid缝线平面固定前交叉韧带胫骨止点撕脱骨折的疗效分析[J].中国修复重建外科杂志,2015(11):1353-1357.
[27]王穗源,肖扬,童作明,等.关节镜下不可吸收缝线联合微型钢板固定治疗前交叉韧带胫骨止点撕脱骨折[J].中国修复重建外科杂志,2013(9):1041-1044.
[28]王江涛,申学振,刘畅,等.缝线领带结套扎固定胫骨髁间嵴撕脱骨折的生物力学研究[J].中国修复重建外科杂志,2015(9):1080-1083.
[29]HAVIV B,BRONAK S,KOSASHVILI Y,et al.Gender Effect on the Outcome of Partial Medial Meniscectomy.[J].Orthopedics,2015,38(10):e925.
[30]CRAWFORD K,BRIGGS K K,RODKEY W G,et al.Reliability,validity,and responsiveness ofthe IKDC score for meniscus injuries ofthe knee[J].Arthroscopythe Journal ofArthroscopic&Related Surgery,2007,23(8):839-844.
[2]陆振飞,赵金忠.前交叉韧带胫骨止点撕脱骨折的治疗进展[J].中华创伤骨科杂志,2008,10(2):186-188.
[3]李锋,周利武,赵建宁.膝关节前交叉韧带损伤的诊断与治疗进展[J].中华解剖与临床杂志,2011,16(5):437-440.
[4]KENDALL N S,HSU S Y,CHAN K M.Fracture of the tibial spine in adults and children.A review of 31 cases[J].Journal of Bone&Joint Surgery-british Volume,1992,74(6):848-852.
[5]YOO J H,CHONG B C,LEE T S,et al.Delayed recurrent hemarthrosis after staple fixation of tibial avulsion fracture of the posterior cruciate ligament:a case report.[J].Knee Surgery Sports Traumatology Arthroscopy Official Journal of the Esska,2006,14(9):854.
[6]KIMS J,SHIN S J,CHOI N H,et al.Arthroscopically Assisted Treatment of Avulsion Fractures of the Posterior Cruciate Ligament from the Tibia[J].Journal ofBone&Joint SurgeryAmerican Volume,2001,83-A(5):698.
[7]高彦平,吴宇峰,邱桂春,等.前交叉韧带胫骨棘止点撕脱骨折的现状与思考[J].中华创伤骨科杂志,2005,7(3):272-274.
[8]GAN Y,XU D,DING J,et al.Tension band wire fixation for anterior cruciate ligament avulsion fracture:biomechanical comparison of four fixation techniques[J].Knee Surgery Sports Traumatology Arthroscopy Official Journal of the Esska,2012,20(5):909-915.
[9]PALYS K E,BERGER V W.A Note on the Jadad Score as an Efficient Tool for Measuring Trial Quality[J].Journal of Gastrointestinal Surgery Official Journal of the Society for Surgery of the Alimentary Tract,2013,17(6):1170-1171.
[10]犹怀勇,邵明,邱伟.关节镜下前交叉韧带胫骨止点撕脱骨折固定方案的研究[J].中国内镜杂志,2015,21(12):1302-1306.
[11]褚青波,邢雅昶,刘大旭.3种方式治疗ⅡⅢ型前交叉韧带胫骨止点撕脱骨折的疗效比较[J].安徽医学,2018,39(1):95-98.
[12]李小磊,魏鹏,邱忠鹏.关节镜下两种固定方式治疗前交叉韧带胫骨止点撕脱骨折的临床研究[J].中国内镜杂志,2018(2):38-42.
[13]PAN R Y,YANG J J,CHANG J H,et al.Clinical outcome of arthroscopic fixation of anterior tibial eminence avulsion fractures in skeletally mature patients:a comparison of suture and screwfixation technique[J].Journal of Trauma&Acute Care Surgery,2012,72(2):E88.
[14]SEON J K,PARK S J,LEE K B,et al.A clinical comparison of screw and suture fixation of anterior cruciate ligament tibial avulsion fractures[J].American Journal of Sports Medicine,2009,37(12):2334-2339.
[15]王庆,黄华扬,张涛,等.关节镜下螺钉与缝线固定前交叉韧带胫骨止点撕脱骨折的疗效比较[J].中华创伤骨科杂志,2015,17(4):309-313.
[16]李桓毅,吴海山,吴宇黎,等.关节镜下两种固定方式治疗前交叉韧带止点撕脱骨折的疗效比较[J].中国修复重建外科杂志,2011(8):899-902.
[17]陈永田,张振兴,姜景尧,等.关节镜下两种固定方式治疗前交叉韧带止点撕脱骨折的比较分析[J].中外医学研究,2016,14(32):23-25.
[18]刁天月,杨挺,李健华,等.全关节镜下复位固定前交叉韧带止点撕脱骨折的效果观察[J].临床合理用药杂志,2016,9(25):142-143.
[19]DI CF,BUDAR,GHERMANDI R,et al.Combined arthroscopic treatment oftibial plateau and intercondylar eminence avulsion fractures[J].Journal of Bone&JointSurgeryAmerican Volume,2010,92 Suppl2(Suppl2):161.
[20]刘云鹏,杨柳,陈光兴,等.关节镜下胫骨髁间棘骨折的治疗[J].中华创伤骨科杂志,2006,8(4):330-333.
[21]LEEBERG V,LEKDORF J,WONG C,et al.Tibial eminentia avulsion fracture in children-a systematic reviewofthe current literature[J].Danish Medical Journal,2014,61(3):A4792.
[22]杨冬发,侯之启,彭昌贵,等.关节镜下应用可吸收界面螺钉固定自体4股腘绳肌腱重建前交叉韧带[J].中华解剖与临床杂志,2010,15(4):253-256.
[23]石青,杨建平,龚仁钰,等.手法复位空心螺钉固定治疗儿童胫骨远端三平面骨折[J].中华骨科杂志,2010,30(9):876-881.
[24]胡勇,程松苗,唐杰.应用改良的关节镜下带垫片的空心螺钉内固定技术治疗儿童前交叉韧带胫骨止点撕脱性骨折[J].第三军医大学学报,2008,30(15):1424-1426.
[25]DE W M,SCHOLES C J,PATEL S,et al.Tibial fixation in anterior cruciate ligament reconstruction:a prospective randomized study comparing metal interference screw and staples with a centrally placed polyethylene screwand sheath[J].American Journal of Sports Medicine,2017,39(9):1858.
[26]王靖,翁晓军,李晶,等.关节镜下ULTRA-Braid缝线平面固定前交叉韧带胫骨止点撕脱骨折的疗效分析[J].中国修复重建外科杂志,2015(11):1353-1357.
[27]王穗源,肖扬,童作明,等.关节镜下不可吸收缝线联合微型钢板固定治疗前交叉韧带胫骨止点撕脱骨折[J].中国修复重建外科杂志,2013(9):1041-1044.
[28]王江涛,申学振,刘畅,等.缝线领带结套扎固定胫骨髁间嵴撕脱骨折的生物力学研究[J].中国修复重建外科杂志,2015(9):1080-1083.
[29]HAVIV B,BRONAK S,KOSASHVILI Y,et al.Gender Effect on the Outcome of Partial Medial Meniscectomy.[J].Orthopedics,2015,38(10):e925.
[30]CRAWFORD K,BRIGGS K K,RODKEY W G,et al.Reliability,validity,and responsiveness ofthe IKDC score for meniscus injuries ofthe knee[J].Arthroscopythe Journal ofArthroscopic&Related Surgery,2007,23(8):839-844.