中国循证医学杂志

中国循证医学杂志

膝关节多发韧带损伤不同手术时机与疗效相关性的 meta 分析

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目的 系统评价膝关节多发韧带损伤(MLIK)早期、延期手术效果的差异,为 MILK 最佳手术时机的选择提供依据。 方法 计算机检索 PubMed、The Cochrane Library、EMbase、CNKI、CBM、WanFang Data 和 VIP 数据库,搜集 MLIK 不同手术时机疗效的队列研究,检索时限均从建库至 2018 年 9 月 23 日。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 meta 分析。 结果 共纳入 8 个队列研究,包括 153 例早期手术患者和 90 例延期手术患者。meta 分析结果显示:与延期手术相比,早期手术患者术后膝关节 Lysholm 评分更优[MD=7.52,95%CI(2.00,13.04),P=0.008];术后 IKDC 评分优良率[OR=2.97,95%CI(1.51,5.84),P=0.002]更高,差异均有统计学意义。但两组患者在术后 Tegner 评分[MD=–0.08,95%CI(–1.07,0.92),P=0.88]和术后膝关节活动度[MD=4.08,95%CI(–2.38,10.55),P=0.22]方面差异无统计学意义。MLIK 手术治疗的主要不良反应包括神经血管损伤、下肢深静脉血栓形成、腓总神经损伤、止血带麻痹、关节活动受限等。早期手术并发症发生率更低(7.1% vs. 30%)。 结论 当前证据表明,早期手术治疗 MLIK 能够获得更高的 Lysholm 评分及 IKDC 优良率,且手术并发症更低。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the differences of operative outcomes between early surgery and delayed surgery in multiple ligament injury of knee joint (MLIK) patients. Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect cohort studies about operative outcomes of different surgery time in MLIK patients from inception to September 23, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 8 cohort studies involving 153 early and 90 delayed operatively treated patients were included. The results of meta-analysis showed that: compared with delayed surgery, early surgery got higher Lysholm Score (MD=7.52, 95%CI 2.00 to 13.04, P<0.000 1) and superior IKDC score rate (OR=2.97, 95%CI 1.51 to 5.84,P=0.002). There were no significant differences in Tegner score (MD=–0.08, 95%CI –1.07 to 0.92, P=0.88) and ROM (MD=4.08, 95%CI –2.38 to 10.55, P=0.22) between two groups. The main adverse reactions of MLIK included neurovascular injury, deep venous thrombosis of lower extremities, common peroneal nerve injury, tourniquet paralysis and limited joint activity. Early surgery had a lower incidence of complications than delayed surgery (7.1% vs. 30%). Conclusion The current evidence shows that early surgery can get higher Lysholm score and superior IKDC score rate in treatment of MLIK, and have a lower incidence of complications. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.

关键词: 膝关节多发韧带损伤; 早期手术; 延期手术; 效果; 系统评价; meta 分析; 队列研究

Key words: Multiple ligament injuries of knee; Early surgery; Delayed surgery; Curative effect; Systematic review; meta-analysis; Cohort study

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