Howell J R, Handoll H H
Orthopaedic Department, Royal Cornwall Hospital (Treliske), Truro, Cornwall, UK.
Cochrane Database Syst Rev. 2000(2):CD001353. doi: 10.1002/14651858.CD001353.
Injuries to the knee menisci are common and operations to treat them are among the most common procedures performed by orthopaedic surgeons.
To evaluate the effects of common surgical interventions in the treatment of meniscal injuries of the knee. The four comparisons under test were: a) surgery versus conservative treatment, b) partial versus total meniscectomy, c) excision versus repair of meniscal tears, d) surgical access, in particular arthroscopic versus open.
We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE and bibliographies of published papers. Date of the most recent search: August 1998.
All randomised and quasi-randomised trials which involved the above four comparisons or which compared other surgical interventions for the treatment of meniscal injury.
Trial inclusion was agreed by both reviewers who independently assessed trial quality, by use of a 12 item scale, and extracted data. Where possible and appropriate, data were presented graphically.
Three trials, involving 260 patients, which addressed two (partial versus total meniscectomy; surgical access) comparisons were included. Partial meniscectomy may allow a slightly enhanced recovery rate as well as a potentially improved overall functional outcome including better knee stability in the long term. It is probably associated with a shorter operating time with no apparent difference in early complications or re-operation between partial and total meniscectomy. The long term advantage of partial meniscectomy indicated by the absence of symptoms (symptoms or further operation at six years or over: 14/98 versus 22/94; Peto odds ratio 0.55, 95% confidence interval 0.27 to 1.14) or radiographical outcome was not established. The results available from the only trial comparing arthroscopic with open meniscectomy were very limited in terms of patient numbers and length of follow-up. However it is likely that partial meniscectomy via arthroscopy is associated with shorter operating times and a quicker recovery.
REVIEWER'S CONCLUSIONS: The lack of randomised trials means that no conclusions can be drawn on the issue of surgical versus non-surgical treatment of meniscal injuries, nor meniscal tear repair versus excision. In randomised trials so far reported, there is no evidence of difference in radiological or long term clinical outcomes between arthroscopic and open meniscal surgery, or between total and partial meniscectomy. Partial meniscectomy seems preferable to the total removal of the meniscus in terms of recovery and overall functional outcome in the short term.
膝关节半月板损伤很常见，治疗此类损伤的手术是骨科医生最常开展的手术之一。
评估常见手术干预措施治疗膝关节半月板损伤的效果。所测试的四项对比为：a）手术治疗与保守治疗；b）部分半月板切除术与全半月板切除术；c）半月板撕裂切除术与修复术；d）手术入路，尤其是关节镜手术与开放手术。
我们检索了Cochrane肌肉骨骼损伤组试验注册库、MEDLINE以及已发表论文的参考文献。最近一次检索日期为1998年8月。
所有涉及上述四项对比或比较其他治疗半月板损伤手术干预措施的随机和半随机试验。
两位评价者就纳入试验达成一致意见，他们使用12项量表独立评估试验质量并提取数据。在可能且合适的情况下，以图表形式呈现数据。
纳入了三项试验，涉及260例患者，涉及两项对比（部分半月板切除术与全半月板切除术；手术入路）。部分半月板切除术可能使恢复率略有提高，且可能改善整体功能结局，包括长期更好的膝关节稳定性。它可能与手术时间较短相关，部分半月板切除术与全半月板切除术在早期并发症或再次手术方面无明显差异。部分半月板切除术在无症状（六年或更长时间出现症状或再次手术：14/98对22/94；Peto比值比0.55，95%置信区间0.27至1.14）或影像学结局方面的长期优势尚未确立。唯一一项比较关节镜下半月板切除术与开放半月板切除术的试验所得结果在患者数量和随访时间方面非常有限。然而，关节镜下部分半月板切除术可能与手术时间较短和恢复较快相关。
缺乏随机试验意味着无法就半月板损伤的手术治疗与非手术治疗问题以及半月板撕裂修复术与切除术得出结论。在迄今报道的随机试验中，没有证据表明关节镜下半月板手术与开放半月板手术之间、全半月板切除术与部分半月板切除术之间在影像学或长期临床结局方面存在差异。就短期恢复和整体功能结局而言，部分半月板切除术似乎优于全半月板切除术。
