Faculty of Health, University of East Anglia, and Institute of Orthopaedics, Norwich University Hospital, Norwich, NR4 7TJ, UK.
Knee Surg Sports Traumatol Arthrosc. 2011 Jun;19(6):988-98. doi: 10.1007/s00167-010-1355-2. Epub 2011 Jan 14.
Conservative management of patellar dislocation can result in recurrent instability in up to 60% of patients. Surgery is therefore advocated in an attempt to reduce the incidence of recurrent dislocation and instability. The purpose of this study was to compare the clinical outcomes of operative to non-operative treatment strategies for patients following patellar dislocation.
A systematic review of published and unpublished literature was undertaken. Following data extraction, a meta-analysis was conducted to compare the two treatment strategies. The methodological quality of the literature was assessed using the PEDro critical appraisal tool.
Eleven studies were included, five randomised controlled trials (RCTs) and six non-RCTs. These assessed 403 patients managed conservatively, compared to 344 managed surgically. The findings of this study indicate that operative management of patellar dislocation is associated with a significantly higher risk of patellofemoral joint osteoarthritis (P=0.04), but a significantly lower risk of subsequent patellar dislocation compared to non-surgical management (P<0.01).
The meta-analysis indicates that there may be a difference in the incidence of patellofemoral joint osteoarthritis and rate of subsequent dislocation. However, this finding should currently be interpreted with great caution due to the demonstration of statistically significant publication bias, issues related to the methodological quality of the evidence base, and due to the variety of different surgical interventions currently presented within the literature.
III.
髌骨脱位的保守治疗可导致多达 60%的患者出现复发性不稳定。因此，提倡手术以降低复发性脱位和不稳定的发生率。本研究旨在比较髌骨脱位患者手术与非手术治疗策略的临床结果。
对已发表和未发表的文献进行系统评价。在提取数据后，进行荟萃分析以比较两种治疗策略。使用 PEDro 批判性评估工具评估文献的方法学质量。
共纳入 11 项研究，其中 5 项为随机对照试验（RCT），6 项为非 RCT。这些研究共评估了 403 例保守治疗的患者，与 344 例手术治疗的患者进行了比较。本研究的结果表明，与非手术治疗相比，手术治疗髌骨脱位与髌股关节骨关节炎（P=0.04）的风险显著增加，但随后发生髌骨脱位的风险显著降低（P<0.01）。
荟萃分析表明，髌股关节骨关节炎的发生率和随后脱位的发生率可能存在差异。然而，由于存在统计学上显著的发表偏倚问题、证据基础方法学质量相关问题以及文献中目前呈现的各种不同手术干预措施，该发现目前应谨慎解释。
III 级。
