Saccomanno Maristella F, Sircana Giuseppe, Fodale Mario, Donati Fabrizio, Milano Giuseppe
Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, Italy.
Int Orthop. 2016 Nov;40(11):2277-2287. doi: 10.1007/s00264-015-2856-x. Epub 2015 Jul 23.
The purpose of this study was to determine the efficacy of surgical and conservative treatment in the prevention of recurrence after primary patellar dislocation.
Studies were searched on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CINHAL from their inception to April 2015. All randomized controlled clinical trials comparing surgical versus conservative treatment after first patellar dislocation were included. Primary outcomes were: recurrent dislocation, subluxation, overall instability and subsequent surgery. Secondary outcomes included imaging, and subjective and objective clinical assessment tools. Methodological quality of the studies was assessed using Cochrane Collaboration's "Risk of Bias" tool. Pooled analyses were reported as risk ratio (RR) using a random effects model. Continuous data were reported as standardized mean difference (SMD) and 95 % confidence intervals (CIs). Heterogeneity was assessed using I².
Nine studies were included in the meta-analyses. Methodological quality of the studies was moderate to low. Meta-analyses showed that surgical treatment significantly reduces the redislocation rate (RR = 0.62; 95% CI = 0.39, 0.98, p = 0.04) and provides better results on Hughston VAS score (SMD = -0.32; 95% CI = -0.61, -0.03; p = 0.03) and running (OR = -0.52; 95% CI = 0.31, 0.88; p = 0.01). Conservative treatment showed less occurrence of minor complications (OR = 3.46; 95% CI = 2.08, 5.77; p = 0.01) and better results in the figure-of-8 run test (SMD = 0.42; 95% CI = 0.06, 0.77; p = 0.02) and in the squat down test (SMD = -0.45; 95% CI = -0.81, -0.10; p < 0.00001). No other significant differences could be found.
Based on the available data, surgical treatment of primary patella dislocation significantly reduces the risk of patella redislocation.
本研究旨在确定手术治疗和保守治疗在预防初次髌骨脱位后复发方面的疗效。
检索MEDLINE、EMBASE、Cochrane对照试验中心注册库和CINHAL数据库，检索时间从建库至2015年4月。纳入所有比较初次髌骨脱位后手术治疗与保守治疗的随机对照临床试验。主要结局指标为：复发性脱位、半脱位、整体不稳定及后续手术。次要结局指标包括影像学检查以及主观和客观的临床评估工具。采用Cochrane协作网的“偏倚风险”工具评估研究的方法学质量。汇总分析采用随机效应模型报告风险比（RR）。连续数据采用标准化均数差（SMD）和95%置信区间（CI）报告。采用I²评估异质性。
9项研究纳入荟萃分析。研究的方法学质量为中等至低等。荟萃分析显示，手术治疗显著降低了再脱位率（RR = 0.62；95%CI = 0.39, 0.98；p = 0.04），并且在休斯顿视觉模拟评分（SMD = -0.32；95%CI = -0.61, -0.03；p = 0.03）和跑步方面（OR = -0.52；95%CI = 0.31, 0.88；p = 0.01）取得了更好的结果。保守治疗显示轻微并发症的发生率较低（OR = 3.46；95%CI = 2.08, 5.77；p = 0.01），并且在“8”字跑试验（SMD = 0.42；95%CI = 0.06, 0.77；p = 0.02）和深蹲试验（SMD = -0.45；95%CI = -0.81, -0.10；p < 0.00001）中取得了更好的结果。未发现其他显著差异。
基于现有数据，初次髌骨脱位的手术治疗显著降低了髌骨再脱位的风险。
