单束腘绳肌前交叉韧带重建采用前内侧与经胫骨技术的结果：一项系统评价和荟萃分析
Outcome of Single-Bundle Hamstring Anterior Cruciate Ligament Reconstruction Using the Anteromedial Versus the Transtibial Technique: A Systematic Review and Meta-analysis.
作者信息
Chen Yongsheng, Chua Kerk Hsiang Zackary, Singh Amritpal, Tan Jun Hao, Chen Xi, Tan Shi Hui, Tai Bee Choo, Lingaraj Krishna
机构信息
Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
出版信息
Arthroscopy. 2015 Sep;31(9):1784-94. doi: 10.1016/j.arthro.2015.06.001.
PURPOSE
To compare the clinical outcomes of single-bundle hamstring anterior cruciate ligament (ACL) reconstruction between the anteromedial (AM) and transtibial (TT) techniques.
METHODS
We performed a comprehensive systematic review and meta-analysis of the English-language literature in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases for articles that compared clinical outcomes of AM versus TT ACL reconstruction. The outcome measures analyzed included postoperative Lachman test, pivot-shift test, International Knee Documentation Committee (IKDC), and Lysholm scores.
RESULTS
We included 10 articles from an initial 308 abstracts for the systematic review and included 6 studies for the meta-analysis. The study population consisted of a total of 733 patients, of whom 366 (49.9%) underwent the AM technique and 367 (50.1%) underwent the TT technique for ACL reconstruction. For postoperative knee stability, the AM technique yielded superior results in terms of the proportion of negative Lachman test results (n = 243; odds ratio [OR], 2.98 [95% confidence interval (CI), 1.29 to 6.88]) and proportion of negative pivot-shift test results (n = 238; OR, 3.67 [95% CI, 1.80 to 7.52]). For postoperative functional status, the AM technique yielded superior results in terms of objective IKDC grading (proportion with IKDC grade A) (n = 269; OR, 2.19 [95% CI, 1.23 to 3.88]) but had comparable Lysholm scores (n = 478; mean difference, 1.43 [95% CI, 0.01 to 2.84]).
CONCLUSIONS
Single-bundle hamstring ACL reconstruction using the AM technique showed superior surgeon-recorded stability according to the IKDC knee score, Lachman test, and pivot-shift test. However, there was no difference in patient-reported functional outcome (Lysholm score).
LEVEL OF EVIDENCE
Level III, systematic review and meta-analysis of Level I, II, and III studies.
目的
比较单束腘绳肌前交叉韧带（ACL）重建术中，前内侧（AM）技术与经胫骨（TT）技术的临床疗效。
方法
我们对PubMed、Scopus、Web of Science和Cochrane对照试验中央注册库数据库中的英文文献进行了全面的系统评价和荟萃分析，以寻找比较AM与TT ACL重建临床疗效的文章。分析的结局指标包括术后Lachman试验、轴移试验、国际膝关节文献委员会（IKDC）评分和Lysholm评分。
结果
我们从最初的308篇摘要中纳入了10篇文章进行系统评价，并纳入了6项研究进行荟萃分析。研究人群共有733例患者，其中366例（49.9%）接受AM技术进行ACL重建，367例（50.1%）接受TT技术进行ACL重建。对于术后膝关节稳定性，AM技术在Lachman试验阴性结果比例（n = 243；优势比[OR]，2.98[95%置信区间（CI），1.29至6.88]）和轴移试验阴性结果比例（n = 238；OR，3.67[95%CI，1.80至7.52]）方面产生了更好的结果。对于术后功能状态，AM技术在客观IKDC分级（IKDC A级比例）方面产生了更好的结果（n = 269；OR，2.19[95%CI，1.23至3.88]），但Lysholm评分相当（n = 478；平均差异，1.43[95%CI，0.01至2.84]）。
结论
根据IKDC膝关节评分、Lachman试验和轴移试验，采用AM技术进行单束腘绳肌ACL重建显示出更好的外科医生记录的稳定性。然而，患者报告的功能结局（Lysholm评分）没有差异。
证据水平
III级，对I、II和III级研究的系统评价和荟萃分析。
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