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自体移植物与同种异体移植物用于后交叉韧带重建的比较:一项荟萃分析。

Comparison of autograft and allograft tendons in posterior cruciate ligament reconstruction: A meta-analysis.

作者信息

Tian Peng, Hu Wen-Qing, Li Zhi-Jun, Sun Xiao-Lei, Ma Xin-Long

机构信息

Department of Orthopedics, Tianjin Hospital Department of Rehabilitation Department of Orthopedics, General Hospital of Tianjin Medical University Department of Orthopedics Institute, Tianjin Hospital, Tianjin, People's Republic of China.

出版信息

Medicine (Baltimore). 2017 Jul;96(27):e7434. doi: 10.1097/MD.0000000000007434.

Abstract

BACKGROUND

The purpose of this meta-analysis of randomized controlled trials (RCTs) and non-RCTs was to compare the clinical outcomes of autograft versus allograft tendons in patients who underwent posterior cruciate ligament (PCL) reconstruction.

METHODS

We conducted a search of PubMed, EMBASE, The Cochrane Library, and Web of Science databases for RCTs and non-RCTs comparing autograft and allograft tendons in PCL reconstruction up to August 2016. The outcomes were Lysholm knee function score, postoperative objective and subjective International Knee Documentation Committee Score (IKDCS), Tegner activity scale, and knee posterior stability. Data analysis was performed using RevMan 5.3 software.

RESULTS

One RCT and 4 non-RCTs met the inclusion criteria. The current meta-analysis indicated that there were no significant differences in the Lysholm knee function score (mean difference [MD] = -0.99, 95% confidence interval [CI]: -5.51 to 3.54, P = .67), Tegner activity scale (MD = 0.46, 95% CI: 0.03 to 0.90, P = .04), postoperative objective IKDCS (odds ratio [OR] = 1.66, 95% CI: 0.77 to 3.58, P = .20), postoperative subjective IKDCS (MD = 3.00, 95% CI: -0.29 to 6.29, P = .07), or knee posterior stability (MD = -0.45, 95% CI: -1.28 to 0.38, P = .29) between patients who received autograft tendons and those who received allograft tendons. The patients with autograft tendons had a higher Tegner activity scale (MD = 0.46, 95% CI: 0.03 to 0.90, P = .04) than those with allograft tendons.

CONCLUSIONS

The present meta-analysis shows that there was insufficient evidence to indicate that allograft tendons were significantly better than autograft tendons for PCL reconstruction. Due to the limited quality and data in the studies currently available, in the future, more high-quality RCTs are required to answer this question more definitively.

摘要

背景

本随机对照试验(RCT)和非随机对照试验的荟萃分析旨在比较接受后交叉韧带(PCL)重建的患者中自体肌腱与异体肌腱的临床疗效。

方法

我们检索了PubMed、EMBASE、Cochrane图书馆和Web of Science数据库,以查找截至2016年8月比较PCL重建中自体肌腱和异体肌腱的RCT和非RCT。结局指标为Lysholm膝关节功能评分、术后客观和主观国际膝关节文献委员会评分(IKDCS)、Tegner活动量表以及膝关节后向稳定性。使用RevMan 5.3软件进行数据分析。

结果

1项RCT和4项非RCT符合纳入标准。当前的荟萃分析表明,接受自体肌腱的患者与接受异体肌腱的患者在Lysholm膝关节功能评分(平均差[MD]=-0.99,95%置信区间[CI]:-5.51至3.54,P=0.67)、Tegner活动量表(MD=0.46,95%CI:0.03至0.90,P=0.04)、术后客观IKDCS(比值比[OR]=1.66,95%CI:0.77至3.58,P=0.20)、术后主观IKDCS(MD=3.00,95%CI:-0.29至6.29,P=0.07)或膝关节后向稳定性(MD=-0.45,95%CI:-1.28至0.38,P=0.29)方面无显著差异。接受自体肌腱的患者的Tegner活动量表得分高于接受异体肌腱的患者(MD=0.46,95%CI:0.03至0.90,P=0.04)。

结论

本荟萃分析表明,没有足够的证据表明在PCL重建中异体肌腱明显优于自体肌腱。由于目前现有研究的质量和数据有限,未来需要更多高质量的RCT来更明确地回答这个问题。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9a7d/5502181/cb64836f9611/medi-96-e7434-g001.jpg

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