Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2018 Jul;26(7):2158-2170. doi: 10.1007/s00167-017-4629-0. Epub 2017 Jul 7.
The purpose of this systematic review was to identify the most effective surgical treatment for talar osteochondral defects after failed primary surgery.
A literature search was conducted to find studies published from January 1996 till July 2016 using PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL. Two authors screened the search results separately and conducted quality assessment independently using the Newcastle-Ottawa scale. Weighted success rates were calculated. Studies eligible for pooling were combined.
Twenty-one studies with a total of 299 patients with 301 talar OCDs that failed primary surgery were investigated. Eight studies were retrospective case series, twelve were prospective case series and there was one randomized controlled trial. Calculated success percentages varied widely and ranged from 17 to 100%. Because of the low level of evidence and the scarce number of patients, no methodologically proper meta-analysis could be performed. A simplified pooling method resulted in a calculated mean success rate of 90% [CI 82-95%] for the osteochondral autograft transfer procedure, 65% [CI 46-81%] for mosaicplasty and 55% [CI 40-70%] for the osteochondral allograft transfer procedure. There was no significant difference between classic autologous chondrocyte implantation (success rate of 59% [CI 39-77%]) and matrix-associated chondrocyte implantation (success rate of 73% [CI 56-85%]).
Multiple surgical treatments are used for talar OCDs after primary surgical failure. More invasive methods are administered in comparison with primary treatment. No methodologically proper meta-analysis could be performed because of the low level of evidence and the limited number of patients. It is therefore inappropriate to draw firm conclusions from the collected results. Besides an expected difference in outcome between the autograft transfer procedure and the more extensive procedures of mosaicplasty and the use of an allograft, neither a clear nor a significant difference between treatment options could be demonstrated. The need for sufficiently powered prospective investigations in a randomized comparative clinical setting remains high. This present systematic review can be used in order to inform patients about expected outcome of the different treatment methods used after failed primary surgery.
IV.
本系统评价的目的是确定初次手术后失败的距骨骨软骨缺损的最有效手术治疗方法。
使用 PubMed（MEDLINE）、EMBASE、CDSR、DARE 和 CENTRAL 进行文献检索，查找 1996 年 1 月至 2016 年 7 月发表的研究。两位作者分别筛选检索结果，并使用纽卡斯尔-渥太华量表（Newcastle-Ottawa scale）独立进行质量评估。计算加权成功率。对符合纳入标准的研究进行合并。
共纳入 21 项研究，共计 299 例初次手术后失败的 301 例距骨 OCD，8 项研究为回顾性病例系列研究，12 项为前瞻性病例系列研究，1 项为随机对照试验。计算出的成功率差异很大，范围为 17%至 100%。由于证据水平低且患者数量少，因此无法进行适当的荟萃分析。简化的合并方法得出的骨软骨自体移植物转移术的平均成功率为 90%[CI 82-95%]，马赛克plasty 为 65%[CI 46-81%]，骨软骨同种异体移植物转移术为 55%[CI 40-70%]。经典的自体软骨细胞移植术（成功率为 59%[CI 39-77%]）与基质相关的软骨细胞移植术（成功率为 73%[CI 56-85%]）之间无显著差异。
初次手术失败后，多种手术方法被用于距骨 OCD。与初次治疗相比，采用了更具侵袭性的方法。由于证据水平低且患者数量有限，因此无法进行适当的荟萃分析。因此，从收集到的结果中得出确切的结论是不合适的。除了自体移植物转移术与马赛克plasty 和同种异体移植物使用等更广泛的手术之间的预期结果差异外，也未能显示出治疗选择之间的明确或显著差异。在随机对照临床试验中，需要进行足够有力的前瞻性研究。本系统评价可用于告知患者不同治疗方法在初次手术后失败后的预期结果。
IV。
Zotero 插件
