全厚度与部分厚度股四头肌腱自体移植物在前交叉韧带重建中无差异：系统评价。
No difference between full thickness and partial thickness quadriceps tendon autografts in anterior cruciate ligament reconstruction: a systematic review.
机构信息
Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA.
Division of Orthopaedic Surgery, Dalhousie University, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):105-116. doi: 10.1007/s00167-018-5042-z. Epub 2018 Jul 4.
PURPOSE
The purpose of this review was to compare outcomes and complication profiles of anterior cruciate ligament reconstruction (ACL-R) between full thickness (FT-Q) and partial thickness (PT-Q) quadriceps tendon (QT) autografts.
METHODS
As per PRISMA guidelines, PubMed, EMBASE, and MEDLINE were searched in September 2017 for English language, human studies of all levels of evidence on patients undergoing primary ACL-R with FT-Q or PT-Q. This search was repeated in March 2018 to capture additional articles. Data regarding postoperative outcomes and complications were abstracted. Due to heterogeneous reporting, data were not combined in meta-analysis and were summarized descriptively.
RESULTS
Upon screening 3670 titles, 18 studies satisfied inclusion/exclusion criteria. The second search identified an additional two studies for a total of 20 studies (50% case-control, 50% case series). These studies examined 1212 patients (1219 knees) of mean age 29.8 years (range 15-59) followed a mean of 42.2 months (range 12-120). FT-Q and PT-Q autografts were used in eight studies (50.5% of knees), and thirteen studies (49.5% of knees), respectively. Only one study directly compared FT-Q to PT-Q. Instrumented laxity was less than 3 mm in 74.8 and 72.4% of the FT-Q and PT-Q groups, respectively. Postoperative IKDC Subjective Knee Form scores were similar between the FT-Q (82.5) and PT-Q (82.1) groups. Postoperative quadriceps strength, measured as a percentage of the contralateral side, were similar in the FT-Q (89.5%) and PT-Q (85.1%) groups. Graft failure rates for the FT-Q and PT-Q groups were 3.7 and 3.0%, respectively.
CONCLUSION
Across the 20 studies included in this review, there appeared to be no difference in outcomes or complications between either FT-Q or PT-Q in primary ACL-R. Moreover, primary ACL-R using QT autografts appears to have successful outcomes with a low rate of graft failure, irrespective of tendon thickness. While further comparative studies are needed to better delineate the optimal thickness of quadriceps tendon for primary ACL-R, these data suggest that, in primary ACL-R, either FT-Q or PT-Q is efficacious and, in the clinical setting, surgeons may be justified in using either graft thickness.
LEVEL OF EVIDENCE
IV, Systematic Review of Level III and IV studies.
目的
本综述旨在比较全厚（FT-Q）和部分厚度（PT-Q）四头肌腱（QT）自体移植物重建前交叉韧带（ACL-R）的结果和并发症情况。
方法
根据 PRISMA 指南，于 2017 年 9 月在 PubMed、EMBASE 和 MEDLINE 上检索了所有证据水平的英语人类研究，以评估接受 ACL-R 的患者的 FT-Q 或 PT-Q 四头肌腱自体移植物的术后结果和并发症。2018 年 3 月再次进行了检索，以捕获其他文章。提取术后结果和并发症的数据。由于报告存在异质性，因此未进行 meta 分析合并，而是进行描述性总结。
结果
经过筛选 3670 篇标题后，有 18 项研究符合纳入/排除标准。第二次检索又确定了另外两项研究，总共 20 项研究（50%病例对照，50%病例系列）。这些研究共纳入了 1212 例患者（1219 个膝关节），平均年龄 29.8 岁（15-59 岁），平均随访 42.2 个月（12-120 个月）。8 项研究（50.5%的膝关节）使用了 FT-Q 和 PT-Q 自体移植物，13 项研究（49.5%的膝关节）分别使用了 FT-Q 和 PT-Q 自体移植物。只有一项研究直接比较了 FT-Q 与 PT-Q。FT-Q 和 PT-Q 组的仪器松弛度分别小于 3mm 的比例分别为 74.8%和 72.4%。FT-Q（82.5）和 PT-Q（82.1）组术后 IKDC 主观膝关节评分相似。FT-Q（89.5%）和 PT-Q（85.1%）组术后股四头肌力量与对侧相比相似。FT-Q 和 PT-Q 组的移植物失败率分别为 3.7%和 3.0%。
结论
在本综述纳入的 20 项研究中，ACL-R 中使用 FT-Q 或 PT-Q 似乎在结果或并发症方面没有差异。此外，使用 QT 自体移植物进行原发性 ACL-R 似乎具有成功的结果，移植物失败率较低，而与肌腱厚度无关。尽管需要进一步的比较研究来更好地确定用于原发性 ACL-R 的四头肌腱的最佳厚度，但这些数据表明，在原发性 ACL-R 中，FT-Q 或 PT-Q 都是有效的，在临床环境中，外科医生可以使用任何一种移植物厚度。
证据水平
IV，对 III 级和 IV 级研究的系统评价。
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