Meta 分析：原发性髌骨脱位的手术与非手术治疗。
A Meta-analysis of Surgical Versus Nonsurgical Treatment of Primary Patella Dislocation.
机构信息
Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland.
Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland.
出版信息
Arthroscopy. 2019 Aug;35(8):2469-2481. doi: 10.1016/j.arthro.2019.03.047.
PURPOSE
To compare outcomes after surgery versus nonsurgical treatment in the management of primary lateral patellar dislocation (LPD) through a meta-analysis of randomized controlled trials (RCTs) in terms of redislocation rate and clinical outcome, investigating both short-term (<6 years) functional recovery and overall benefit over time (>6 years).
METHODS
A systematic search of the literature was performed in November 2018. Risk of bias and quality of evidence were evaluated according to the Cochrane guidelines. RCTs investigating differences between surgery and nonsurgical treatment in primary LPD were included. The outcomes evaluated were redislocation rate, reinterventions, and Kujala score at short-, mid-, and long-term follow-up, with subanalyses for the pediatric population.
RESULTS
We included 510 patients from 10 RCTs in the meta-analysis. Redislocation rate was 0.40 (0.25 to 0.66; P < .001) and 0.58 (0.29 to 1.15; P = .12) at the short- and mid-term follow-ups, respectively, and the risk ratio for the need for further operations at 6 to 9 months' follow-up was 0.14 (0.02 to 1.03; P = .05), all favoring surgery. Concerning the Kujala score, an advantage of the surgical approach of 10.2 points (1.6 to 18.7; P = .02) at short-term follow-up was seen, whereas long-term follow-up results were similar between the groups. The subanalysis of the pediatric population at heterogeneous follow-up confirmed a lower risk of recurrence in surgery, with a risk ratio of 0.60 (0.26 to 1.37; P = .22), although not significant.
CONCLUSION
The literature documents a low number of high-level trials. The meta-analysis of RCTs underlined that the redislocation rate is higher with the nonsurgical approach compared with the surgical one. Moreover, when looking at the clinical outcome, more favorable findings were found with the surgical approach up to 6 years, whereas results seems to be similar at a longer follow-up after either surgical or nonsurgical treatment of primary LPD.
LEVEL OF EVIDENCE
II, meta-analysis of level I and level II randomized clinical trials.
目的
通过对原发性外侧髌骨脱位（LPD）的随机对照试验（RCT）的荟萃分析，比较手术与非手术治疗在再脱位率和临床结果方面的差异，同时探讨短期（<6 年）功能恢复和长期（>6 年）整体获益。
方法
于 2018 年 11 月进行文献系统检索。根据 Cochrane 指南评估偏倚风险和证据质量。纳入比较原发性 LPD 手术与非手术治疗差异的 RCT。评估的结局包括再脱位率、再次干预和 Kujala 评分的短期、中期和长期随访结果，同时对儿科人群进行亚分析。
结果
本荟萃分析纳入了 10 项 RCT 的 510 例患者。短期和中期随访的再脱位率分别为 0.40（0.25 至 0.66；P<0.001）和 0.58（0.29 至 1.15；P=0.12），6 至 9 个月随访时需要进一步手术的风险比为 0.14（0.02 至 1.03；P=0.05），均表明手术治疗具有优势。在 Kujala 评分方面，短期随访时手术组的优势为 10.2 分（1.6 至 18.7；P=0.02），而长期随访结果两组相似。在随访时间存在异质性的儿科人群亚分析中，手术组的复发风险较低，风险比为 0.60（0.26 至 1.37；P=0.22），但无统计学意义。
结论
文献中记录的高质量试验数量较少。RCT 的荟萃分析强调，与手术治疗相比，非手术治疗的再脱位率更高。此外，在观察临床结局时，手术治疗在 6 年内更有优势，而在原发性 LPD 接受手术或非手术治疗后的更长随访时间，结果似乎相似。
证据等级
II 级，对 I 级和 II 级随机临床试验的荟萃分析。
Zotero 插件