膝关节软骨修复的手术技术：一项大型随机对照试验的更新系统评价和网络荟萃分析。
Surgical Techniques for Knee Cartilage Repair: An Updated Large-Scale Systematic Review and Network Meta-analysis of Randomized Controlled Trials.
机构信息
Department of Orthopaedics, Comenius University Bratislava and the National Institute of Children's Diseases, Bratislava, Slovakia; Expert Medical Services s.r.o, Bratislava, Slovakia.
Institute of Medical Biology, Genetics and Clinical Genetics, Comenius University, Bratislava, Slovakia.
出版信息
Arthroscopy. 2020 Mar;36(3):845-858. doi: 10.1016/j.arthro.2019.11.096.
PURPOSE
The aim of this study was to investigate the most appropriate surgical interventions for patients with knee articular cartilage defects from the level I randomized clinical trials.
METHODS
We searched five databases for level I randomized clinical trials. Treatments were compared if reported in more than one study using network meta-analysis to boost the number of included studies per comparison.
RESULTS
We studied 21 articles that included 891 patients. Traumatic lesion was the most common cause in the included patients. There were significantly higher failure rates in the microfracture (MF) group compared to autologous chondrocyte implantation (ACI) group at 10-year follow-up. Moreover, osteochondral autograft transplantation (OAT) showed significantly more excellent or good results at > 3-year follow-up compared to MF, whereas MF showed significantly more poor results versus ACI and matrix-induced autologous chondrocyte implantation (MACI). Furthermore, OAT showed significantly more poor results than MACI at 1-year follow-up. Similarly, patients who underwent OAT had higher return-to-activity rates than those with MF. It is noteworthy that the Knee injury and Osteoarthritis Outcome Score was higher in patients who underwent characterized chondrocyte implantation or MACI compared to MF. Finally, there were no significant differences among the various interventions regarding reintervention, biopsy types or adverse events. According to the P scores for interventions ranking, there was a disagreement concerning the best intervention; however, MF was always ranked as the last.
CONCLUSIONS
Cartilage repair techniques, rather than MF, provide higher quality repair of tissue and have lower failure and higher return-to-activity rates. Moreover, OAT had significantly more excellent or good results compared to MF, whereas MF had significantly more poor results than ACI and MACI. Future studies need to have longer follow-up periods and more representative populations to investigate the efficacy and safety of these interventions.
LEVEL OF EVIDENCE
Level I: meta-analysis of Level I studies.
目的
本研究旨在从一级随机临床试验中探讨膝关节关节软骨缺损患者最适宜的手术干预措施。
方法
我们检索了五个数据库中的一级随机临床试验。如果同一治疗措施在超过一篇研究中报道，则使用网状 Meta 分析进行比较，以增加每一次比较的纳入研究数量。
结果
我们共研究了 21 篇文章，其中纳入了 891 名患者。纳入患者中最常见的病因是创伤性病变。在 10 年随访中，微骨折（MF）组的失败率明显高于自体软骨细胞移植（ACI）组。此外，在>3 年随访中，骨软骨自体移植（OAT）组的优良率显著高于 MF 组，而 MF 组的优良率显著低于 ACI 和基质诱导自体软骨细胞移植（MACI）组。此外，在 1 年随访中，OAT 组的优良率显著低于 MACI 组。同样，接受 OAT 的患者的活动恢复率高于接受 MF 的患者。值得注意的是，与 MF 相比，接受有特征性的软骨细胞移植或 MACI 的患者的膝关节损伤和骨关节炎结果评分更高。最后，在各种干预措施的再干预、活检类型或不良事件方面，没有明显差异。根据干预措施排名的 P 评分，对于最佳干预措施存在分歧；然而，MF 总是排在最后。
结论
软骨修复技术，而不是 MF，提供了更高质量的组织修复，并且失败率更低，活动恢复率更高。此外，与 MF 相比，OAT 的优良率显著更高，而 MF 的优良率显著低于 ACI 和 MACI。未来的研究需要有更长的随访期和更具代表性的人群，以调查这些干预措施的疗效和安全性。
证据水平
一级：一级研究的 Meta 分析。
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