压配固定在前交叉韧带重建中可降低移植物失败和翻修率：系统评价和荟萃分析。
Press-fit fixation in anterior cruciate ligament reconstruction yields low graft failure and revision rates: a systematic review and meta-analysis.
机构信息
Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2021 Jun;29(6):1750-1759. doi: 10.1007/s00167-020-06173-4. Epub 2020 Aug 12.
PURPOSE
Press-fit fixation is a hardware-free technique in anterior cruciate ligament reconstruction (ACLR). The purpose of this review was to quantitatively assess the risk profile and outcomes of press-fit fixation and provide an update on its effectiveness compared to more standard fixation techniques of ACLR.
METHODS
The electronic databases PUBMED, MEDLINE, and EMBASE were searched on March 26, 2020 for therapeutic randomized controlled trials (RCT) addressing press-fit fixation for primary ACLR. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the quality for randomized studies. A meta-analysis with a random-effects model was used to pool applicable outcomes data.
RESULTS
A total of six eligible RCTs were included in this review. There were 292 patients (72.9% male) with a mean age of 28.8 ± 3.8 years and a mean follow-up of 81.3 ± 88.3 months that underwent press-fit ACLR on the femoral, tibial or both tunnels. Femoral fixation techniques included press-fit fixation (96.6%) and cross-pin fixation (3.4%). Tibial fixation techniques included press-fit (37.0%), staples (28.1%), interference screws (21.2%) and abarticular post-screws (13.7%). Graft options included bone-patellar tend--bone autografts (73.6%) and semitendinosus and gracilis tendon autograft (26.4%). Significant improvements (p < 0.05) from baseline to follow-up were found for clinical outcomes. Significantly less postoperative bone tunnel enlargement (p < 0.05) was found with tibial press-fit fixation when compared to biodegradable screws. The overall complication rate was 13.3%. There were no significant differences in complication rates [odds ratio = 0.84 (95%CI 0.43-1.66); p = n.s.] (I = 0%) between patients undergoing femoral press-fit fixation and femoral metal interference screw fixation.
CONCLUSION
The overall graft failure and revision rates with press-fit ACLR were low. There were no significant differences in complication rates between patients undergoing femoral press-fit and femoral metal interference screw fixation. Included studies found that patients undergoing press-fit fixation for ACLR had significant improvements in functional outcome scores postoperatively and had significantly reduced postoperative bone tunnel enlargement compared to patients undergoing bioabsorbable fixation. Thus, early evidence suggests that press-fit fixation appears to be a good option for patients undergoing ACLR.
LEVEL OF EVIDENCE
I.
目的
压配固定是前交叉韧带重建（ACL）中一种无硬件技术。本综述的目的是定量评估压配固定的风险状况和结果，并提供其与 ACLR 更标准固定技术相比的有效性更新。
方法
于 2020 年 3 月 26 日，检索电子数据库 PUBMED、MEDLINE 和 EMBASE，以查找涉及原发性 ACLR 压配固定的治疗性随机对照试验（RCT）。使用 Grading of Recommendations Assessment, Development and Evaluation 工具评估随机研究的质量。使用随机效应模型进行荟萃分析以汇总适用的结果数据。
结果
本综述共纳入了 6 项符合条件的 RCT。共有 292 名患者（72.9%为男性），平均年龄 28.8±3.8 岁，平均随访 81.3±88.3 个月，在股骨、胫骨或两者的隧道中进行了压配 ACLR。股骨固定技术包括压配固定（96.6%）和交叉钉固定（3.4%）。胫骨固定技术包括压配固定（37.0%）、钉（28.1%）、干扰螺钉（21.2%）和关节外后螺钉（13.7%）。移植物选择包括骨-髌腱-骨自体移植物（73.6%）和半腱肌和股薄肌肌腱自体移植物（26.4%）。与基线相比，随访时发现临床结局有显著改善（p<0.05）。与生物可吸收螺钉相比，胫骨压配固定术后骨隧道扩大程度显著降低（p<0.05）。总体并发症发生率为 13.3%。行股骨压配固定和股骨金属干扰螺钉固定的患者，并发症发生率无显著差异[比值比=0.84（95%CI 0.43-1.66）；p=无统计学意义]（I=0%）。
结论
压配 ACLR 的总体移植物失败和翻修率较低。行股骨压配固定和股骨金属干扰螺钉固定的患者，并发症发生率无显著差异。纳入的研究发现，行 ACLR 压配固定的患者术后功能结局评分有显著改善，与行生物可吸收固定的患者相比，术后骨隧道扩大程度显著降低。因此，早期证据表明，压配固定似乎是 ACLR 患者的一个不错选择。
证据水平
I。
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