Zhang Kaibo, Jiang Hua, Li Jian, Fu Weili
Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.
Orthop J Sports Med. 2020 Sep 22;8(9):2325967120946446. doi: 10.1177/2325967120946446. eCollection 2020 Sep.
Whether surgical or nonsurgical management is more appropriate for primary patellar dislocations (PPDs) in adolescents (younger than 18 years) remains controversial.
To compare the clinical outcomes of surgical versus nonsurgical treatment for adolescents and children with PPDs.
Systematic review; Level of evidence, 3.
There were 2 reviewers who independently searched the PubMed, Embase, Ovid, and Cochrane databases for English-language studies of randomized controlled trials (RCTs), quasi-RCTs, and observational studies comparing surgical with nonsurgical treatment for PPDs. The primary outcomes were redislocations, the Kujala score, and the Knee injury and Osteoarthritis Outcome Score (KOOS), and the secondary outcome was subsequent surgery.
A total of 6 studies were included in our systematic review and meta-analysis. Among patients younger than 18 years, surgery was associated with a lower redislocation rate compared with nonsurgical treatment within 5 years of treatment (risk ratio [RR], 0.58 [95% CI, 0.37-0.91]; = .02; = 47%) but not beyond 5 years (RR, 0.80 [95% CI, 0.59-1.07]; = .14; = 34%). However, surgery resulted in worse Kujala and KOOS scores compared with nonsurgical treatment. Yet, the treatment difference between the 2 groups tended to decrease over time.
The available evidence suggests that for adolescents with PPDs, surgery was superior to nonsurgical treatment in the short term to reduce the redislocation rate but resulted in poorer outcomes of knee function based on the Kujala and KOOS scores. However, the superiority of either surgical or nonsurgical treatment in adolescents did not appear to persist in the long term.
对于青少年（18岁以下）原发性髌骨脱位（PPD），手术治疗还是非手术治疗更为合适仍存在争议。
比较青少年和儿童PPD手术治疗与非手术治疗的临床结果。
系统评价；证据等级，3级。
两名研究者独立检索PubMed、Embase、Ovid和Cochrane数据库，查找比较PPD手术治疗与非手术治疗的英文随机对照试验（RCT）、半随机对照试验和观察性研究。主要结局指标为再脱位、库贾拉评分和膝关节损伤与骨关节炎疗效评分（KOOS），次要结局指标为后续手术。
我们的系统评价和荟萃分析共纳入6项研究。在18岁以下患者中，与非手术治疗相比，手术治疗在治疗后5年内再脱位率较低（风险比[RR]，0.58[95%CI，0.37 - 0.91]；P = 0.02；I² = 47%），但5年后并非如此（RR，0.80[95%CI，0.59 - 1.07]；P = 0.14；I² = 34%）。然而，与非手术治疗相比，手术治疗的库贾拉评分和KOOS评分更差。不过，两组之间的治疗差异随时间推移有减小趋势。
现有证据表明，对于PPD青少年患者，短期内手术治疗在降低再脱位率方面优于非手术治疗，但根据库贾拉评分和KOOS评分，手术治疗的膝关节功能结局较差。然而，青少年手术治疗或非手术治疗的优势在长期似乎并不持续。
