经骨隧道与缝线锚钉修复急性股四头肌和髌腱断裂的比较：生物力学研究的系统评价和荟萃分析
Transosseous tunnels versus suture anchors for the repair of acute quadriceps and patellar tendon ruptures: A systematic review and meta-analysis of biomechanical studies.
作者信息
Dankert John F, Mehta Devan D, Remark Lindsey H, Leucht Philipp
机构信息
NYU Grossman School of Medicine - NYU Langone Orthopedic Hospital, Department of Orthopedic Surgery, New York, NY, USA.
NYU Grossman School of Medicine - NYU Langone Orthopedic Hospital, Department of Orthopedic Surgery, New York, NY, USA.
出版信息
J Orthop Sci. 2023 Jul;28(4):821-828. doi: 10.1016/j.jos.2022.04.001. Epub 2022 Apr 28.
BACKGROUND
Multiple techniques have been developed for the repair of acute quadriceps and patellar tendon ruptures with the goal of optimizing clinical outcomes while minimizing complications and costs. The purpose of this study was to evaluate the biomechanical properties of transosseous tunnels and suture anchors for the repair of quadriceps and patellar tendon ruptures.
METHODS
A systematic review of the PubMed and Embase databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using specific search terms and eligibility criteria. Meta-analysis was performed by fixed-effects models for studies of low heterogeneity (I <25%) and random-effects models for studies of moderate to high heterogeneity (I ≥25%).
RESULTS
A total of 392 studies were identified from the initial literature search with 7 studies meeting the eligibility criteria for quadriceps tendon repair and 8 studies meeting the eligibility criteria for patellar tendon repair. Based on the random-effects model for total gap formation and load to failure for quadriceps tendon repair, the mean difference was 8.88 mm (95% CI, -8.31 mm to 26.06 mm; p = 0.31) in favor of a larger gap with transosseous tunnels and -117.25N (95%CI, -242.73N to 8.23N; p = 0.07) in favor of a larger load to failure with suture anchors. A similar analysis for patellar tendon repair demonstrated a mean difference of 2.86 mm (95% CI, 1.08 mm to 4.64 mm; p = 0.002) in favor of a larger gap with transosseous tunnels and -56.34N (95% CI, -226.75 to 114.07N; p = 0.52) in favor of a larger load to failure with suture anchor repair.
CONCLUSIONS
Transosseous tunnels are biomechanically similar to suture anchors for quadriceps tendon repair. Patellar tendon repair may benefit from reduced gap formation after cycling with suture anchor repair, but the load to failure for both techniques is biomechanically similar. Additional studies are necessary to evaluate these and alternative repair techniques.
LEVEL OF EVIDENCE
Systematic review and meta-analysis of biomechanical studies, Level V.
背景
已开发出多种技术用于修复急性股四头肌和髌腱断裂，目的是在优化临床疗效的同时，将并发症和成本降至最低。本研究的目的是评估用于修复股四头肌和髌腱断裂的经骨隧道和缝线锚钉的生物力学特性。
方法
根据系统评价与Meta分析的首选报告项目（PRISMA）指南，使用特定的检索词和纳入标准，对PubMed和Embase数据库进行系统评价。对于低异质性（I<25%）的研究，采用固定效应模型进行Meta分析；对于中度至高度异质性（I≥25%）的研究，采用随机效应模型进行Meta分析。
结果
从初步文献检索中总共识别出392项研究，其中7项研究符合股四头肌肌腱修复的纳入标准，8项研究符合髌腱修复的纳入标准。基于股四头肌肌腱修复中总间隙形成和失效负荷的随机效应模型，平均差异为8.88mm（95%CI，-8.31mm至26.06mm；p=0.31），倾向于经骨隧道形成更大的间隙；平均差异为-117.25N（95%CI，-242.73N至8.23N；p=0.07），倾向于缝线锚钉有更大的失效负荷。对髌腱修复进行的类似分析显示，平均差异为2.86mm（95%CI，1.08mm至4.64mm；p=0.002），倾向于经骨隧道形成更大的间隙；平均差异为-56.34N（95%CI，-226.75至114.07N；p=0.52），倾向于缝线锚钉修复有更大的失效负荷。
结论
对于股四头肌肌腱修复，经骨隧道在生物力学上与缝线锚钉相似。髌腱修复可能受益于缝线锚钉修复循环后间隙形成的减少，但两种技术的失效负荷在生物力学上相似。需要进一步的研究来评估这些技术以及其他替代修复技术。
证据级别
生物力学研究的系统评价和Meta分析，V级。
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