Orthopedics department Ningbo Medical Center Lihuili Hospital, Ningbo 315000, China.
Comput Intell Neurosci. 2022 Jun 29;2022:5085143. doi: 10.1155/2022/5085143. eCollection 2022.
This investigation was undertaken to systematically assess the impact of increasingly rapid recovery treatment on the functional status of the knee following anterior cruciate ligament restructuring.
Computer search from the establishment of the database to March 2022 in China Knowledge Network Database (CNKI), PubMed, EMBASE, ScienceDirect, CochraneLibrary, China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM). The control group was given only traditional rehabilitation training, and the observation group was treated with perioperative accelerated rehabilitation surgery intervention randomized controlled trial (RCT). Data for all included studies were extracted by two independent researchers, and the risk of bias for the quality of each included study was assessed by the Cochrane Handbook 5.1.0 criteria. Meta-analysis of the collected data by using RevMan5.4 statistical software.
A total of 593 articles were retrieved from the computer database and 8 RCT articles with a total of 636 samples were finally included for meta-analysis. According to the Jadad scale, the RCT score of 8 articles was ≥4 points. Meta-analysis was performed on the postoperative VAS scores of the ERAS group and the traditional rehabilitation group, and the heterogeneity test showed Chi = 288.60, d = 5, < 0.00001, and = 99%. There was a statistically significant difference in the postoperative VAS scale between the intervention and the traditional rehabilitation model ( < 0.05). Eight articles reported the effect of accelerated rehabilitation surgery on the recovery of knee joint motion after ACL rehabilitation. After meta-analysis, the heterogeneity test showed Chi = 314.98, d = 7, < 0.00001, and = 98%, and it can be concluded from the analysis that, compared with the traditional rehabilitation model, the enhanced rehabilitation surgery has an effect on the joint function after anterior cruciate ligament reconstruction. The improvement effect was more significant, and the difference was statistically significant ( < 0.05). Four articles reported the effect of enhanced recovery after surgery intervention on the range of motion of the knee joint of patients, the heterogeneity test showed Chi = 117.52, d = 2, < 0.00001, and = 98%, through analysis, and compared with the traditional rehabilitation model and the enhanced recovery. The effect of surgery on the range of motion of the knee joint after ACL reconstruction was more significant, and the difference was statistically significant ( < 0.05). The effect of enhanced recovery after surgery and traditional rehabilitation mode on the incidence of postoperative adverse reactions in patients undergoing ACL reoperation was analyzed. The results of heterogeneity test showed that Chi = 1.59, d = 2, =0.66 > 0.05, and = 98%, and the analysis showed that, compared with the traditional rehabilitation mode, enhanced rehabilitation surgery can significantly reduce the risk of adverse reactions after anterior cruciate ligament reconstruction ( < 0.05). An inverted funnel plot was used to analyze publication bias in studies with quality of life as an outcome measure. The results showed that Egger's test =0.0005 < 0.001 suggesting that there may be a certain degree of publication bias.
The existing research evidence shows that accelerating the reconstruction of anterior cruciate ligament can effectively promote the recovery of knee joint function, reduce the pain of patients, and reduce postoperative complications. However, more research is needed to further verify this.
本研究旨在系统评估在进行前交叉韧带重建术后,越来越快的恢复治疗对膝关节功能的影响。
计算机检索中国知网数据库(CNKI)、PubMed、EMBASE、ScienceDirect、CochraneLibrary、中国维普数据库(VIP)、万方数据库和中国生物医学文献数据库(CBM)自数据库建立至 2022 年 3 月的文献。对照组仅给予传统康复训练,观察组给予围手术期加速康复外科干预的随机对照试验(RCT)。由 2 位研究者独立提取所有纳入研究的数据,并采用 Cochrane 手册 5.1.0 标准评估纳入研究的质量风险偏倚。使用 RevMan5.4 统计软件对收集的数据进行荟萃分析。
共从计算机数据库中检索到 593 篇文章,最终纳入 8 篇 RCT 文章,共 636 个样本进行荟萃分析。根据 Jadad 量表,8 篇 RCT 文章的 RCT 评分均≥4 分。对 ERAS 组和传统康复组术后 VAS 评分进行荟萃分析,异质性检验显示 Chi²=288.60,d=5,<0.00001, =99%。干预组和传统康复模型在术后 VAS 量表上的差异有统计学意义(<0.05)。8 篇文章报道了加速康复外科对 ACL 康复后膝关节运动恢复的影响。荟萃分析后,异质性检验显示 Chi²=314.98,d=7,<0.00001, =98%,可以得出结论,与传统康复模型相比,增强康复手术对前交叉韧带重建后关节功能的恢复有影响。改善效果更为显著,差异有统计学意义(<0.05)。4 篇文章报道了加速康复手术后干预对 ACL 重建患者膝关节活动度的影响,异质性检验显示 Chi²=117.52,d=2,<0.00001, =98%,通过分析,与传统康复模型和增强康复相比。手术对 ACL 重建后膝关节活动度的影响更为显著,差异有统计学意义(<0.05)。分析加速康复手术后和传统康复模式对 ACL 再手术患者术后不良反应发生率的影响。异质性检验结果显示 Chi²=1.59,d=2, =0.66>0.05, =98%,分析表明与传统康复模式相比,增强康复手术可显著降低 ACL 重建后不良反应的风险(<0.05)。采用漏斗图分析以生活质量为结局指标的研究的发表偏倚。结果显示 Egger 检验 =0.0005<0.001,提示可能存在一定程度的发表偏倚。
现有研究证据表明,加速前交叉韧带重建可有效促进膝关节功能恢复,减轻患者疼痛,降低术后并发症。但是,还需要更多的研究来进一步验证这一点。