手术时机对多韧带膝关节损伤的治疗结果及并发症的影响：系统评价概述与荟萃分析
Effect of Timing of Surgery on the Outcomes and Complications in Multi-ligament Knee Injuries: An Overview of Systematic Reviews and A Meta-analysis.
作者信息
Vaishya Raju, Patralekh Mohit Kumar, Vaish Abhishek, Tollefson Luke V, LaPrade Robert F
机构信息
Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076 India.
Central Institute of Orthopaedics, Safdarjung Hospital and VMMC, New Delhi, India.
出版信息
Indian J Orthop. 2024 Jul 19;58(9):1175-1187. doi: 10.1007/s43465-024-01224-1. eCollection 2024 Sep.
BACKGROUND AND AIMS
Multi-ligament knee injuries (MLKI) are serious and challenging to manage. This study aimed to elucidate the impact of surgical timing on both early and long-term outcomes following an MLKI.
METHODS
A comprehensive search strategy was employed across PubMed, Scopus, Web of Science, and the Cochrane Library. Studies were identified using a combination of relevant keywords encompassing "multi-ligament knee injury," "knee dislocation," "reconstruction," "repair," "surgery," and "timing," and their synonyms, along with appropriate Boolean operators. Selection of articles (systematic reviews and meta-analyses) adhered to predefined inclusion and exclusion criteria. Furthermore, a meta-analysis was conducted utilizing data extracted from primary studies.
RESULTS
Early surgery for MLKI demonstrated a significant advantage over delayed surgery, reflected by significantly higher Lysholm scores (Mean Difference [MD] 3.51; 95% Confidence Interval [CI] 1.79, 5.22), IKDC objective scores (Mantel-Haenszel Odds Ratio [MH-OR] 2.95; 95% CI 1.30, 6.69), Tegner activity scores (MD 0.38; 95% CI 0.08, 0.69), and Mayer's ratings (MH-OR 5.47; 95% CI 1.27, 23.56). In addition, we found a significantly reduced risk of secondary chondral lesions (MH-OR 0.33; 95% CI 0.23, 0.48), lower instrumented anterior tibial translation in the early surgery group (MD -0.92; 95% CI -1.83, -0.01), but no significant difference was observed in the secondary meniscal tears, between the two groups. However, the early surgery group also exhibited a significantly increased risk of knee stiffness (MH-OR 2.47; 95% CI 1.22, 5.01) and a greater likelihood of requiring manipulation under anaesthesia (MH-OR 3.91; 95% CI 1.10, 13.87).
CONCLUSION
Early surgery for MLKI improves function, and stability, and reduces further articular cartilage damage, but increases the risk of stiffness.
LEVEL OF EVIDENCE
IV.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s43465-024-01224-1.
背景与目的
膝关节多韧带损伤（MLKI）病情严重，治疗颇具挑战性。本研究旨在阐明手术时机对MLKI术后早期及长期疗效的影响。
方法
在PubMed、Scopus、科学网和考克兰图书馆进行全面检索。通过结合相关关键词（包括“膝关节多韧带损伤”“膝关节脱位”“重建”“修复”“手术”“时机”及其同义词）以及适当的布尔运算符来确定研究。文章（系统评价和荟萃分析）的选择遵循预定义的纳入和排除标准。此外，利用从原始研究中提取的数据进行荟萃分析。
结果
MLKI早期手术相较于延迟手术显示出显著优势，表现为Lysholm评分显著更高（平均差[MD] 3.51；95%置信区间[CI] 1.79，5.22）、IKDC客观评分（曼特尔-亨塞尔优势比[MH-OR] 2.95；95% CI 1.30，6.69）、Tegner活动评分（MD 0.38；95% CI 0.08，0.69）和迈尔评分（MH-OR 5.47；95% CI 1.27，23.56）。此外，我们发现早期手术组继发软骨损伤的风险显著降低（MH-OR 0.33；95% CI 0.23，0.48），早期手术组仪器测量的胫骨前移更低（MD -0.92；95% CI -1.83，-0.01），但两组之间继发半月板撕裂无显著差异。然而，早期手术组膝关节僵硬的风险也显著增加（MH-OR 2.47；95% CI 1.22，5.01），且在麻醉下需要手法治疗的可能性更大（MH-OR 3.91；95% CI 1.10，13.87）。
结论
MLKI早期手术可改善功能和稳定性，并减少进一步的关节软骨损伤，但会增加僵硬的风险。
证据等级
IV级。
补充信息
在线版本包含可在10.1007/s43465-024-01224-1获取的补充材料。
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