前交叉韧带双束与单束重建术临床结果比较的Meta分析

目的比较前交叉韧带双束重建术和单束重建术的中长期临床疗效。方法依照Cochrane系统评价方法比较随机对照或半随机对照试验，计算机检索Scopus，Pubmed，Medline和Cochrane等数据库，选择符合条件文献并作出方法学评估后，统计分析在Revman5．1上进行。结果纳入文献25篇，双束重建的结果在KT-1000（WMD=-0．31，P〈0．05；WMD=-0．59，P〈0．01），IKDC评分（RR=1．43，P〈0．05；RR=1．17，P〈0．01），长期Lachman（RR=1．32，P〈0．01）和长期Tegner运动评分（RR=0．37，P〈0．01）优于单束重建；轴移试验中期随访结果双束组更好（RR=1．20，P〈0．01），但长期效果无区别。结论通过Meta分析本文发现相比单束重建术，双束重建术能更好的恢复膝关节的生物力学。由于双束重建后生物力学性质更接近正常，可能更好的保护包括软骨在内的关节内组织。因此认为双束重建术总体临床效果优于单束重建术。

Meta-analysis on clinical outcomes of double-bundle and single-bundle anterior cruciate ligament reconstruction

Objective To compare the mid- and long-term clinical follow-up of the double-bundle （DB） technique and the single-bundle （SB） technique in the anterior crueiate ligament reconstruction. Methods According to Cochrane Handbook, randomized controlled trials or Quasi-experiments were identified from databases including Seopus, Pubmed, Medline and Cochrane. Eligible studies were assessed for quality and statistical analysis was performed on Revman 5. 1. Results 25 studies were included. Better outcomes were found following the double-bundle reconstruction in KT-1000 measurement （WMD= -0.31, P〈0.05; WMD= -0.59, P〈0.01）, IKDC objective score （RR= 1.43, P〈0.05; RR = 1.17, P 〈0. 01 ） , long-term Lachman （ RR = 1.32, P 〈 0. 01 ） and long-term Tegner activity score （RR =0. 37, P 〈 0. 01 ）. The outcome of pivot shift tended to favor double-bundle reconstruction in the mid-term follow-up （ RR = 1.20, P 〈 0. 01 ）, whereas it was not significantly different in the long-term follow-up between two groups. Conclusions The main finding of this meta-analysis is that the double- bundle technique restores better knee biomechanics comparing to the single-bundle techniques. As the biomeehanical properties following the double-bundle reconstruction are more close to normal, the structures such as cartilage are likely to be better protected in the knee joint. The double-bundle reconstruction leads to superior clinical outcomes.