腓骨长肌腱和腘绳肌腱重建前交叉韧带的系统评价

背景:近年报道,腓骨长肌腱可作为重建前交叉韧带新的移植材料,且能取得与腘绳肌腱同等效果,有必要对这2种重建前交叉韧带的移植材料进行系统评价。目的:采用Meta分析方法评价腓骨长肌腱和腘绳肌腱重建前交叉韧带的临床疗效。方法:采用中英文分别在中文数据库(万方医学、中国知网、维普医药、中国生物医学)、英文数据库(Ovid、Pub Med、Web of Science、Embase、Cochrane library)检索腓骨长肌腱和腘绳肌腱重建前交叉韧带的临床对照试验,检索时限从自建库至2019年3月,并由2名评价员通过筛选文献、文献评价、提取数据,并在Revman5.3软件进行Meta分析。结果与结论:(1)通过制定的检索式共检索出中英文文献413篇,最终符合纳入标准10篇,包括647例重建前交叉韧带患者,其中271例使用腓骨长肌腱重建,376例采用腘绳肌腱重建;(2)Meta分析显示:腓骨长肌腱组术后12个月的Lysholm评分、术后6个月的IKDC评分高于腘绳肌腱组(MD=1.23,95%CI0.31,2.51],P=0.0009;MD=3.19,95%CI0.07,6.31],P=0.02),术后并发症发生率低于腘绳肌腱组(OR=0.15,95%CI0.03,0.69],P=0.01);两组术后6,12个月的Tegner评分、关节活动度、关节松弛程度,以及术后6个月的Lysholm评分、术后12个月的IKDC评分比较差异均无显著性意义(P> 0.05);(3)结果表明,腓骨长肌腱重建前交叉韧带的临床效果与腘绳肌腱相当,术后12个月的Lysholm评分、术后6个月的IKDC评分优于腘绳肌腱组,并且可减少术后并发症。临床上可推荐腓骨长肌腱代替腘绳肌腱重建前交叉韧带,但是纳入文献质量限制,需要更高级别的证据。

Systematic evaluation of anterior cruciate ligament reconstruction with peroneus longus tendon and hamstring tendon

BACKGROUND:In recent years,it has been reported that peroneus longus tendon can be used as a new graft material for anterior cruciate ligament reconstruction and can achieve the same effect as hamstring tendon.Therefore,it is necessary to systematically evaluate the two graft materials for anterior cruciate ligament reconstruction.OBJECTIVE:To evaluate the clinical effect of reconstruction of anterior cruciate ligament with peroneus longus tendon and hamstring tendon by meta-analysis.METHODS:We retrieved controlled clinical trials which compared the long peroneal tendons and hamstring tendons in reconstructing anterior cruciate ligament respectively in Chinese database(Wan Fang,CNKI,VIP,Chinese biological medicine) and English database(Ovid,PubMed Web of Science,Embase,the Cochrane library).The retrieval time was from database creation to March 2019.Literature screening and evaluation and data extraction were performed by two evaluators.Meta-analysis was evaluated using Revman5.3 software.RESULTS AND CONCLUSION:(1) A total of 413 Chinese or English literatures were retrieved and 10 of them were included in the final analysis.Among 647 patients receiving anterior cruciate ligament reconstruction,271 patients used peroneus longus tendon reconstruction and 376 patients used hamstring tendon reconstruction.(2) Meta-analysis results:postoperative functional score:There was significant difference in Lysholm score at postoperative 12 months(MD=1.23,95%CI0.31,2.51],P=0.000 9) and IKDC score at postoperative 6 months(MD=3.19,95%C/0.07,6.31],P=0.02) between peroneus longus tendon reconstruction and hamstring tendon groups.The occurrence of postoperative complications in the peroneus longus tendon group was significantly lower than that in the hamstring tendon group(OR=0.15,95%C/0.03,0.69],P=0.01).However,there were no significant differences in Tegner scores,degree of joint motion,degree of joint relaxation at postoperative 6 and 12 months between peroneus longus tendon reconstruction and hamstring tendon groups.No significant difference was found in Lysholm score at postoperative 6 months and in IKDC score at postoperative 12 months between these two groups.The results showed that the clinical effect of peroneus longus tendon in reconstruction of anterior cruciate ligament was comparable to that of hamstring tendon;in the peroneus longus tendon reconstruction group,the Lysholm score at postoperative 12 months and IKDC score at postoperative 6 months were significantly superior to those in the hamstring tendon group.The incidence of postoperative complications in the peroneus longus tendon reconstruction group was lower than that in the hamstring tendon group.The peroneus longus tendon can be clinically recommended to substitute hamstring tendon in the reconstruction of the anterior cruciate ligament.However,the quality of included literatures is limited;therefore higher quality of evidence is required to validate this conclusion.