切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 307 -317. doi: 10.3877/cma.j.issn.1674-134X.2021.03.008

荟萃分析

前交叉韧带重建术后下肢行走过程中的异常步态表现
周天平1, 徐一宏1, 徐卫东1,†()   
  1. 1. 200433　上海，海军军医大学附属长海医院关节骨病外科
  • 收稿日期:2020-11-04 出版日期:2021-06-01
  • 通信作者: 徐卫东
  • 基金资助:
    2020年上海市体育科技"备战攻关"项目(20J017)

Systematic review and meta analysis on aberrant gait during treadmill walking after anterior cruciate ligament reconstruction

Tianping Zhou1, Yihong Xu1, Weidong Xu1,†()   

  1. 1. Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai 200433, China
  • Received:2020-11-04 Published:2021-06-01
  • Corresponding author: Weidong Xu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

周天平, 徐一宏, 徐卫东. 前交叉韧带重建术后下肢行走过程中的异常步态表现[J]. 中华关节外科杂志(电子版), 2021, 15(03): 307-317.

Tianping Zhou, Yihong Xu, Weidong Xu. Systematic review and meta analysis on aberrant gait during treadmill walking after anterior cruciate ligament reconstruction[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(03): 307-317.

目的

系统评价前交叉韧带重建术(ACLR)后，和对侧肢体和健康对照组相比，术侧下肢在行走过程中存在的异常步态表现。

方法

以"前交叉韧带损伤"、"手术治疗"、"前交叉韧带重建"、"生物力学"、"步态分析"、"运动学"等为主题词和关键词，全面检索2021年03月01日之前收录在Pubmed、Web of Since、Embase、Cochrane Library、中国知网(CNKI)、维普数据库、中国生物医学文献数据库(CBM)等数据库中的中文和英文文献。由两名工作人员分别阅读题目、摘要和全文后筛选出最终纳入的文献。对纳入文献分别进行数据提取、方法学质量评估，采用RevMan 5.3进行统计分析并得出结论。

结果

最终纳入35篇文献，共包含925例ACLR患者和241例健康对照者。和对侧和对照组相比，ACLR术侧下肢在支撑相膝关节最大屈曲角度(pKFA)[平均差(MD)＝-1.19，95%置信区间(CI)(-1.96，-0.42)，P＝0.002]、膝关节屈曲力矩[MD＝-0.06，95%CI(-0.12，0)，P＝0.04]、膝关节伸展力矩[MD＝-0.01，95%CI(-0.01，0)，P＝0.04]、垂直地面反作用力峰值[MD＝-0.03，95%CI(-0.04，-0.01)，P＝0.0003]等指标差异存在统计学意义。

结论

ACLR后术侧肢体在行走过程中长期存在异常步态表现，包括支撑相膝关节最大屈曲角度、膝关节屈曲力矩、膝关节伸展力矩和垂直地面反作用力减小，值得引起关注。

关键词: 前交叉韧带重建, 生物力学现象, 步态, Meta分析
Objective

To systematic analyze gait of operated limb after anterior cruciate ligament reconstruction, compared with contralateral limb or healthy control limb.

Methods

A comprehensive retrieve was performed in Pubmed, Web of Since, Cochrane Library, China National Knowledge Internet(CNKI), Viper database and China Biology Medicine (CBM) in March 1, 2021, with subject term and keywords focusing on "anterior cruciate ligament injury" "surgery" 、"anterior cruciate ligament reconstruction" 、"biometrics" 、"gait analysis" and "kinematics" and language restricted to English or Chinese. Articles were finally included after screened of titles, abstracts and full texts by two researchers. After data extraction and methodological quality evaluation, a statistic analysis was performed with RevMan 5.3.

Results

A total of 35 articles including 925 ACLR patients and 241 healthy control participants met the inclusion criteria finally. Compared with contralateral limbs or healthy control limbs, operated limbs showed smaller peak knee flexion angle [mean deviation (MD)=-1.19, 95%confidence interval(CI)(-1.96, -0.42), P=0.002], knee flexion moment [MD=-0.06, 95%CI(-0.12, 0), P=0.04], knee extension moment [MD=-0.01, 95%CI(-0.01, 0), P=0.04] and peak vertical ground react force [MD=-0.03, 95%CI(-0.04, -0.01), P=0.0003].

Conclusion

Aberrant gait of operated limb during treadmill walking could exist in long term after anterior cruciate ligament reconstruction, including smaller peak knee flexion angle, knee flexion moment, knee extension moment as well as peak vertical ground react force.

Key words: Anterior cruciate ligament reconstruction, Biomechanical Phenomena, Gait, Meta analysis
图1 PRISMA(系统评价和荟萃分析优先报告条目)文献筛选流程图
表1 纳入文献的基本信息及方法学质量评价
第一作者 发表时间 国家 例数(男/女) 移植物类型 随访时间 结局指标 NOS评分
ACLR组 健康对照组
Shimizu[2] 2020 美国 20/16 9/5 24HT，12ST 3年 pKFA、pKFM、vGRF 9
Blackburn[5] 2019 美国 20/52 无 41PT，25HT，3QT, 3AT (27±16)个月 pKFA、pKEM、pKVrA、pKVrM、vGRF 7
Davis-Wilson[6] 2019 美国 16/16 无 PT 1年 pKFA、vGRF 7
Lin[7] 2018 美国 7/13 无 PT，HT (112±17)d pKEM、vGRF 6
Pfeiffer[8] 2018 美国 14/15 无 PT 6个月 pKEM、vGRF 7
Johnston[9] 2019 美国 5/19 无 HT (43±34)个月 pKFA、pKEM、pKVrA、pKVgM、vGRF 6
      29/45 无 PT (22±26)个月
Pamukoff[10] 2018 美国 0/25 无 14PT，8HT，3AT (60.6±24.8)个月 pKFA、pKFM、pKVrA、pKVrM、vGRF 6
Lin[11] 2018 美国 10/20 无 14PT，3HT，2QT, 11AT (108±17)d pKEM、vGRF 6
Shi[12] 2018 中国 25/0 无 HT (7.4±1.3)个月 pKFA、pKVrA、pKVrM、pKVgM 7
Luc-Harkey[13] 2018 美国 9/21 无 16HT，14PT (47.83±26.97)个月 pKEM、vGRF 7
Pietrosimone[14] 2018 美国 13/12 无 HT，PT 6个月 vGRF 6
Capin[15] 2018 美国 35/0 无 19HT，8PT，8AT 2年 pKFA、pKEM 8
Pfeiffer[16] 2018 美国 9/26 无 HT，PT 4年 pKFA、pKEM、pKVrA、pKVgM、vGRF 7
Erhart-Hledik[17] 2017 美国 42 17 HT，PT (7.7±0.7)年 pKFA、pKErA、pKVgA 7
Teng[18] 2017 美国 20/13 8/4 HT，PT 1年 pKFA、pKFM、vGRF 7
Blackburn[19] 2016 美国 29 无 HT，PT (48±41)个月 vGRF 6
Pietrosimone[20] 2015 美国 11/8 无 HT，PT (31±29)个月 vGRF 7
Patterson[21] 2014 美国 17 17 HT，PT 3.5年 pKVrM 6
White[22] 2013 美国 30/10 无 HT，PT 1年 pKFA、pKFM、pKEM 7
Hall[23] 2012 美国 7/8 7/10 HT，PT 6年 pKFM、pKVrA 6
Webster[24] 2011 美国 18/18 无 HT，PT (13.1±9.0)个月 pKFA、pKFM、pKVrA、pKVrM 7
Roewer[25] 2011 美国 18/8 无 HT，PT 2年 pKFA 7
Lewek[26] 2002 美国 18 10 HT 5个月 pKFA、pKFM 6
李锐[27] 2018 中国 0/5 无 HT (4.4±2.1)个月 vGRF 5
Bulter[28] 2009 美国 4/13 4/13 HT，PT (5.3±4.4)年 pKVrA、pKVrM、vGRF 8
Webster[29] 2012 美国 13/3 无 HT，PT (3.3±0.4)年 pKFA、pKFM、pKEM、pKIrA、pKVrA、pKVrM 6
Wang[30] 2013 美国 14/10 15/5 HT，PT (8.8±4.3)个月 pKFA、pKErA、pKVrA 7
Zabala[31] 2013 美国 26/19 26/19 HT，PT，AT 26个月 pKFM、pKErM、pVrM 7
Shin[32] 2009 美国 15/9 无 HT，PT，AT 34个月 pKFM、pKIrM、pKErM、pKVrA、PKVgA 7
Asaeda[33] 2017 美国 16/16 16/16 HT，PT，AT 12个月 pKFA、pKEM、pKIrA、pKErA、pKVrA 7
Czamara[34] 2015 波兰 23 15 HT，PT (13.6±3.27)周 pKErA 6
Georgoulis[35] 2003 美国 19/2 8/2 HT，PT (30±16.9)周 pKFA、pKErA、pKVrA 6
Sato[36] 2013 日本 3/4 无 HT，PT (14.3±1.8)个月 pKIrM 5
Goetschius[37] 2018 美国 13/23 7/13 HT，PT (8.6±2.8)年 pKFM、pKEM、pKVrA、pKVrM 6
图2 前交叉韧带重建(ACLR)术后术侧肢体和对侧/健康对照支撑相膝关节最大屈曲角度比较
表2 ACLR术后术侧肢体和对侧/健康对照运动学比较
项目 纳入文献(篇) 异质性检验 模型 合并效应量
I2 P值 MD 95%CI P值
支撑相膝关节最大内收角度(术后1年内) 3 0.00 1.00 固定效应 0.43 (-0.37，1.24) 0.29
支撑相膝关节最大内收角度(术后1年后) 13 0.00 0.81 固定效应 0.00 (-0.10，0.11) 0.93
支撑相膝关节最大外翻角度 2 0.15 0.31 固定效应 -0.17 (-0.39，0.05) 0.14
支撑相膝关节最大内旋角度 3 0.52 0.10 固定效应 -0.45 (-1.82，0.93) 0.53
支撑相膝关节最大外旋角度 5 0.54 0.04 随机效应 0.00 (-0.89，0.90) 0.99
图3 ACLR(前交叉韧带重建)术后术侧肢体和对侧/健康对照膝关节屈曲力矩比较
图4 ACLR(前交叉韧带重建)术后术侧肢体和对侧/健康对照膝关节伸展力矩比较
表3 ACLR术后术侧肢体和对侧/健康对照动力学比较
项目 纳入文献(篇) 异质性检验 模型 合并效应量
I2 P值 MD 95%CI P值
膝关节内收力矩 10 0.23 0.002 随机效应 -0.01 (-0.04，0.03) 0.70
膝关节外翻力矩 2 0.15 0.31 固定效应 -0.17 (-0.39，0.05) 0.14
膝关节内旋力矩 2 0.76 0.04 随机效应 -1.96 (-6.76，2.84) 0.42
膝关节外旋力矩 2 0.00 0.64 固定效应 -0.04 (-0.08，0.00) 0.07
图5 ACLR(前交叉韧带重建)术后术侧肢体和对侧/健康对照膝关节垂直地面反作用力峰值比较
图6 术侧肢体与对侧/健康对照肢体术后1年内的支撑相膝关节最大屈曲角度比较漏斗图
[1]
Herzog MM, Marshall SW, Lund JL, et al. Trends in incidence of ACL reconstruction and concomitant procedures among commercially insured individuals in the United States, 2002-2014[J]. Sports Health, 2018, 10(6): 523-531.
[2]
Shimizu T, Markes AR, Ma SA, et al. Patients with abnormal limb kinetics at 6 months after anterior cruciate ligament reconstruction have an increased risk of persistent medial meniscal abnormality at 3 years[J/OL]. Orthop J Sports Med, 2020, 8(1): 2325967119895248.doi: 10.1177/2325967119895248.
[3]
Lo CK, Mertz D, Loeb M. Newcastle-Ottawa scale: comparing reviewers′ to authors′ assessments[J/OL]. BMC Med Res Methodol, 2014, 14: 45. doi：10.1186/1471-2288-14-45.
[4]
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement[J]. J Clin Epidemiol, 2009, 62 (10): 1006-1012.
[5]
Blackburn JT, Pietrosimone B, Spang JT, et al. Somatosensory function influences aberrant gait biomechanics following anterior cruciate ligament reconstruction[J]. J Orthop Res, 2020, 38(3): 620-628.
[6]
Davis-Wilson HC, Pfeiffer SJ, Johnston CD, et al. Bilateral gait 6 and 12 months post-anterior cruciate ligament reconstruction compared with controls[J]. Med Sci Sports Exerc, 2020, 52(4): 785-794.
[7]
Lin PE, Sigward SM. Subtle alterations in whole body mechanics during gait following anterior cruciate ligament reconstruction[J]. Gait Posture, 2019, 68: 494-499.
[8]
Pfeiffer SJ, Spang J, Nissman D, et al. Gait mechanics and T1ρ MRI of tibiofemoral cartilage 6 months after ACL reconstruction[J]. Med Sci Sports Exerc, 2019, 51(4): 630-639.
[9]
Johnston CD, Goodwin JS, Spang JT, et al. Gait biomechanics in individuals with patellar tendon and hamstring tendon anterior cruciate ligament reconstruction grafts[J]. J Biomech, 2019, 82: 103-108.
[10]
Pamukoff DN, Montgomery MM, Holmes SC, et al. Association between gait mechanics and ultrasonographic measures of femoral cartilage thickness in individuals with ACL reconstruction[J]. Gait Posture, 2018, 65: 221-227.
[11]
Lin PE, Sigward SM. Contributors to knee loading deficits during gait in individuals following anterior cruciate ligament reconstruction[J]. Gait Posture, 2018, 66: 83-87.
[12]
Shi H, Huang H, Yu Y, et al. Effect of dual task on gait asymmetry in patients after anterior cruciate ligament reconstruction[J/OL]. Sci Rep, 2018, 8(1): 12057. doi：10.1038/s41598-018-30459-w.
[13]
Luc-Harkey B, Franz JR, Blackburn JT, et al. Real-time biofeedback can increase and decrease vertical ground reaction force, knee flexion excursion, and knee extension moment during walking in individuals with anterior cruciate ligament reconstruction[J]. J Biomech, 2018, 76: 94-102.
[14]
Pietrosimone B, Blackburn JT, Padua DA, et al. Walking gait asymmetries 6 months following anterior cruciate ligament reconstruction predict 12-month patient-reported outcomes[J]. J Orthop Res, 2018, 36(11): 2932-2940.
[15]
Capin JJ, Khandha A, Zarzycki R, et al. Gait mechanics and tibiofemoral loading in men of the ACL-SPORTS randomized control trial[J]. J Orthop Res, 2018, 36(9): 2364-2372.
[16]
Pfeiffer SJ, Blackburn JT, Luc-Harkey BA, et al. Peak knee biomechanics and limb symmetry following unilateral anterior cruciate ligament reconstruction: associations of walking gait and jump-landing outcomes[J]. Clin Biomech (Bristol, Avon), 2018, 53: 79-85.
[17]
Erhart-Hledik JC, Chu CR, Asay JL, et al. Longitudinal changes in knee gait mechanics between 2 and 8 years after anterior cruciate ligament reconstruction[J]. J Orthop Res, 2018, 36(5): 1478-1486.
[18]
Teng HL, Wu D, Su F, et al. Gait characteristics associated with a greater increase in medial knee cartilage T1ρ and T2 relaxation times in patients undergoing anterior cruciate ligament reconstruction[J]. Am J Sports Med, 2017, 45(14): 3262-3271.
[19]
Blackburn JT, Pietrosimone B, Harkey MS, et al. Inter-limb differences in impulsive loading following anterior cruciate ligament reconstruction in females [J]. J Biomech, 2016, 49(13): 3017-3021.
[20]
Pietrosimone B, Blackburn JT, Harkey MS, et al. Greater mechanical loading during walking is associated with less collagen turnover in individuals with anterior cruciate ligament reconstruction [J]. Am J Sports Med, 2016, 44(2): 425-432.
[21]
Patterson MR, Delahunt E, Caulfield B. Peak knee adduction moment during gait in anterior cruciate ligament reconstructed females[J]. Clin Biomech (Bristol, Avon), 2014, 29(2): 138-142.
[22]
White K, Logerstedt D, Snyder-Mackler L. Gait asymmetries persist 1 year after anterior cruciate ligament reconstruction [J/OL]. Orthop J Sports Med, 2013, 1(2): 2325967113496967. doi: 10.1177/2325967113496967.
[23]
Hall M, Stevermer CA, Gillette JC. Gait analysis post anterior cruciate ligament reconstruction: knee osteoarthritis perspective [J]. Gait Posture, 2012, 36(1): 56-60.
[24]
Webster KE, Feller JA. Alterations in joint kinematics during walking following hamstring and patellar tendon anterior cruciate ligament reconstruction surgery [J]. Clin Biomech (Bristol, Avon), 2011, 26(2): 175-180.
[25]
Roewer BD, Di Stasi SL, Snyder-Mackler L. Quadriceps strength and weight acceptance strategies continue to improve two years after anterior cruciate ligament reconstruction[J]. J Biomech, 2011, 44(10): 1948-1953.
[26]
Lewek M, Rudolph K, Axe M, et al. The effect of insufficient quadriceps strength on gait after anterior cruciate ligament reconstruction [J]. Clin Biomech (Bristol, Avon), 2002, 17(1): 56-63.
[27]
李锐，王芹，陈露，等．单束前交叉韧带重建后步态的对称性研究[J/CD]．临床医药文献电子杂志，2018，5(60)：29-30.
[28]
Butler RJ, Minick KI, Ferber R, et al. Gait mechanics after ACL Reconstruction: implications for the early onset of knee osteoarthritis[J]. Br J Sports Med, 2009, 43(5): 366-370.
[29]
Webster KE, Feller JA, Wittwer JE. Longitudinal changes in knee joint biomechanics during level walking following anterior cruciate ligament reconstruction surgery[J]. Gait Posture, 2012, 36(2): 167-171.
[30]
Wang HS, Fleischli JE, Zheng N. Transtibial versus anteromedial portal technique in single-bundle anterior cruciate ligament reconstruction outcomes of knee joint kinematics during walking [J]. Am J Sports Med, 2013, 41(8): 1847-1856.
[31]
Zabala M, Favre J, Scanlan SF, et al. Three-dimensional knee moments of ACL reconstructed and control subjects during gait, stair ascent, and stair descent[J]. J Biomech, 2013, 46(3): 515-520.
[32]
Shin CS, Chaudhari AM, Dyrby CO, et al. Influence of patellar ligament insertion angle on quadriceps usage during walking in anterior cruciate ligament reconstructed subjects[J]. J Orthop Res, 2009, 27(6): 730-735.
[33]
Asaeda M, Deie M, Fujita N, et al. Gender differences in the restoration of knee joint biomechanics during gait after anterior cruciate ligament reconstruction[J]. Knee, 2017, 24(2): 280-288.
[34]
Czamara A, Markowska I, Królikowska A, et al. Kinematics of rotation in joints of the lower limbs and pelvis during gait: early results-SB ACLR approach versus DB ACLR approach [J/OL]. Biomed Res Int, 2015: 707168. doi: 10.1155/2015/707168.
[35]
Georgoulis AD, Papadonikolakis A, Papageorgiou CD, et al. Three-dimensional tibiofemoral kinematics of the anterior cruciate ligament-deficient and reconstructed knee during walking[J]. Am J Sports Med, 2003, 31(1): 75-79.
[36]
Sato K, Maeda A, Takano Y, et al. Relationship between static anterior laxity using the KT-1000 and dynamic tibial rotation during motion in patients with anatomical anterior cruciate ligament reconstruction[J]. Kurume Med J, 2013, 60(1): 1-6.
[37]
Goetschius J, Hertel J, Sa SB, et al. Gait biomechanics in anterior cruciate ligament-reconstructed knees at different time frames postsurgery[J]. Med Sci Sports Exerc, 2018, 50(11): 2209-2216.
[38]
Moore JM, Cessford K, Willmott AP, et al. Lower limb biomechanics before and after anterior cruciate ligament reconstruction: a systematic review [J/OL]. J Biomech, 2020, 106: 109828. doi: 10.1016/j.jbiomech.2020.109828.
[39]
Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions [J/OL]. Cochrane Database Syst Rev, 2019, 10: ED000142. doi: 10.1002/14651858.ED000142.
[40]
Van Dyck P, Billiet T, Desbuquoit D, et al. Diffusion tensor imaging of the anterior cruciate ligament graft following reconstruction: a longitudinal study [J]. Eur Radiol, 2020, 30(12): 6673-6684.
[41]
Garcia S, Curran MT, Palmieri-Smith RM. Longitudinal assessment of quadriceps muscle morphology before and after anterior cruciate ligament reconstruction and its associations with patient-reported outcomes[J]. Sports Health, 2020, 12(3): 271-278.
[42]
Birchmeier T, Lisee C, Kane K, et al. Quadriceps muscle size following ACL injury and reconstruction: a systematic review[J]. J Orthop Res, 2020, 38(3): 598-608.
[43]
Leszczynski EC, Kuenze C, Brazier B, et al. The effect of ACL reconstruction on involved and contralateral limb vastus lateralis morphology and histology: a pilot study[J]. J Knee Surg, 2021, 34(5): 533-537.
[44]
Blackburn T, Pietrosimone B, Goodwin JS, et al. Co-activation during gait following anterior cruciate ligament reconstruction[J]. Clin Biomech (Bristol, Avon), 2019, 67: 153-159.
[45]
Littlefield CP, Belk JW, Houck D, et al. The anterolateral ligament of the knee: an updated systematic review of anatomy, biomechanics, and clinical outcomes[J]. Arthroscopy, 2021, 37(5): 1654-1666.
[46]
Pietrosimone B, Seeley MK, Johnston C, et al. Walking ground reaction force post-ACL reconstruction: analysis of time and symptoms[J]. Med Sci Sports Exerc, 2019, 51(2): 246-254.
[47]
Shimizu T, Ma SA, Tanaka MS, et al. Abnormal biomechanics at 6 months are associated with cartilage degeneration at 3 years after anterior cruciate ligament reconstruction[J]. Arthroscopy, 2019, 35(2): 511-520.
[48]
Milandri G, Sivarasu S. A randomized controlled trial of eccentric versus concentric cycling for anterior cruciate ligament reconstruction rehabilitation[J]. Am J Sports Med, 2021, 49(3): 626-636.
[49]
Moran U, Gottlieb U, Gam A, et al. Functional electrical stimulation following anterior cruciate ligament reconstruction: a randomized controlled pilot study[J/OL]. J Neuroeng Rehabil, 2019, 16(1): 89. doi: 10.1186/s12984-019-0566-0.
[1] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[2] 罗旺林, 杨传军, 许国星, 俞建国, 孙伟东, 颜文娟, 冯志. 开放性楔形胫骨高位截骨术不同植入材料的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 818-826.
[3] 黄子荣, 罗渝鑫, 杨文瀚, 陈小虎, 谢环宇, 朱伟民. 前交叉韧带重建对膝关节稳定性影响的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 847-854.
[4] 梁家敏, 黄子荣, 崔家鸣, 钟名金, 冯文哲, 陈康, 胡艳, 欧阳侃, 杨雷, 王大平, 王满宜, 朱伟民. 前交叉韧带保留残端重建促进膝关节功能的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(05): 708-714.
[5] 马鹏程, 刘伟, 张思平. 股骨髋臼撞击综合征关节镜手术中闭合关节囊的疗效影响[J]. 中华关节外科杂志(电子版), 2023, 17(05): 653-662.
[6] 陈宏兴, 张立军, 张勇, 李虎, 周驰, 凡一诺. 膝骨关节炎关节镜清理术后中药外用疗效的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(05): 663-672.
[7] 李雄雄, 周灿, 徐婷, 任予, 尚进. 初诊导管原位癌伴微浸润腋窝淋巴结转移率的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 466-474.
[8] 张再博, 王冰雨, 焦志凯, 檀碧波. 胃癌术后下肢深静脉血栓危险因素的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 475-480.
[9] 武慧铭, 郭仁凯, 李辉宇. 机器人辅助下经自然腔道取标本手术治疗结直肠癌安全性和有效性的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(05): 395-400.
[10] 莫闲, 杨闯. 肝硬化患者并发门静脉血栓危险因素的Meta分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 678-683.
[11] 刘佳铭, 孙晓容, 文健, 何晓丽, 任茂玲. 有氧运动对成人哮喘肺功能、生活质量以及哮喘控制影响的Meta分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 592-595.
[12] 段文忠, 白延霞, 徐文亭, 祁虹霞, 吕志坚. 七氟烷和丙泊酚在肝切除术中麻醉效果比较Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 640-645.
[13] 杨海龙, 邓满军, 樊羿辰, 徐梦钰, 陈芳德, 吴威浩, 张生元. 腹腔镜胆总管探查术一期缝合术后胆漏危险因素Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 545-550.
[14] 邱红生, 林树体, 梁朝莹, 劳世高, 何荷. 模拟现实步态训练对膝关节前交叉韧带损伤的功能恢复及对跌倒恐惧的影响[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 343-350.
[15] 徐红莉, 杨钰琳, 薛清, 张茜, 马丽虹, 邱振刚. 体外冲击波治疗非特异性腰痛疗效的系统评价和Meta分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 307-314.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号