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中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 29 -36. doi: 10.3877/cma.j.issn.1674-134X.2022.01.005

荟萃分析

自体骨软骨移植与微骨折术临床疗效的Meta分析
宋文杰1, 牛文杰1, 梁浩然1, 刘洋1, 王薛丁1, 任智远1, 李鹏翠1, 卫小春1, 段王平1,()   
  1. 1. 030001 太原,山西医科大学第二医院骨科
  • 收稿日期:2020-12-19 出版日期:2022-02-01
  • 通信作者: 段王平
  • 基金资助:
    山西省重点研发计划项目(201903D421019)

Meta-analysis on clinical efficacy of osteochondral autograft transfer and microfracture surgery

Wenjie Song1, Wenjie Niu1, Haoran Liang1, Yang Liu1, Xueding Wang1, Zhiyuan Ren1, Pengcui Li1, Xiaochun Wei1, Wangping Duan1,()   

  1. 1. Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2020-12-19 Published:2022-02-01
  • Corresponding author: Wangping Duan
引用本文:

宋文杰, 牛文杰, 梁浩然, 刘洋, 王薛丁, 任智远, 李鹏翠, 卫小春, 段王平. 自体骨软骨移植与微骨折术临床疗效的Meta分析[J]. 中华关节外科杂志(电子版), 2022, 16(01): 29-36.

Wenjie Song, Wenjie Niu, Haoran Liang, Yang Liu, Xueding Wang, Zhiyuan Ren, Pengcui Li, Xiaochun Wei, Wangping Duan. Meta-analysis on clinical efficacy of osteochondral autograft transfer and microfracture surgery[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(01): 29-36.

目的

通过Meta分析比较自体骨软骨移植与微骨折对膝关节软骨缺损修复手术疗效的影响。

方法

通过计算机检索建库至2020年8月PubMed,荷兰医学文摘数据库(EMbase),Cochrane图书馆,万方数据库、维普中文科技期刊数据库和中国知网发表的比较自体骨软骨移植与微骨折术的相关研究文献,根据纳入标准如国内外公开发表的自体骨软骨移植与微骨折直接比较的随机病例对照研究与排除标准如无法获取全文及缺乏原始数据的研究等进行文献筛选,质量评价及数据提取,采用Review Manager 5.4统计学软件对患者术后Lysholm评分,术后患者恢复活动情况,以及术后优良率,失败率和骨关节炎患病数等方面进行Meta分析。

结果

共纳入7篇文献,345例患者,其中自体骨软骨移植171例,微骨折174例。Meta分析结果显示:自体骨软骨移植与微骨折术在术后Lyshlom评分[均数差(MD)=-10.19;95%置信区间(CI)(-19.28,-1.10);P=0.03],术后优良率[比值比(OR)=0.24;95%CI(0.08,0.72);P=0.01],失败率[OR=5.96;95%CI(2.58,13.75);P<0.0001],术后患者恢复活动数[OR=0.15;95%CI(0.08,0.28);P<0.0001],骨关节炎患者数[OR=2.76;95%CI(1.07,7.10);P=0.03]等方面比较,差异存在统计学意义;在这些方面,自体骨软骨移植均优于微骨折。

结论

结果证实,自体骨软骨移植在术后患骨关节炎患者数、临床评分及术后恢复活动等方面均优于微骨折。对于膝关节软骨缺损修复患者,自体骨软骨移植可作为优先选择的一线手术方式。

Objective

To compare the effects of osteochondral autograft transfer (OAT) and microfracture on the surgical treatment of articular cartilage defect (ACD) by meta-analysis.

Methods

The related research literature comparing OAT and microfracture published by PubMed, Excerpta Medica Database (EMbase), Cochrane Library, Wanfang Database, China Science and Technology Journal Database and China National Knowledge Infrastructure(CNKI) until August 2020 was searched by computer. Literature screening, quality evaluation and data extraction were conducted according to inclusion criteria such as randomized case-control studies of direct comparison between OAT and microfracture published at home and abroad, and exclusion criteria such as studies that could not obtain full text and lacked original data. The Lysholm score, recovery activity, excellent and good rate, failure rate and incidence of osteoarthritis were analyzed by meta analysis using Review Manager 5.4 statistical software.

Results

A total of 345 patients with OAT were included in seven articles, including 171 cases and 174 cases of microfracture. Meta-analysis showed that between OAT and microfracture surgery, the postoperative Lyshlom score [mean difference(MD)=-10.19, 95% confidence interval(CI) (-19.28, -1.10), P=0.03], excellent and good rate after operation [odds ratio (OR )=0.24, 95% CI (0.08, 0.72), P=0. 01], failure rate [ OR=5.96, 95% CI (2.58, 13.75), P<0.0001], the number of postoperative recovery activities [OR =0.15, 95% CI (0.08, 0.28), P<0.0001], the number of patients with osteoarthritis [OR =2.76, 95% CI (1.07, 7.10), P=0.03], the differences of all these were statistically significant. In these aspects, OAT was superior to microfracture.

Conclusions

OAT is superior to microfracture in the number of patients with osteoarthritis, clinical score and postoperative recovery activity. OAT is the preferred first-line operation for patients with ACD repair.

图1 文献筛选流程图
图2 文献偏倚风险图
表1 纳入文献的基本特征和质量评价
表2 纳入文献的术后并发症及手术失败定义
图3 OAT(自体骨软骨移植)和MF(微骨折)治疗软骨缺损术后Lysholm评分比较
图4 OAT(自体骨软骨移植)和MF(微骨折)治疗软骨缺损术后优良率比较
图5 OAT(自体骨软骨移植)和MF(微骨折)治疗软骨缺损术后患者恢复活动数比较
图6 OAT(自体骨软骨移植)和MF(微骨折)治疗软骨缺损术后失败率比较
图7 OAT(自体骨软骨移植)和MF(微骨折)治疗软骨缺损术后骨关节炎患者数比较
图8 发表偏倚漏斗图
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