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中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 576 -585. doi: 10.3877/cma.j.issn.1674-134X.2022.05.008

荟萃分析

前交叉韧带对膝关节单髁置换疗效影响的荟萃分析
刘典琦1, 李之琛1, 唐林1, 潘恩豪1, 卢伟杰1,†()   
  1. 1. 510120　广州医科大学附属第一医院关节外科
  • 收稿日期:2021-12-22 出版日期:2022-10-01
  • 通信作者: 卢伟杰

Meta analysis of anterior cruciate ligament influence on curative effect of unicompartmental knee arthroplasty

Dianqi Liu1, Zhichen Li1, Lin Tang1, Enhao Pan1, Weijie Lu1,†()   

  1. 1. Joint Surgery Department of the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
  • Received:2021-12-22 Published:2022-10-01
  • Corresponding author: Weijie Lu
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引用本文：

刘典琦, 李之琛, 唐林, 潘恩豪, 卢伟杰. 前交叉韧带对膝关节单髁置换疗效影响的荟萃分析[J/OL]. 中华关节外科杂志(电子版), 2022, 16(05): 576-585.

Dianqi Liu, Zhichen Li, Lin Tang, Enhao Pan, Weijie Lu. Meta analysis of anterior cruciate ligament influence on curative effect of unicompartmental knee arthroplasty[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(05): 576-585.

目的

比较前交叉韧带(ACL)损伤和完整行膝关节单髁置换术(UKA)后的临床疗效，进一步探索前交叉韧带损伤是否为UKA的禁忌证之一。

方法

计算机搜索中国生物医学文献数据库、中国知网、万方数据库等中文数据库和PubMed、Web of Science、荷兰医学文摘数据库(EMBASE)、循证医学数据库(Cochrane Library)等英文数据库中与ACL有关的UKA的病例对照文献，检索时限为建库至2022年4月。排除同时应用其他术式文献，没有评估ACL损伤程度文献，观察指标不符文献以及无法获得全文的文献，2名研究员独立筛选、评价文献。采用RevMan 5.4软件进行Meta分析。

结果

最终12篇文献纳入本研究，其中英文文献9篇，中文文献3篇；共有3 177例膝：ACL损伤组665例膝；ACL完整组2 512例膝。Meta分析显示：在膝关节活动度(ROM)[均数差(MD)＝－1.40，95%置信区间(CI)(－3.08，0.29)]、膝关节翻修率[比值比(OR)＝1.24，95%CI(0.82，1.89)]、胫骨后倾角度[MD＝－0.06，95%CI(－0.51，0.40)]、美国特种医院(HSS)评分[MD＝－0.47，95%CI(－4.33，3.39)]、牛津膝关节评分(OKS)[MD＝－0.21，95%CI(－1.42，1.01)]和Tenger评分[MD＝－0.09，95%CI(－0.39，0.20)]方面，两组差异无统计学意义(均为P>0.05)。在膝外翻角度方面[标准化均数差(SMD)＝－0.39，95%CI(－0.64，－0.13)]，ACL损伤组大于ACL完整组(P＝0.003，P<0.05)。

结论

ACL损伤被定义为韧带在术中用小拉勾用力牵拉后不能保持正常张力或被拉断，此类患者的术后中远期疗效与ACL完整组对比相似，ACL损伤可能不是UKA的手术禁忌证之一。

关键词: 前交叉韧带, 关节成形术，置换，膝, Meta分析
Objective

To compare the efficacy of deficient and intact anterior cruciate ligament in treatment of unicompartmental knee arthroplasty(UKA)of the knee joint. Further explored whether the deficiency of the anterior cruciate ligament is one of the contraindications for UKA.

Methods

Databases of BioMedical Literature Database, China National Knowledge Infrastructure, WanFang Data, PubMed, Web of Science, Excerpta Medica Database(EMBASE)and Cochrane Library were searched for studies about the case-control literature on ACL-related UKA surgery from inception to April 2022. The literature that using other methods concurrently, no assessment of the ACL, irrelevant to the observation index or not accessed to the full-text were excluded. Two researchers strictly screened and evaluated the literature. The meta-analysis was performed by RevMan 5.4.

Results

Twelve articles were enrolled in this study, including nine articles in English and three articles in Chinese. A total of 3177 knees were investigated, including 665 knees in the ACL deficient group and 2512 knees in ACL intact group. The meta-analysis showed that there was no statistically significant difference in the range of motion of the knee [ mean difference(MD)=-1.40, 95% confidence interval(CI)(-3.08, 0.29)], the rate of revision [ odds ratio(OR)=1.24, 95% CI(0.82, 1.89)], the posterior slope of the tibial implant [ standard mean difference(SMD)=-0.39, 95% CI(-0.51, -0.40)], the Hospital for Special Surgery(HSS)score [ MD=-0.47, 95% CI(-4.33, 3.39)], the Oxford Knee Score(OKS) [ MD=-0.21, 95% CI(-1.42, 1.01)] and the Tenger score [MD=-0.09, 95% CI(-0.39, 0.20)] between the two groups (P>0.05). In the valgus angle of the knee [SMD=-0.39, 95% CI(-0.64, -0.13)], the ACL deficient group was superior to ACL intact group (P =0.003, P < 0.05).

Conclusions

ACL deficiency is defined as that the ligament can not maintain normal tension or be pulled off after being forcibly pulled with a small hook during the operation. The mid-term and long-term efficacy of such patients after the operation is similar to that of the ACL intact group. ACL deficiency may not be one of the contraindications for UKA.

Key words: Anterior cruciate ligament, Arthroplasty, replacement, knee, Meta analysis
表1 纳入文章的基本特征
作者及年份 性别(男/女) 年龄(岁) BMI(kg/m2) 样本量(例膝) 评价指标
Plancher[12] 2022 ACLD：33/25 ACLD：65±10 ACLD：28±4 ACLD：58 ①⑦
  ACLI：86/71 ACLI：65±11 ACLI：28±5 ACLI：157  
Kikuchi[11] 2021 ACLD：6/26 ACLD：72.9 ACLD：25.8 ACLD：32 ①⑦
  ACLI：90/279 ACLI：72.7 ACLI：25.5 ACLI：369  
Plancher[8] 2021 总体：61/70* ACLD：65±12 平均：27.9 ± 4 ACLD：32 ①②
    ACLI：65±9   ACLI：99  
Tao[13] 2021 ACLD：8/32 ACLD：69.35±7.9 NR ACLD：40 ⑦
  ACLI：10/35 ACLI：64.27±8.55   ACLI：45  
Zumbrunn[14] 2020 ACLD：3/5 ACLD：63 ACLD：26.9 ACLD：8 ⑦
  ACLI：8/2 ACLI：67 ACLI：25.3 ACLI：10  
Hamilton[16] 2016 ACLD：150/105 ACLD：68.19±9.28 NR ACLD：255 ①⑤⑥
  ACLI：271/294 ACLI：66.1±9.7   ACLI：565  
Engh[17] 2014 总体：223/338* 平均：66±10 平均：29.5±6 ACLD：68 ①
        ACLI：706
Boissonneault[18] 2013 ACLD：32/10 ACLD：65±11 NR ACLD：46 ①②③⑥
  ACLI：35/10 ACLI：65±11   ACLI：46  
Hernigou[19] 2004 NR 平均：70 NR ACLD：18 ①
        ACLI：81
彭松[15] 2016 ACLD：8/24 ACLD：62.4±8 ACLD：22.34±3.5 ACLD：32 ①⑤
  ACLI：21/160 ACLI：61.9±9 ACLI：22.67±3.6 ACLI：181  
刘少华[9] 2021 ACLD：17/28 ACLD：63.52±10.48 ACLD：22.53±3.12 ACLD：45 ①②③④⑥
  ACLI：94/129 ACLI：64.22±11.01 ACLI：23.15±2.99 ACLI：223
吴颖斌[10] 2021 ACLD：5/24* ACLD：68±6 ACLD：26±3 ACLD：31 ④⑦
  ACLI：8/18* ACLI：67±10 ACLI：26±4 ACLI：30  
表2 纳入文章的MINORS评分
  Plancher等[12]2022 Kikuchi等[11]2021 Plancher等[8]2021 Tao等[13]2021 Zumbrunn等[14]2020 Hamilton等[16]2016
明确给出研究目的 2 2 2 2 2 2
纳入患者连贯性 2 2 2 2 2 2
预期数据的收集 2 0 2 0 0 0
终点指标是否恰当反映研究目的 1 2 1 2 1 2
终点指标评价客观性 1 0 0 1 0 2
随访时间是否充分 2 2 2 0 0 2
失访率低于5% 2 2 2 0 2 0
是否估算样本量 0 0 0 0 0 0
对照组选择是否恰当 2 2 2 2 2 1
对照组是否同步 2 2 2 2 2 2
组间基线是否可比 2 2 2 1 0 1
统计分析是否恰当 2 2 2 2 2 2
总结 20 18 19 14 13 16
  Engh等[17]2014 Boissonneault等[18]2013 Hernigou等[19]2004 彭松等[15]2016 刘少华等[9]2021 吴颖斌等[10]2021
明确给出研究目的 2 2 2 2 2 2
纳入患者连贯性 2 2 2 2 2 2
预期数据的收集 0 0 0 0 0 0
终点指标是否恰当反映研究目的 2 1 2 2 2 2
终点指标评价客观性 2 2 0 2 0 0
随访时间是否充分 2 1 2 0 1 0
失访率低于5% 0 2 0 0 2 0
是否估算样本量 0 0 0 0 0 0
对照组选择是否恰当 2 2 2 2 2 2
对照组是否同步 2 2 2 2 2 2
组间基线是否可比 1 1 0 1 2 2
统计分析是否恰当 2 2 2 2 2 2
总结 17 17 14 15 17 14
图1 文献检索及筛选流程图
图2 不同评价指标的漏斗图分析。图A为ROM(膝关节活动度)漏斗图；图B为膝关节翻修率漏斗图；图C为Tenger评分漏斗图；图D为膝外翻角度漏斗图；图E为OKS(牛津膝关节功能)评分漏斗图；图F为胫骨后倾角度漏斗图；图G为HSS(美国特种医院)评分漏斗图
图3 ACL(前交叉韧带)损伤组和ACL完整组UKA(膝关节单髁置换术)术后ROM(膝关节活动度)比较森林图
图4 ACL(前交叉韧带)损伤组和ACL完整组UKA(膝关节单髁置换术)术后翻修率比较森林图
图5 ACL(前交叉韧带)损伤组和ACL完整组UKA(膝关节单髁置换)术后Tenger评分比较森林图
图6 ACL(前交叉韧带)损伤组和ACL完整组UKA(膝关节单髁置换术)术后膝外翻角度比较的森林图
图7 ACL(前交叉韧带)损伤组和ACL完整组UKA(膝关节单髁置换术)术后OKS(牛津膝关节功能)评分比较的森林图
图8 ACL(前交叉韧带)损伤组和ACL完整组UKA(膝关节单髁置换术)术后胫骨后倾角度比较的森林图
图9 ACL(前交叉韧带)损伤组和ACL完整组UKA(膝关节单髁置换术)术后HSS(美国特种医院)评分比较的森林图
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