自体腘绳肌腱单束与双束重建前交叉韧带临床结果的Meta分析

目的 基于已发表的随机对照试验（randomized controlled trials, RCTs），对关节镜下采用自体腘绳肌腱单束或双束重建前交叉韧带的整体疗效比较进行Meta分析。方法 计算机检索PubMed、Cochrane library、Springerlink数据库，收集自体腘绳肌键单束对比双束重建前交叉韧带的RCTs，检索时间及语种不限。两名研究人员按照指定的纳入标准及排除标准独立对文献进行筛选，提取有关数据资料，并采用Cochrane Collaboration工具表对文献质量进行评价。采用Revman 5.3软件进行Meta分析，比较两种重建方式术后国际膝关节评分委员会（International Knee Documentation Committee, IKDC）主观评分和客观评分、Lachman试验、轴移试验、Lysholm膝关节评分、Tegner膝关节评分、KT-1000或KT-2000关节活动度测量仪测量的数值，评价手术疗效。结果 纳入19篇RCTs，共1 190例研究对象，其中单束重建组580例，双束重建组610例。两组间在IKDC主观评分[MD=-0.90，95% CI（-3.07，1.27），P=0.42]、IKDC客观评分[RR=0.98，95% CI（0.94，1.02），P=0.38]、Lachman试验结果[RR=0.81，95% CI（0.63，1.05），P=0.11]、Lysholm膝关节评分[MD=0.40，95% CI（-1.24，2.05），P=0.63]、Tegner膝关节评分[MD=-0.08，95% CI（-0.47，0.33），P=0.74]、KT-1000或KT-2000测量值[MD=0.30，95% CI（-0.05，0.64），P=0.09]方面，差异均无统计学意义。轴移试验结果在两组间的差异具有统计学意义[RR=0.85，95% CI（0.74，0.97），P=0.02]。结论 对于膝关节功能恢复和前直向稳定性，用自体腘绳肌腱单束或双束重建前交叉韧带的临床结果无明显差异；而对于恢复膝关节旋转稳定性，双束重建技术优于单束重建。

Single-bundle versus double-bundle anterior cruciate ligament reconstruction with autogenous hamstring tendon: a Meta-analysis

Objective Based on published randomized controlled trials (RCTs), a meta-analysis was performed on the overall efficacy of arthroscopic reconstruction of the anterior cruciate ligament using single or double hamstring tendons. Methods PubMed, Cochrane library, Springerlink and other databases were searched. The RCTs of single-bundle and double-bundle reconstruction of anterior cruciate ligament were obtained. Date and language were not limited. According to the criteria, the literature was screened and data were extracted by two reviewers independently, and the Cochrane Collaboration''s risk of bias tool was used to assess the quality of literature. RevMan 5.3 software was used to perform the Meta analysis, including the contrast of International Knee Documentation Committee (IKDC) scores, Lachman testing, pivot-shift testing, Lysholm scores, Tegner scores, KT-1000 or KT-2000 arthrometer measurement. Results Nineteen RCTs were included, with a total of 1 190 patients (580 cases in the single-bundle group, and 610 cases in the double-bundle group). Meta-analysis results showed that there was no significant difference in postoperative IKDC objective scores [MD=-0.90, 95% CI (-3.07, 1.27), P=0.42], IKDC subjective scores [RR=0.98, 95% CI (0.94, 1.02), P=0.38], Lachman testing [RR=0.81, 95% CI (0.63, 1.05), P=0.11], Lysholm scores [MD=0.40, 95% CI (-1.24, 2.05), P=0.63], Tegner scores [MD=-0.08, 95% CI (-0.47, 0.33), P=0.74], KT-1000 or KT-2000 arthrometer measurement [MD=0.30, 95% CI (-0.05, 0.64), P=0.09], but the statistically significant difference was found in the pivot-shift testing [RR=0.85, 95% CI (0.74, 0.97), P=0.02] between two groups. Conclusion There was no significant difference in the clinical results of the anterior cruciate ligament reconstruction with single or double bundle of hamstring tendon autograft for the functional recovery and anterior straight stability of knee joint, while the double bundle reconstruction was superior to the single bundle reconstruction for the restoration of rotational stability of knee joint.