摘要
【目的】通过Meta分析,探讨保守和手术两种方法治疗急性髌骨脱位的临床疗效有无差异。【方法】在PubMed、Cochrane图书馆、MEDLINE、EMBase等数据库(均截止至2014年2月)中检索比较保守和手术治疗急性髌骨脱位的随机对照研究,使用RevMan 5.2软件进行Meta分析。临床指标为髌骨脱位复发率、髌骨半脱位的复发率、Kujala评分、再次手术率以及膝关节不稳等情况。【结果】纳入8篇随机对照研究(400例),Meta分析结果显示:对于急性髌骨脱位患者,两种治疗方法在半脱位复发率(RR=0.73,95%CI:0.46-1.15)、Kujala评分(WMD=5.56,95%CI:-3.54-14.67)、再次手术率(RR=1.09,95%CI:0.72-1.65)、膝关节不稳症状发生率(RR=0.57,95%CI:0.25-1.30)等方面差异均无统计学意义(P>0.05),手术治疗后脱位复发率(RR=0.65,95%CI:0.48-0.88)低于保守治疗,且2年随访期内,手术治疗Kujala评分(WMD=13.94,95%CI:5.36-22.52)方面优于保守治疗(P<0.05)。【结论】对于急性髌骨脱位,手术治疗后脱位复发率较保守治疗低,且膝关节短期功能恢复及稳定性优于保守治疗,但是保守和手术两种治疗方法在膝关节Kujala评分、半脱位复发率、再次手术率以及膝关节不稳症状发生率方面并无统计学差异。
[Objective]The purpose of this review was to assess the clinical outcomes of surgical,compared with non-surgical interventions,for treating people with acute patellar dislocation.[Methods]We searched the PubMed,Cochrane Library,MEDLINE,EMBASE （from beginning to February 2014） for the randomized controlled trials and clinical trials on comparison of surgical versus conservative interventions for acute patellar dislocation.Meta analysis was conducted using the RevMan5.2 software.The risk of recurrent dislocation/subluxation,Kujala scores,subsequent surgery rate and patient-reported instability symptoms were observed after treated with surgical and conservative treatment methods.[Results]Eight randomized controlled trials were included involving 400 patients met the criteria of the present study.Four trials present to be high quality RCTs.Follow-up was a minimum of two years in five studies and between five and seven years in three studies.Meta analysis results showed that there was no significant difference between surgical and conservative group of acute patellar dislocation in the risk of recurrent subluxation （RR=0.73,95%CI：0.46-1.15）,Kujala scores （WMD=5.56,95%CI：-3.54-14.67）,subsequent surgery rate （RR=1.09,95%CI：0.72-1.65） and patient-reported instability symptoms （RR=0.57,95%CI：0.25-1.30） （P 〉 0.05）,surgical treatment was superior than conservative in the risk of recurrent disloacation （RR=0.65,95%CI：0.48-0.88）.Further analysis was performed between the short-term 2 years follow-up group and long-term 5-7 years follow-up group,and found that only in the short-term 2 years follow-up group,Kujala scores （WMD=13.94,95%CI：5.36-22.52） of surgical group were better than that of the conservative group （P 〈 0.05）.[Conclusion]For patients with acute patellar dislocation,the surgical treatment has a lower risk of recurrent dislocation and a quicker recovery of the knee function,but surgical treatment result is equivalent to conservative treatment in Kujala score,risk
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2014年第4期624-631,共8页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省科技计划项目(2011B090400079)
广东省自然科学基金(S2013010016014)
