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中华临床医师杂志(电子版) ›› 2017, Vol. 11 ›› Issue (12) : 1934 -1941. doi: 10.3877/cma.j.issn.1674-0785.2017.12.005

所属专题: 文献

循证医学

LARS人工韧带与自体腘绳肌腱重建前交叉韧带的Meta分析
梁智勇1, 解通1, 孙剑1, 蔡龙1, 向川1,()   
  1. 1. 030000 太原,山西医科大学第二临床医学院骨科
  • 收稿日期:2017-03-06 出版日期:2017-06-15
  • 通信作者: 向川
  • 基金资助:
    国家自然科学基金项目(81472091); 山西省留学归国人员基金项目(2013-059)

LARS artificial ligament versus hamstring tendon autograft for anterior cruciate ligament reconstruction: a meta-analysis

Zhiyong Liang1, Tong Xie1, Jian Sun1, Long Cai1, Chuan Xiang1,()   

  1. 1. Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, 030000 China
  • Received:2017-03-06 Published:2017-06-15
  • Corresponding author: Chuan Xiang
  • About author:
    Corresponding author: Xiang Chuan,
引用本文:

梁智勇, 解通, 孙剑, 蔡龙, 向川. LARS人工韧带与自体腘绳肌腱重建前交叉韧带的Meta分析[J/OL]. 中华临床医师杂志(电子版), 2017, 11(12): 1934-1941.

Zhiyong Liang, Tong Xie, Jian Sun, Long Cai, Chuan Xiang. LARS artificial ligament versus hamstring tendon autograft for anterior cruciate ligament reconstruction: a meta-analysis[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(12): 1934-1941.

目的

用Meta分析的方法对关节镜下LARS人工韧带与自体腘绳肌腱重建前交叉韧带(ACL)术后疗效进行系统评价。

方法

检索1995年1月~2016年10月公开发表的关于LARS人工韧带与自体腘绳肌腱重建ACL的病例对照相关文献,按照特定的纳入和排除标准选择文献并提取数据,用Review Manager 5.3软件对数据进行Meta分析。

结果

最终共纳入12篇临床对照研究(NOS评分在4~8星之间)。Meta分析结果显示,术后3个月、6个月时,LARS人工韧带重建组(实验组)Lysholm评分、Tegner膝关节评分、IKDC评分明显高于自体腘绳肌腱重建组(对照组),术后12个月时实验组仅在Tegner膝关节评分中较对照组高,术后24个月时实验组Lysholm评分、Tegner膝关节评分、IKDC评分较对照组无明显优势。

结论

通过Meta分析发现,LARS人工韧带重建ACL在术后12个月内较自体腘绳肌腱重建ACL有更好的疗效,但这种优势随着术后重建的自体韧带功能不断改善而逐渐缩小,术后24个月时LARS韧带与自体腘绳肌腱重建ACL的术后疗效基本相当。但是结果仍需长期随访、高质量的临床研究来进一步证实。

Objective

To systematically evaluate the efficacy of LARS artificial ligament versus autologous hamstring tendon for knee anterior cruciate ligament (ACL) reconstruction by arthroscopy.

Methods

The related articles published from January 1995 to October 2016 were electronically searched. According to the specific inclusion and exclusion criteria, the articles were selected, and then the data were collected and analyzed using RevMan 5.3 software.

Results

A total of 12 controlled clinical trials with Newcastle-Ottawa Scale scores of 4 to 8 were included. A statistical difference was found in the Lysholm score at both 3 and 6 months after surgery between LARS artificial ligament (treatment group) and autologous hamstring tendon (control group), and the treatment group had a significantly higher score. Similar results were also observed for Tegner knee score and IKDC score. However, at 12 months, only the Tegner knee score was higher in the treatment group. At 24 months, there was no significant advantage of the treatment group over the control group with regard to all the three scores mentioned above.

Conclusion

The results of this meta-analysis suggest that LARS artificial ligament has a better clinical outcome than autologous hamstring tendon within 12 months of surgery. This advantage is gradually reduced with the improvement of autologous ligament function, and after 24 months, their clinical outcomes are equivalent. As for longer-term outcomes, further follow-ups and high-quality clinical studies will be needed.

表1 纳入研究基本情况
图1 术后3个月实验组与对照组Lysholm评分比较森林图
图2 术后3个月实验组与对照组Tegner评分比较森林图
图3 术后3个月实验组与对照组IKDC评分比较森林图
图4 术后6个月实验组与对照组Lysholm评分比较森林图
图5 术后6个月实验组与对照组Tegner评分比较森林图
图6 术后6个月实验组与对照组IKDC评分比较森林图
图7 术后12个月实验组与对照组Lysholm评分比较森林图
图8 术后12个月实验组与对照组Tegner评分比较森林图
图9 术后12个月实验组与对照组IKDC评分比较森林图
图10 术后12个月实验组与对照组Lysholm评分比较森林图
图11 术后12个月实验组与对照组Tegner评分比较森林图
图12 术后12个月实验组与对照组IKDC评分比较森林图
[1]
Frank CB, Jackson DW. The science of reconstruction of the anterior cruciate ligament [J]. J Bone Joint Surg (Am), 1997, 79(10): 1556.
[2]
Feller J, Webster K, Gavin B. Early postoperative morbidity following anterior cruciate ligament construction: patellar tendon versus hamstring graft [J]. Knee Surg Sports Traumatol Arthrosc 2001, 9(5): 260-266.
[3]
Weiler A, Scheffler S, Hoher J. Transplant selection for primary replacement of the anterior cruciate ligament (in German) [J]. Orthopade, 2002, 31(8): 731-740.
[4]
Hamido F, Misfer A, Al Harran H, et al. The use of the LARS ligament to augment a short or undersized ACL hamstrings tendon graft hamstrings tendon graft [J]. Knee, 2011, 18(6): 373-378.
[5]
Nau T, Lavoie P, Duval N. A new generation of artificial ligaments in reconstruction of the anterior cruciate ligament. Two years follow up of a randamised Trail [J]. J Bone Joint Surg, 2002, 84(3): 356-360.
[6]
Gao K, Chen S, Wang L, et al. Anterior cruciate ligament reconstruction with LARS artificial ligament: a multicenter study with 3-to-5 year follow-up [J]. Arthroscopy, 2010, 26(4): 515-523.
[7]
陆晴友,王予彬,袁锋. 三种不同移植物重建前交叉韧带的疗效分析 [J]. 中国骨与关节损伤杂志, 2009, 24(4): 295-297.
[8]
任磊,董彦荣,万钧. 关节镜下自体半腱肌、股薄肌与人工韧带重建前交叉韧带临床疗效的对比 [J]. 宁夏医学杂志, 2015, 37(8): 727-729.
[9]
范文斌,赵建宁. 关节镜下LARS韧带与自体腘绳肌腱重建前交叉韧带的早期临床疗效比较 [J]. 中国骨与关节损伤杂志, 2013, 28(7): 235-237.
[10]
唐波,张开刚. 关节镜下采用3种不同移植材料重建前交叉韧带的近期疗效比较[D]. 泰安:泰山医学院,2013.
[11]
宁超,潘新. LARS韧带与自体肌腱重建前交叉韧带的临床疗效观察[D]. 济南: 山东大学医学院, 2012.
[12]
季振涛,王少山. 关节镜下LARS人工韧带及4股半腱肌肌腱重建前交叉韧带 [J]. 临床骨科杂志, 2011, 14(3): 268-270.
[13]
王庆锋,温鹏. 自体四股腘绳肌腱与LARS人工韧带重建前交叉韧带临床疗效比较 [J]. 中国骨与关节损伤杂志, 2011, 26(12): 1113-1115.
[14]
Liu ZH, Zhang XL, Jiang Y. Four-strand hamstring tendon autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction [J]. Int Orthop, 2010, 34(1) : 45-49.
[15]
张兵,刘毅. LARS人工韧带与自体胭绳肌健重建前交叉韧带的早期临床疗效比较[D]. 遵义: 遵义医学院, 2009.
[16]
范钦波,范继峰. 关节镜下先进人工韧带加强系统和四股自体半腱肌腱重建前交叉韧带的疗效比较 [J]. 中国修复重建外科杂志, 2008, 22(6): 676-679.
[17]
黄长明,沈瑞群,王建雄. 关节镜下解剖等长重建技术在重建前交叉韧带中的应用 [J]. 中国矫形外科杂志, 2007, 15(24): 1844-1847.
[18]
陈世益,洪国威,陈疾忤. LARS人工韧带与自体腘绳肌腱重建前交叉韧带早期临床疗效比较 [J]. 中国运动医学杂志, 2007, 26(5): 530-533.
[19]
Randy M, Mac Donald PB. Anterior cruciate ligament reconstruction: a look atprosthetics-past, present and possible future [J]. Mcgill J Med, 2008, 11(1): 29-37.
[20]
Di Giovine NM, Shields CL. Synthetic ligaments in ACL reconstruction: a review [J]. Am Knee Surg, 1991, 4(1): 42-48.
[21]
Gillquist J, Odensten M. Reconstruction of old anterior cruciate ligament tears with a Dacron prosthesis: a prospective study [J]. Am J Sports Med, 1993, 21(3): 358-366.
[22]
Legnani C, Ventura A, Terzaghi C, et al. Anterior cruciate ligament reconstruction with artificial ligaments. A review of literature [J]. Int Orthop, 2010, 34(4): 465-471.
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