关节镜下半月板成形术联合运动疗法对比单纯运动疗法在退行性半月板撕裂中的meta分析

doi:10.3969/j.issn.1009-976X.2023.03.006

摘要/Abstract

摘要： 目的退行性半月板撕裂的最佳治疗方案仍有争议,通过荟萃分析探讨关节镜下半月板成形术联合运动疗法对比单纯运动疗法治疗退行性半月板撕裂的临床疗效。方法依据PICOS原则,检索公开发表于PubMed、EMBASE、Web of science、中国知网、中国万方数据数据库关于对比半月板成形术联合运动疗法和单纯运动疗法治疗退行性半月板撕裂的前瞻性随机对照试验（RCT）文献,检索时间由建库至2022年9月30日。根据Cochrane手册进行系统评价的文献筛选和数据提取,并进行文献质量评价。根据是否有异质性选择固定效应或者随机效应模型行meta分析,结果用森林图显示。结果最终纳入了12项RCT,包含1306名患者。总体偏倚风险都被评定为低风险,漏斗图和Egger检验显示无明显偏移风险。对于疼痛评分,两组在2月、6月、12月和24月的差异均无统计学意义（P>0.05）。而对于功能评分,结果显示在2月时,关节镜下半月板成形术联合运动疗法比单纯运动疗法更高（MD=3.31;95%CI：1.60~5.03;P<0.01）。而在6月、12月、24月和5年时,两组的功能评分也无显著差异。结论在早期的功能评分方面,关节镜下半月板成形术联合运动疗法效果更优。然而在中长期随访中疼痛和功能评分均没有差异。因此临床工作中应重视运动疗法在治疗退行性半月板撕裂方面的潜能。

关键词: 退行性半月板撕裂, 关节镜下半月板成形术, 运动疗法, 荟萃分析

Abstract: Objective The optimal treatment of degenerative meniscus tears is still controversial. A meta-analysis was conducted to investigate the clinical efficacy of arthroscopic meniscal plasty combined with exercise therapy versus exercise therapy alone in the treatment of degenerative meniscal tears. Methods According to the principles of PICOS, we searched the literature of prospective randomized controlled trials （RCT） published in PubMed, EMBASE, Web of Science, CNKI, and China Wanfang Data database on the comparison of meniscoplasty combined with exercise therapy and exercise therapy alone in the treatment of degenerative meniscus tears. The search period was from the establishment of the database to September 30, 2022. Literature screening and data extraction were conducted according to the Cochrane manual, and literature risk assessment was conducted. Fixed-effect or random-effect models were selected for meta-analysis according to whether there was heterogeneity, and the results were shown in forest plots. Results Ultimately, twelve RCTS were enrolled, including 1306 patients. The overall risk of bias was rated as low, and the funnel plot showed no significant risk of bias. For pain scores, there were no statistically significant differences between the two groups at 2, 6, 12, and 24 months （P>0.05）. For functional scores, the results showed that arthroscopic partial meniscectomy combined with exercise therapy was higher than exercise therapy alone at 2 months （MD=3.31； 95%CI： 1.60~5.03； P<0.01）. There were no significant differences in functional scores between the two groups at 6, 12, 24 months and 5 years. Conclusion In terms of early functional scores, arthroscopic partial meniscectomy combined with exercise therapy is more effective. However, there were no differences in pain or functional scores during medium- and long-term follow-up. Therefore, the potential of exercise therapy in the treatment of degenerative meniscal tears should be emphasized in clinical work.

Key words: degenerative meniscus tear, arthroscopic partial meniscectomy, exercise therapy, meta-analysis

中图分类号:

R684.7

邓伟, 张圣华, 张雪锋. 关节镜下半月板成形术联合运动疗法对比单纯运动疗法在退行性半月板撕裂中的meta分析[J]. 岭南现代临床外科, 2023, 23(03): 242-251.

DENG Wei, ZHANG Sheng-hua, ZHANG Xue-feng. Arthroscopic partial meniscectomy combined with exercise therapy versus exercise therapy alone in degenerative meniscal tears：an updated meta-analysis[J]. Lingnan Modern Clinics In Surgery, 2023, 23(03): 242-251.

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