原发性髌骨脱位在保守治疗与手术治疗长期比较的荟萃分析

Meta-Analysis of Primary Patellar Dislocation in Long-Term Comparison of Conservative versus Surgical Treatment

摘要: 目的：在治疗原发髌骨脱位的问题上，保守治疗与手术治疗至今仍存在很大的争议。本研究的目的是进行原发髌骨脱位手术治疗和保守方法治疗长期(大于等于6年)的疗效比较。方法：我们用来搜索研究的数据库包括MEDLINE、Embase和Cochrane图书馆。本研究分析包括4项比较手术治疗与保守治疗初次髌骨脱位疗效的随机对照研究，总共253例患者。主要结果为髌再脱位率，次要结果包括Kujala评分、患者满意度、Tegner评分、再手术率。结果：髌骨再脱位率(p = 0.02)及Tegner activity评分(p = 0.26)在两种治疗方法来看具有显著差异，且认为手术治疗后长期来看具有更低的再脱位率，保守治疗则能带来更高的Tegner activity评分。而在Kujala评分、患者满意度和再手术率方面无显着性差异。结论：在治疗原发性髌骨脱位长期(6年)后，非手术治疗与手术治疗相比具有更高的再脱位率但同时具有更高的Tegner activity评分。

Abstract: Objective: There is still a great controversy between conservative and surgical treatment of primary patella dislocation. The purpose of this study was to compare surgical treatment with conservative treatment for primary patella dislocation after a long term (6 years or more). Methods: Databases that we used to search the study included MEDLINE, EMBASE, and Cochrane Library. The analysis included four randomized controlled studies comparing surgical versus conservative treatment of primary patellar dislocation with 253 patients in total. The primary outcome is the rate of patellar redislocation, and secondary outcomes included Kujala score, patient satisfaction, Tegner score, and rate of reoperation. Results: There are significant differences in the rate of patella redislocation (p = 0.02) and Tegner activity score (p = 0.26) between the two treatment methods, and it is considered that the rate of patella redislocation is lower in surgical treatment after a long term, while conservative treatment could bring higher Tegner activity score. There are no significant differences in Kujala score, patient satisfaction, and reoperation rate. Conclusions: After a long period (6 years) of treatment for primary patellar dislocation, compared with surgical treatment, non-surgical treatment had a higher rate of redislocation while a higher Tegner Activity score.