前交叉韌帶雙束重建術與單束重建術對恢復膝關節穩定性的系統評價_《中國循證醫學雜志》

作者：

石俊俊 ,  紀斌平

山西醫科大學第二醫院骨科（太原 030001）;

關鍵詞：

前交叉韌帶重建雙束單束系統評價

DOI：

10.7507/1672-2531.20080079

視頻：

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目的　系統評價前交叉韌帶雙束重建術與單束重建術在恢復膝關節前交叉韌帶的前直向穩定性和旋轉穩定性方面的臨床療效，為前交叉韌帶重建方法的選擇提供依據。
方法　按Cochrane系統評價方法，計算機檢索MEDLINE（1966～2007.10），OVID（1950～2007.10），Cochrane圖書館（2007年第4期），中國期刊全文數據庫（1979～2007.10），收集所有相關隨機和半隨機對照試驗。采用Juni評價法評價文獻質量并提取有效數據后，利用RevMan4.2.10軟件進行Meta分析。
結果　共納入隨機和半隨機對照試驗6篇。文獻質量B級1篇，C級5篇。Meta分析結果顯示：雙束重建組術后前交叉韌帶的前直向穩定性［WMD= –0.75（–1.14，–0.37），P=0.000 1］和旋轉穩定性［RR=1.38，95%CI（1.17，1.61），P lt;0.000 1］均優于單束重建組，其差異有統計學意義。
結論　前交叉韌帶雙束重建術在恢復膝關節的前直向穩定性和旋轉穩定性方面優于單束重建術。由于納入文獻數量較少，質量不高，上述結論尚需開展大樣本高質量的臨床研究來證實。

引用本文： 石俊俊,紀斌平. 前交叉韌帶雙束重建術與單束重建術對恢復膝關節穩定性的系統評價. 中國循證醫學雜志, 2008, 08(5): 364-369. doi: 10.7507/1672-2531.20080079 復制

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2.	Girgis FG, Marshall JL, Monajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res, 1975, 106: 216-231.
3.	Ristanis S, Giakas G, Papageorgiou CD, et al. The effects of anterior cruciate ligament reconstruction on tibial rotation during pivoting after descending stairs. Knee Surg Sports Traumatol Arthrosc, 2003, 11(6): 360-365.
4.	Tashman S, Collon D, Anderson K, et al. Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med, 2004, 32(4): 975-983.
5.	Georgoulis AD, Ristanis S, Chouliaras V, et al. Anterior cruciate ligament reconstruction with a quadrupled hamstring autograft does not restore tibial rotation. Techniques in Orthopaedics, 2005, 20(3): 328-333.
6.	Georgoulis AD, Ristanis S, Chouliaras V, et al. Tibial rotation is not restored after ACL reconstruction with a hamstring graft. Clin Orthop Relat Res, 2007, 454: 89-94.
7.	Mae T, Shino K, Matsumoto N, et al. Force sharing between two grafts in the anatomical two-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2006, 14(6): 505-509.
8.	Miura K, Woo SL, Brinkley R, et al. Effects of knee flexion angles for graft fixation on force distribution in double-bundle anterior cruciate ligament grafts. Am J Sports Med, 2006, 34: 577-585.
9.	Yagi M, Wong EK, Kanamori A, et al. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med, 2002, 30: 660-666.
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11.	Petersen W, Tretow H, Weimann A, et al. One tibial tunnel versus two tibial tunnels biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction. Am J Sports Med, 2007, 35: 228-234.
12.	Järvelä T. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study. Knee Surg Sports Traumatol Arthrosc, 2007, 15(5): 500-507.
13.	Järvelä T, Moisala AS, Sihvonen R, et al. Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts and Bioabsorbable Interference Screw Fixation: Prospective, Randomized Clinical Study with Two-Year Results. Am J Sports Med, 2007 Oct 16; [Epub ahead of print].
14.	Adachi N, Ochi M, Uchio Y, et al. Reconstruction of the anterior cruciate ligament. Single- versus double-bundle multistranded hamstring tendons. J Bone Joint Surg Br, 2004, 86(4): 515-520.
15.	Yasuda K, Kondo E, Ichiyama H, et al. Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy, 2006, 22(3): 240-251.
16.	Muneta T, Koga H, Mochizuki T, et al. A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy, 2007, 23(6): 618-628.
17.	Yagi M, Kuroda R, Nagamune K, et al. Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res, 2007, 454: 100-107.
18.	Aglietti P, Giron F, Cuomo P, et al. Single-and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res, 2007, 454: 108-113.
19.	Steckel H, Starman JS, Baums MH, et al. Anatomy of the anterior cruciate ligament double bundle structure: a macroscopic evaluation. Scand J Med Sci Sports, 2007, 17(4): 387-392.
20.	Hara K, Kubo T, Suginoshita T, et al. Reconstruction of the anterior cruciate ligament using a double bundle. Arthroscopy, 2000, 16(8): 860–864.
21.	Sonnery-Cottet B, Chambat P. Anatomic double bundle: a new concept in anterior cruciate ligament reconstruction using quadriceps tendon. Arthroscopy, 2006, 22(11): 1249.e1-1249.e4.
22.	Yagi M, Wong EK, Kanamori A, et al. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med, 2002, 30: 660-666.
23.	Cuomo P, Giron F, Bull A, et al. Double bundle anterior cruciate ligament reconstruction: an in vitro biomechanical study. J Bone Joint Surg Br Proceedings, 2006, 88-B: 426.
24.	Guardamagna L, Seedhom BB, Ostell AE. Double-band reconstruction of the ACL using a synthetic implant: a cadaveric study of knee laxity. J Orthop Sci, 2004, 9(4): 372-379.
25.	Asagumo H, Kimura M, Kobayashi Y. Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy, 2007, 23(6): 602-609.

1. Voigt C, Schönaich M, Lill H. Anterior cruciate ligament reconstruction: state of the art. Eur J Trauma, 2006, 32: 332-329.
2. Girgis FG, Marshall JL, Monajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res, 1975, 106: 216-231.
3. Ristanis S, Giakas G, Papageorgiou CD, et al. The effects of anterior cruciate ligament reconstruction on tibial rotation during pivoting after descending stairs. Knee Surg Sports Traumatol Arthrosc, 2003, 11(6): 360-365.
4. Tashman S, Collon D, Anderson K, et al. Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med, 2004, 32(4): 975-983.
5. Georgoulis AD, Ristanis S, Chouliaras V, et al. Anterior cruciate ligament reconstruction with a quadrupled hamstring autograft does not restore tibial rotation. Techniques in Orthopaedics, 2005, 20(3): 328-333.
6. Georgoulis AD, Ristanis S, Chouliaras V, et al. Tibial rotation is not restored after ACL reconstruction with a hamstring graft. Clin Orthop Relat Res, 2007, 454: 89-94.
7. Mae T, Shino K, Matsumoto N, et al. Force sharing between two grafts in the anatomical two-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2006, 14(6): 505-509.
8. Miura K, Woo SL, Brinkley R, et al. Effects of knee flexion angles for graft fixation on force distribution in double-bundle anterior cruciate ligament grafts. Am J Sports Med, 2006, 34: 577-585.
9. Yagi M, Wong EK, Kanamori A, et al. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med, 2002, 30: 660-666.
10. Guardamagna L, Seedhom BB, Ostell AE. Double-band reconstruction of the ACL using a synthetic implant: a cadaveric study of knee laxity. J Orthop Sci, 2004, 9(4): 372-379.
11. Petersen W, Tretow H, Weimann A, et al. One tibial tunnel versus two tibial tunnels biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction. Am J Sports Med, 2007, 35: 228-234.
12. Järvelä T. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study. Knee Surg Sports Traumatol Arthrosc, 2007, 15(5): 500-507.
13. Järvelä T, Moisala AS, Sihvonen R, et al. Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts and Bioabsorbable Interference Screw Fixation: Prospective, Randomized Clinical Study with Two-Year Results. Am J Sports Med, 2007 Oct 16; [Epub ahead of print].
14. Adachi N, Ochi M, Uchio Y, et al. Reconstruction of the anterior cruciate ligament. Single- versus double-bundle multistranded hamstring tendons. J Bone Joint Surg Br, 2004, 86(4): 515-520.
15. Yasuda K, Kondo E, Ichiyama H, et al. Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy, 2006, 22(3): 240-251.
16. Muneta T, Koga H, Mochizuki T, et al. A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy, 2007, 23(6): 618-628.
17. Yagi M, Kuroda R, Nagamune K, et al. Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res, 2007, 454: 100-107.
18. Aglietti P, Giron F, Cuomo P, et al. Single-and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res, 2007, 454: 108-113.
19. Steckel H, Starman JS, Baums MH, et al. Anatomy of the anterior cruciate ligament double bundle structure: a macroscopic evaluation. Scand J Med Sci Sports, 2007, 17(4): 387-392.
20. Hara K, Kubo T, Suginoshita T, et al. Reconstruction of the anterior cruciate ligament using a double bundle. Arthroscopy, 2000, 16(8): 860–864.
21. Sonnery-Cottet B, Chambat P. Anatomic double bundle: a new concept in anterior cruciate ligament reconstruction using quadriceps tendon. Arthroscopy, 2006, 22(11): 1249.e1-1249.e4.
22. Yagi M, Wong EK, Kanamori A, et al. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med, 2002, 30: 660-666.
23. Cuomo P, Giron F, Bull A, et al. Double bundle anterior cruciate ligament reconstruction: an in vitro biomechanical study. J Bone Joint Surg Br Proceedings, 2006, 88-B: 426.
24. Guardamagna L, Seedhom BB, Ostell AE. Double-band reconstruction of the ACL using a synthetic implant: a cadaveric study of knee laxity. J Orthop Sci, 2004, 9(4): 372-379.
25. Asagumo H, Kimura M, Kobayashi Y. Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy, 2007, 23(6): 602-609.

《中國循證醫學雜志》

前交叉韌帶雙束重建術與單束重建術對恢復膝關節穩定性的系統評價

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《中國循證醫學雜志》

前交叉韌帶雙束重建術與單束重建術對恢復膝關節穩定性的系統評價

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