PDF(Pubmed)
Abstract：
Background: Literature is sparse on outcome comparisons between different trochleoplasty techniques in the treatment of patella instability. To date, it is unclear whether there is a technique that offers superior outcomes. This systematic review and meta-analysis aims to compare and evaluate the outcomes of trochleoplasty techniques in the treatment of patellofemoral instability in trochlea dysplasia to establish whether there is an ideal choice of trochleoplasty technique for superior outcomes. Methods: 21 studies involving 880 knees were included. The mean age of the patients was 21.7 years (range 8-49 years). Mean follow-up timeframe of 43.5 months (range 8.8-100 months). Clinical outcomes assessed included rates of recurrence of patellofemoral dislocation, patient satisfaction, Kujala score, International Knee Documentation Committee (IKDC) score, Tegner score, and Lysholm score. Egger\'s test showed no publication bias across all outcomes assessed. Results: Favourable results were seen across all outcomes assessed and patient satisfaction. Improvements were seen with Kujala, IKDC, and Lysholm scores. Tegner scores showed good return to function. Post-operative dislocation and complication rates were low across the different techniques. Meta-regression for Kujala and IKDC scores showed good outcomes regardless of trochleoplasty technique used (Kujala, p = 0.549, relative risk 492.06; IKDC, p = 0.193, RR 0.001). The exact risk that trochleoplasty poses to the cartilage remains uncertain, as no study had a conservatively managed arm for comparison. Conclusions: Trochleoplasty yielded good outcomes irrespective of technique used with no clear superiority demonstrated in any technique in terms of outcome scores, satisfaction, post-operative dislocation rates or complications.
摘要：
背景：关于不同滑环成形术技术治疗髌骨不稳定的结果比较的文献很少。迄今为止,目前尚不清楚是否有一种技术能提供更好的结局.本系统综述和荟萃分析旨在比较和评估滑车成形术技术治疗滑车发育不良髌股不稳定的结果，以确定是否有理想的滑车成形术技术选择以获得更好的结果。方法：纳入21项研究，涉及880个膝关节。患者的平均年龄为21.7岁（范围8-49岁）。平均随访时间为43.5个月（范围8.8-100个月）。评估的临床结果包括髌股脱位的复发率，患者满意度,Kujala得分,国际膝关节文献委员会（IKDC）评分，Tegner得分,和Lysholm得分。Egger检验显示所有评估结果均无发表偏倚。结果：在评估的所有结果和患者满意度中都看到了良好的结果。Kujala的情况有所改善，IKDC,和Lysholm得分。Tegner得分显示出良好的功能恢复。不同技术的术后脱位和并发症发生率较低。无论使用何种滑车成形术技术，Kujala和IKDC评分的Meta回归均显示出良好的预后（Kujala，p=0.549，相对风险492.06；IKDC，p=0.193，RR0.001)。滑车成形术对软骨造成的确切风险仍不确定，因为没有研究有保守管理的手臂进行比较。结论：滑车成形术无论采用何种技术均取得了良好的疗效，任何技术在结果评分方面均无明显优势。满意,术后脱位率或并发症。
