背景:传统的微骨折(MFx)技术已经取得了许多进展,涉及将各种无细胞第二代MFx和细胞MFx-III组分递送到软骨缺损区域。MFx技术的这些不同修饰的相对益处和缺陷仍未被广泛理解。
目的:比较分析功能,放射学,和组织学结果,以及可用于治疗软骨缺损的各代MFx的并发症。
方法:使用PubMed进行了系统评价,EMBASE,WebofScience,科克伦,还有Scopus.考虑任何年龄和性别的软骨缺损患者接受任何形式的MFx进行分析。我们仅纳入随机对照试验(RCT)报告功能,放射学,用于治疗软骨缺损的各代MFx的组织学结果或并发症。在Stata中进行网络荟萃分析(NMA),并利用Cochrane的NMA方法进行证据评估。
结果:44个RCT纳入分析,患者平均年龄为39.40(±9.46)岁。在将其他世代的结果与MFX-I作为常数比较器时,我们注意到疼痛控制和功能结局更好的趋势(KOOS,IKDC,和辛辛那提得分)在1-结束时,2-,和MFx-III的5年时间点,差异无统计学意义(P>0.05)。我们还注意到1年时较高代微骨折的软骨修复组织评分的磁共振观察具有统计学意义(加权平均差异:17.44,95%置信区间:0.72,34.16,P=0.025;无明显异质性)。然而,差异在2年未维持。第二代和第三代MFx在MRI上有更好的缺损填充趋势,虽然差异无统计学意义(P>0.05)。
结论:传统MFx技术利用无细胞和细胞成分来增强其在治疗软骨缺损方面的潜力,在临床和放射学结果方面仅显示出微小的改善。
BACKGROUND: Multitudinous advancements have been made to the traditional
microfracture (MFx) technique, which have involved delivery of various acellular 2nd generation MFx and cellular MFx-III components to the area of cartilage defect. The relative benefits and pitfalls of these diverse modifications of MFx technique are still not widely understood.
OBJECTIVE: To comparatively analyze the functional, radiological, and histological outcomes, and complications of various generations of MFx available for the treatment of cartilage defects.
METHODS: A systematic review was performed using PubMed, EMBASE, Web of Science, Cochrane, and Scopus. Patients of any age and sex with cartilage defects undergoing any form of MFx were considered for analysis. We included only randomized controlled trials (RCTs) reporting functional, radiological, histological outcomes or complications of various generations of MFx for the management of cartilage defects. Network meta-analysis (NMA) was conducted in Stata and Cochrane\'s Confidence in NMA approach was utilized for appraisal of evidence.
RESULTS: Forty-four RCTs were included in the analysis with patients of mean age of 39.40 (± 9.46) years. Upon comparing the results of the other generations with MFX-I as a constant comparator, we noted a trend towards better pain control and functional outcome (KOOS, IKDC, and Cincinnati scores) at the end of 1-, 2-, and 5-year time points with MFx-III, although the differences were not statistically significant (P > 0.05). We also noted statistically significant Magnetic resonance observation of cartilage repair tissue score in the higher generations of
microfracture (weighted mean difference: 17.44, 95% confidence interval: 0.72, 34.16, P = 0.025; without significant heterogeneity) at 1 year. However, the difference was not maintained at 2 years. There was a trend towards better defect filling on MRI with the second and third generation MFx, although the difference was not statistically significant (P > 0.05).
CONCLUSIONS: The higher generations of traditional MFx technique utilizing acellular and cellular components to augment its potential in the management of cartilage defects has shown only marginal improvement in the clinical and radiological outcomes.