■考虑到良好的生物力学特性的初步报道,使用缝合带增强治疗尺侧副韧带(UCL)撕裂已经引起了人们的兴趣。迄今为止,尚无研究定量评估多种增强技术相对于天然UCL的生物力学效果。
■对对照实验室研究进行系统评价和荟萃分析,以评估和比较有或没有增强的UCL修复或重建的生物力学效果。
■系统评价和荟萃分析;证据水平,4.
■PubMed,OVID/Medline,和Cochrane数据库在2023年1月进行了查询。使用频率网络荟萃分析方法对有和没有增强的UCL修复和重建技术进行混合治疗比较,以本机UCL作为参考条件。在随机效应假设下量化汇总治疗估计值。在网络荟萃分析中,通过使用点估计和标准误差来计算P评分(较大的P评分表明治疗对给定结果的优越性)来对竞争的治疗进行排名。
■10项研究涉及206个肘部标本,其中模拟了远端UCL撕裂。使用缝合胶带增强(AugRecon)进行的UCL重建可将负荷恢复到统计学上不较差的程度(平均差异[MD],-1.99N·m;95%CI,-10.2至6.2N·m;P=.63)与天然UCL相比。UCL重建(Recon)(MD,-12.7N·m;P<.001)和UCL修复,缝合胶带增强(AugRepair)(MD,-14.8N·m;P<.001)在统计学上均低于天然UCL。与Recon(P<.001)和AugRepair(P=.002)条件相比,AugRecon条件赋予了更大的失效负荷。AugRecon相对于所有其他条件赋予了更大的扭转刚度,并且与天然UCL没有统计学差异(MD,0.32N·m/deg;95%CI,-0.30至0.95N·m/deg;P=.31)。AugRepair的肱骨内侧间隙没有统计学差异(MD,0.30mm;95%CI,-1.22至1.82mm;P=0.70),AugRecon(MD,0.57毫米;95%CI,-0.70至1.84毫米;P=.38),或侦察(MD,1.02毫米;95%CI,-0.02至2.05毫米;P=.055)与天然UCL相比的条件。P分数分析表明,AugRecon是增加极限破坏载荷和扭转刚度的最有效方法,而AugRepair是最有效的减少内侧间隙。
■AugRecon恢复的破坏载荷和扭转刚度与原生UCL的参数最相似,而Recon和AugRepair在时间零点没有恢复相同的有利特性。所有3种治疗方法都将外翻负荷期间的内侧肱骨间隙降至最低。基于网络交互,AugRecon是在零时间恢复UCL的重要生物力学特征的最佳治疗方法,这些特征在完全远端撕裂期间会受到危害。
UNASSIGNED: Treatment of ulnar collateral ligament (UCL) tears with suture tape augmentation has gained interest given preliminary reports of favorable biomechanical characteristics. No study to date has quantitatively assessed the biomechanical effects of multiple augmentation techniques relative to the native UCL.
UNASSIGNED: To perform a systematic review and meta-analysis of controlled laboratory studies to assess and comparatively rank biomechanical effects of UCL repair or reconstruction with or without augmentation.
UNASSIGNED: Systematic review and meta-analysis; Level of evidence, 4.
UNASSIGNED: PubMed, OVID/Medline, and Cochrane databases were queried in January 2023. A frequentist network meta-analytic approach was used to perform mixed-treatment comparisons of UCL repair and reconstruction techniques with and without augmentation, with the native UCL as the reference condition. Pooled treatment estimates were quantified under the random-effects assumption. Competing treatments were ranked in the network meta-analysis by using point estimates and standard errors to calculate P scores (greater P score indicates superiority of treatment for given outcome).
UNASSIGNED: Ten studies involving 206 elbow specimens in which a distal UCL tear was simulated were included. UCL reconstruction with suture tape augmentation (AugRecon) restored load to failure to a statistically noninferior magnitude (mean difference [MD], -1.99 N·m; 95% CI, -10.2 to 6.2 N·m; P = .63) compared with the native UCL. UCL reconstruction (Recon) (MD, -12.7 N·m; P < .001) and UCL repair with suture tape augmentation (AugRepair) (MD, -14.8 N·m; P < .001) were both statistically inferior to the native UCL. The AugRecon condition conferred greater load to failure compared with Recon (P < .001) and AugRepair (P = .002) conditions. AugRecon conferred greater torsional stiffness relative to all other conditions and was not statistically different from the native UCL (MD, 0.32 N·m/deg; 95% CI, -0.30 to 0.95 N·m/deg; P = .31). Medial ulnohumeral gapping was not statistically different for the AugRepair (MD, 0.30 mm; 95% CI, -1.22 to 1.82 mm; P = .70), AugRecon (MD, 0.57 mm; 95% CI, -0.70 to 1.84 mm; P = .38), or Recon (MD, 1.02 mm; 95% CI, -0.02 to 2.05 mm; P = .055) conditions compared with the native UCL. P-score analysis indicated that AugRecon was the most effective treatment for increasing ultimate load to failure and torsional stiffness, whereas AugRepair was the most effective for minimizing medial gapping.
UNASSIGNED: AugRecon restored load to failure and torsional stiffness most similar to the parameters of the native UCL, whereas Recon and AugRepair did not restore the same advantageous properties at time zero. Medial ulnohumeral gapping during a valgus load was minimized by all 3 treatments. Based on network interactions, AugRecon was the superior treatment approach for restoring important biomechanical features of the UCL at time zero that are jeopardized during a complete distal tear.