背景:原发性TKA术中医源性MCL损伤是罕见的并发症,缺乏黄金标准的治疗方案。这篇综述旨在深入了解各种治疗方式和循证指导,以改善患者的预后。
方法:对5个数据库进行全面检索,确定了相关的随机对照试验和有报道结果的回顾性队列研究。共纳入17项研究,以及诸如患者人口统计等变量,损伤类型,管理,和膝关节社会得分(KSS)进行评估。使用关键评估技能计划工具评估了纳入研究的质量。
结果:纳入患者的平均年龄为60.0至71.4岁。平均体重指数为26.75至34.40kg/m2。其中包括膝盖,298被归类为MCL撕脱,和167作为中间物质/横切伤。缝合或骨钉的初级修复是最常见的治疗方法。术中MCL损伤与术前活动范围(ROM)和术后KSS临床相关,功能,和疼痛评分与对照组相比。MCL损伤组与对照组术后ROM比较,范围从100.0°到130.0°和107.0°到130.0°,分别。
结论:目前的证据支持一期修复作为该并发症的首选治疗方法。撕裂程度等因素,损伤类型,和外科医生的经验也有助于指导治疗。虽然同种异体移植或自体移植重建等治疗方式显示出希望,需要更大样本量的进一步研究,以提高未来的结局.
BACKGROUND: Intraoperative iatrogenic MCL injuries during primary TKA are rare complications that lack a gold standard management protocol. This review aims to provide insight into various treatment modalities and evidence-based guidance for improved patient outcomes.
METHODS: A comprehensive search across five databases identified relevant randomized control trials and retrospective cohort studies with reported outcomes. A total of 17 studies were included, and variables such as patient demographics, injury type, management, and Knee Society Scores (KSS) were assessed. The quality of included studies was evaluated using the Critical Appraisal Skills Programme tool.
RESULTS: Mean age of included patients ranged from 60.0 to 71.4 years. The mean Body Mass Index ranged from 26.75 to 34.40 kg/m2. Among the included knees, 298 were categorized as MCL avulsion, and 167 as midsubstance/transection injuries. Primary repair with sutures or bone staples emerged as the most common management. Intraoperative MCL injury was correlated with reduced preoperative range of motion (ROM) and postoperative KSS clinical, functional, and pain scores compared to control groups. Postoperative ROM was comparable between MCL injury and control groups, ranging from 100.0° to 130.0° and 107.0° to 130.0°, respectively.
CONCLUSIONS: Current evidence supports primary repair as the preferred management for this complication. Factors such as extent of the tear, type of injury, and the surgeon\'s experience also help to guide treatment. While treatment modalities like allograft or autograft reconstruction show promise, further research with larger sample sizes is needed to enhance future outcomes.