目的:本研究的目的是系统回顾文献并评估骨髓刺激(BMS)治疗距骨非原发性骨软骨损伤(OLT)后的结果。
方法:进行了文献检索,以确定使用PubMed(MEDLINE)发表的研究,EMBASE,CDSR,DARE,中央。审查是根据PRISMA指南进行的。两位作者分别独立筛选搜索结果,并使用非随机研究方法学指数(MINORS)进行质量评估。研究集中在临床上,体育,工作,和成像结果,以及翻修率和并发症。主要结果是临床成功率。
结果:有5项研究纳入了70例患者,其中非原发性OLT接受了继发性BMS治疗。合并临床成功率为61%(95%置信区间[CI],50-72)。任何运动水平的回报率为83%(95%CI,70-91),而恢复到受伤前的运动水平为55%(95%CI,34-74)。工作回报率为92%(95%CI,78-97),并发症发生率评估为10%(95%CI,4-22)。影像学结果在结果评估中具有异质性,尽管在91%的患者中观察到软骨下骨板凹陷。修订率为27%(95%CI,18-40)。
结论:关节镜下BMS治疗距骨非原发性骨软骨损伤的总成功率为61%,包括27%的修订率。回到运动,工作,和并发症的结果产生了从公平到良好的结果。
OBJECTIVE: The purpose of this study is to systematically review the literature and to evaluate the outcomes following bone marrow stimulation (BMS) for nonprimary osteochondral lesions of the talus (OLT).
METHODS: A literature search was performed to identify studies published using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. The review was performed according to the PRISMA guidelines. Two authors separately and independently screened the search results and conducted the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Studies were pooled on clinical, sports, work, and imaging outcomes, as well as revision rates and complications. The primary outcome was clinical success rate.
RESULTS: Five studies with 70 patients were included in whom nonprimary OLTs were treated with secondary BMS. The pooled clinical success rate was 61% (95% confidence interval [CI], 50-72). The rate of return to any level of sport was 83% (95% CI, 70-91), while the return to pre-injury level of sport was 55% (95% CI, 34-74). The rate of return to work was 92% (95% CI, 78-97), and the complication rate was assessed to be 10% (95% CI, 4-22). Imaging outcomes were heterogeneous in outcome assessment, though a depressed subchondral bone plate was observed in 91% of the patients. The revision rate was 27% (95% CI, 18-40).
CONCLUSIONS: The overall success rate of arthroscopic BMS for nonprimary osteochondral lesions of the talus was 61%, including a revision rate of 27%. Return to sports, work, and complication outcomes yielded fair to good results.