邢学武医生的科普号

AbstractPurpose:The objective of this study was to conduct the latest meta-analysis of randomized controlled trials (RCTs) that compare clinical results between surgery and conservative therapy of acute primary patellar dislocation (APPD), focusing on medial patellofemoral ligament (MPFL) reconstruction.Methods:We performed a literature search in Embase, The Cochrane Library, PubMed, and Medline to identify RCTs comparing APPD surgical treatment with conservative treatment from the establishment of each database to January 2019. The methodological quality of each RCT was assessed independently by the two authors through the Cochrane Collaboration’s“Risk of Bias”tool. Mean differences of continuous variables and risk ratios of dichotomous variables were computed for the pooled data analyses. TheI2statistic and theχ2test were used to evaluate heterogeneity, with the significance level set atI2> 50% orP< 0.10.Results:Ten RCTs with a sum of 569 patients (297 receiving surgical treatment and 263 receiving conservative treatment) met the inclusion criteria for meta-analysis. Pooled data analysis showed no statistical difference in the field of subluxation rate, Kujala score, patient satisfaction, and frequency of reoperation between the two groups. Tegner activity score and recurrent dislocation rate in the conservative group were significantly higher than those in the surgically treated group.Conclusions:Conservative treatment may produce better outcomes than surgery for APPD in consideration of Tegner activity score. However, in view of limited research available, the interpretation of the discoveries should be cautious. More convincing evidence is required to confirm the effect of MPFL reconstruction.

髌骨是人体最大的籽骨，从3—5岁开始骨化，一直持续到9~10岁。大部分儿童仅有一个骨化中心，约23%的儿童有2~3个骨化中心。约半数人群在儿童及青少年时期完成髌骨融合，而其余人群外上侧的副骨化中心无法与主髌骨融合，最终导致二分或多分髌骨。二分髌骨通常没有症状，但它是造成青少年和年轻运动员膝前痛的原因之一。大部分疼痛性二分髌骨的患者通过保守治疗即可治愈，保守治疗无效时可以考虑手术治疗。目前最常用于治疗疼痛二分髌骨的手术方法是将副髌骨切除，但当副髌骨较大时，切除可能导致髌股关节不协调。现就二分髌骨的诊治新进展做一综述。