前交叉韧带双束重建术与单束重建术对恢复膝关节稳定性的系统评价_《中国循证医学杂志》

作者：

石俊俊 ,  纪斌平

山西医科大学第二医院骨科（太原 030001）;

关键词：

前交叉韧带重建双束单束系统评价

DOI：

10.7507/1672-2531.20080079

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价前交叉韧带双束重建术与单束重建术在恢复膝关节前交叉韧带的前直向稳定性和旋转稳定性方面的临床疗效，为前交叉韧带重建方法的选择提供依据。
方法　按Cochrane系统评价方法，计算机检索MEDLINE（1966～2007.10），OVID（1950～2007.10），Cochrane图书馆（2007年第4期），中国期刊全文数据库（1979～2007.10），收集所有相关随机和半随机对照试验。采用Juni评价法评价文献质量并提取有效数据后，利用RevMan4.2.10软件进行Meta分析。
结果　共纳入随机和半随机对照试验6篇。文献质量B级1篇，C级5篇。Meta分析结果显示：双束重建组术后前交叉韧带的前直向稳定性［WMD= –0.75（–1.14，–0.37），P=0.000 1］和旋转稳定性［RR=1.38，95%CI（1.17，1.61），P lt;0.000 1］均优于单束重建组，其差异有统计学意义。
结论　前交叉韧带双束重建术在恢复膝关节的前直向稳定性和旋转稳定性方面优于单束重建术。由于纳入文献数量较少，质量不高，上述结论尚需开展大样本高质量的临床研究来证实。

引用本文： 石俊俊,纪斌平. 前交叉韧带双束重建术与单束重建术对恢复膝关节稳定性的系统评价. 中国循证医学杂志, 2008, 08(5): 364-369. doi: 10.7507/1672-2531.20080079 复制

1.	Voigt C, Schönaich M, Lill H. Anterior cruciate ligament reconstruction: state of the art. Eur J Trauma, 2006, 32: 332-329.
2.	Girgis FG, Marshall JL, Monajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res, 1975, 106: 216-231.
3.	Ristanis S, Giakas G, Papageorgiou CD, et al. The effects of anterior cruciate ligament reconstruction on tibial rotation during pivoting after descending stairs. Knee Surg Sports Traumatol Arthrosc, 2003, 11(6): 360-365.
4.	Tashman S, Collon D, Anderson K, et al. Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med, 2004, 32(4): 975-983.
5.	Georgoulis AD, Ristanis S, Chouliaras V, et al. Anterior cruciate ligament reconstruction with a quadrupled hamstring autograft does not restore tibial rotation. Techniques in Orthopaedics, 2005, 20(3): 328-333.
6.	Georgoulis AD, Ristanis S, Chouliaras V, et al. Tibial rotation is not restored after ACL reconstruction with a hamstring graft. Clin Orthop Relat Res, 2007, 454: 89-94.
7.	Mae T, Shino K, Matsumoto N, et al. Force sharing between two grafts in the anatomical two-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2006, 14(6): 505-509.
8.	Miura K, Woo SL, Brinkley R, et al. Effects of knee flexion angles for graft fixation on force distribution in double-bundle anterior cruciate ligament grafts. Am J Sports Med, 2006, 34: 577-585.
9.	Yagi M, Wong EK, Kanamori A, et al. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med, 2002, 30: 660-666.
10.	Guardamagna L, Seedhom BB, Ostell AE. Double-band reconstruction of the ACL using a synthetic implant: a cadaveric study of knee laxity. J Orthop Sci, 2004, 9(4): 372-379.
11.	Petersen W, Tretow H, Weimann A, et al. One tibial tunnel versus two tibial tunnels biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction. Am J Sports Med, 2007, 35: 228-234.
12.	Järvelä T. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study. Knee Surg Sports Traumatol Arthrosc, 2007, 15(5): 500-507.
13.	Järvelä T, Moisala AS, Sihvonen R, et al. Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts and Bioabsorbable Interference Screw Fixation: Prospective, Randomized Clinical Study with Two-Year Results. Am J Sports Med, 2007 Oct 16; [Epub ahead of print].
14.	Adachi N, Ochi M, Uchio Y, et al. Reconstruction of the anterior cruciate ligament. Single- versus double-bundle multistranded hamstring tendons. J Bone Joint Surg Br, 2004, 86(4): 515-520.
15.	Yasuda K, Kondo E, Ichiyama H, et al. Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy, 2006, 22(3): 240-251.
16.	Muneta T, Koga H, Mochizuki T, et al. A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy, 2007, 23(6): 618-628.
17.	Yagi M, Kuroda R, Nagamune K, et al. Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res, 2007, 454: 100-107.
18.	Aglietti P, Giron F, Cuomo P, et al. Single-and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res, 2007, 454: 108-113.
19.	Steckel H, Starman JS, Baums MH, et al. Anatomy of the anterior cruciate ligament double bundle structure: a macroscopic evaluation. Scand J Med Sci Sports, 2007, 17(4): 387-392.
20.	Hara K, Kubo T, Suginoshita T, et al. Reconstruction of the anterior cruciate ligament using a double bundle. Arthroscopy, 2000, 16(8): 860–864.
21.	Sonnery-Cottet B, Chambat P. Anatomic double bundle: a new concept in anterior cruciate ligament reconstruction using quadriceps tendon. Arthroscopy, 2006, 22(11): 1249.e1-1249.e4.
22.	Yagi M, Wong EK, Kanamori A, et al. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med, 2002, 30: 660-666.
23.	Cuomo P, Giron F, Bull A, et al. Double bundle anterior cruciate ligament reconstruction: an in vitro biomechanical study. J Bone Joint Surg Br Proceedings, 2006, 88-B: 426.
24.	Guardamagna L, Seedhom BB, Ostell AE. Double-band reconstruction of the ACL using a synthetic implant: a cadaveric study of knee laxity. J Orthop Sci, 2004, 9(4): 372-379.
25.	Asagumo H, Kimura M, Kobayashi Y. Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy, 2007, 23(6): 602-609.

1. Voigt C, Schönaich M, Lill H. Anterior cruciate ligament reconstruction: state of the art. Eur J Trauma, 2006, 32: 332-329.
2. Girgis FG, Marshall JL, Monajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res, 1975, 106: 216-231.
3. Ristanis S, Giakas G, Papageorgiou CD, et al. The effects of anterior cruciate ligament reconstruction on tibial rotation during pivoting after descending stairs. Knee Surg Sports Traumatol Arthrosc, 2003, 11(6): 360-365.
4. Tashman S, Collon D, Anderson K, et al. Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med, 2004, 32(4): 975-983.
5. Georgoulis AD, Ristanis S, Chouliaras V, et al. Anterior cruciate ligament reconstruction with a quadrupled hamstring autograft does not restore tibial rotation. Techniques in Orthopaedics, 2005, 20(3): 328-333.
6. Georgoulis AD, Ristanis S, Chouliaras V, et al. Tibial rotation is not restored after ACL reconstruction with a hamstring graft. Clin Orthop Relat Res, 2007, 454: 89-94.
7. Mae T, Shino K, Matsumoto N, et al. Force sharing between two grafts in the anatomical two-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2006, 14(6): 505-509.
8. Miura K, Woo SL, Brinkley R, et al. Effects of knee flexion angles for graft fixation on force distribution in double-bundle anterior cruciate ligament grafts. Am J Sports Med, 2006, 34: 577-585.
9. Yagi M, Wong EK, Kanamori A, et al. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med, 2002, 30: 660-666.
10. Guardamagna L, Seedhom BB, Ostell AE. Double-band reconstruction of the ACL using a synthetic implant: a cadaveric study of knee laxity. J Orthop Sci, 2004, 9(4): 372-379.
11. Petersen W, Tretow H, Weimann A, et al. One tibial tunnel versus two tibial tunnels biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction. Am J Sports Med, 2007, 35: 228-234.
12. Järvelä T. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study. Knee Surg Sports Traumatol Arthrosc, 2007, 15(5): 500-507.
13. Järvelä T, Moisala AS, Sihvonen R, et al. Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts and Bioabsorbable Interference Screw Fixation: Prospective, Randomized Clinical Study with Two-Year Results. Am J Sports Med, 2007 Oct 16; [Epub ahead of print].
14. Adachi N, Ochi M, Uchio Y, et al. Reconstruction of the anterior cruciate ligament. Single- versus double-bundle multistranded hamstring tendons. J Bone Joint Surg Br, 2004, 86(4): 515-520.
15. Yasuda K, Kondo E, Ichiyama H, et al. Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy, 2006, 22(3): 240-251.
16. Muneta T, Koga H, Mochizuki T, et al. A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy, 2007, 23(6): 618-628.
17. Yagi M, Kuroda R, Nagamune K, et al. Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res, 2007, 454: 100-107.
18. Aglietti P, Giron F, Cuomo P, et al. Single-and double-incision double-bundle ACL reconstruction. Clin Orthop Relat Res, 2007, 454: 108-113.
19. Steckel H, Starman JS, Baums MH, et al. Anatomy of the anterior cruciate ligament double bundle structure: a macroscopic evaluation. Scand J Med Sci Sports, 2007, 17(4): 387-392.
20. Hara K, Kubo T, Suginoshita T, et al. Reconstruction of the anterior cruciate ligament using a double bundle. Arthroscopy, 2000, 16(8): 860–864.
21. Sonnery-Cottet B, Chambat P. Anatomic double bundle: a new concept in anterior cruciate ligament reconstruction using quadriceps tendon. Arthroscopy, 2006, 22(11): 1249.e1-1249.e4.
22. Yagi M, Wong EK, Kanamori A, et al. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med, 2002, 30: 660-666.
23. Cuomo P, Giron F, Bull A, et al. Double bundle anterior cruciate ligament reconstruction: an in vitro biomechanical study. J Bone Joint Surg Br Proceedings, 2006, 88-B: 426.
24. Guardamagna L, Seedhom BB, Ostell AE. Double-band reconstruction of the ACL using a synthetic implant: a cadaveric study of knee laxity. J Orthop Sci, 2004, 9(4): 372-379.
25. Asagumo H, Kimura M, Kobayashi Y. Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy, 2007, 23(6): 602-609.

《中国循证医学杂志》

前交叉韧带双束重建术与单束重建术对恢复膝关节稳定性的系统评价

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《中国循证医学杂志》

前交叉韧带双束重建术与单束重建术对恢复膝关节稳定性的系统评价

摘要 全文 图表 视频 参考文献 施引文献 补充材料

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