目的 探究关节镜手术与不同的非手术疗法及假手术干预治疗半月板相关损伤的短期与中长期疗效，比较二者的优劣性，对临床工作提供一定指导。方法 检索PubMed、Embase、Cochrane Library、Web of Science中有关于关节镜手术、半月板切除术等手术治疗与非手术治疗针对膝关节半月板损伤的临床随机对照试验，检索时限为建库至2023年7月30日。由2名研究者独立根据制定好的文献纳排标准筛选文献，采用Cochrane偏倚风险评估工具对纳入文献进行偏倚风险评价，同时使用PEDro标度评价工具对随机对照试验的文献质量进行评价，采集的数据使用RevMan 5。3软件进行定量分析。结果 由定性分析可知，手术疗法可能更适合应用在无骨关节炎、无机械症状的患者，半月板缝合修复手术相比于传统的半月板部分切除术具有更好的中长期疗效。通过定量分析可知，关节镜手术和其他的非手术疗法在数项短期和中长期疗效对比中，差异均没有统计学意义(均P＞0。05)。如Lysholm膝关节评分短期对比的MD=0。15，95％CI:-4。05～4。35，I2=0％;中长期 Lysholm 评分对比的 MD=-1。30，95％CI:-3。16～0。57，I2=0％;短期VAS 评分的 MD=-0。18，95％CI:-0。59～0。23，I2=45％;中长期 VAS 评分的 MD=-0。01，95％CI:-0。20～0。19，I2=36％等。另外，在单独针对退行性半月板损伤的亚组分析中，发现两种疗法在临床应用中的疗效差异均不具有统计学意义(均P＞0。05)。结论 手术疗法与非手术疗法在对半月板损伤短期和中长期疗效的各项结局指标对比中无统计学意义上的差异。针对单一的损伤类型，如退行性半月板损伤，两种疗法的效果差异同样没有统计学意义。
Comparison in Efficacy of Arthroscopic Surgery and Nonsurgical Therapies in Treatment of Meniscus-related Injuries:A Systematic Review and Meta-analysis
Objective To explore the short-term and long-term efficacy of arthroscopic surgery,different non-surgical ther-apy and sham operation intervention in the treatment of meniscus related injuries,and to compare their advantages and disadvan-tages,so as to provide guidance for clinical practice.Methods Randomized controlled trials on arthroscopic surgery,meniscecto-my and other surgical and non-surgical treatments for knee meniscus injury were searched in PubMed,Embase,Cochrane Librar-y and Web of Science,and the search time was from its inception to July 2023.Two researchers independently screened the liter-ature according to the established literature ranking criteria,and the Cochrane Risk of Bias Assessment Tool was used to evalu-ate the risk of bias of the included literature,while the PEDro Scale Evaluation Tool was used to evaluate the quality of the liter-ature of the randomized controlled trials,and the collected data were quantitatively analyzed using RevMan 5.3 software.Results From the qualitative analysis,it was clear that surgical therapies might be more appropriately applied to patients without osteo-arthritis and without mechanical symptoms,and that meniscal suture repair surgery had a more favorable long-term outcome compared with traditional partial meniscectomy.Quantitative analysis showed that there was no statistical significance between arthroscopic surgery and other non-surgical therapies in several short and long term efficacy(all P＞0.05).For example,MD=0.15,95％CI:-4.05～4.35,I2=0％in the short-term comparison of Lysholm knee score;MD=-1.30,95％CI:-3.16～0.57,I2=0％;Short-term VAS score MD=-0.18,95％CI:-0.59～0.23,I2=45％;MD=-0.01,95％CI:-0.20～0.19,I2=36％.In addition,in the subgroup analysis of degenerative meniscus injury alone,the difference in clinical efficacy between the two therapies was also not statistically significant(all P＞0.05).Conclusion There is no practical difference between surgi-cal therapy and non-surgical therapy in the short-term and long-term outcomes.For single type injury,such as degenerative me-niscus injury,there is no practical difference between the two therapies.
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