{"title":"对儿童和青少年急性髌骨脱位的保守治疗和手术治疗进行比较的系统回顾和荟萃分析。","authors":"Dong-Yeong Lee, Dong-Geun Kang, Ho-Seung Jo, Se-Joon Heo, Ji-Ho Bae, Sun-Chul Hwang","doi":"10.1186/s43019-023-00189-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>This study sought to clarify treatment evidence to treat patellar dislocation by evaluating which treatment could yield better improvement of clinical outcomes for acute patellar dislocation in children and adolescents 18 years of age or younger.</p><p><strong>Materials and methods: </strong>MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials electronic databases were searched for relevant articles comparing clinical outcomes of conservative and surgical treatments for acute patellar dislocation in children and adolescents published from March 2008 to August 2022. Data searching, extraction, analysis, and quality assessment were performed on the basis of the Cochrane Collaboration guidelines. The quality assessment of each study was investigated using the Physiotherapy Evidence Database (PEDro) critical appraisal scoring system and Newcastle-Ottawa Quality Assessment Scale scores. To calculate the overall combined effect size for each outcome, Review Manager Version 5.3 (The Cochrane Collaboration, Software Update, Oxford) was employed.</p><p><strong>Results: </strong>Three randomized controlled trials (RCTs) and one prospective study were investigated. In terms of pain [mean difference (MD) 6.59, 95% confidence interval (CI) 1.73-11.45, I<sup>2</sup> 0%], there were significantly better outcomes in conservative group. Nevertheless, there were no significant differences in any evaluated outcomes such as redislocation [risk ratio (RR) 1.36, 95% CI 0.72-2.54, I<sup>2</sup> 65%], Kujala score (MD 3.92, 95% CI -0.17 to 8.01, I<sup>2</sup> 0%), Tegner score (MD 1.04, 95% CI -0.04 to 2.11, I<sup>2</sup> 71%), or subjective results (RR 0.99, 95% CI 0.74-1.34, I<sup>2</sup> 33%) between conservative and surgical treatment groups.</p><p><strong>Conclusions: </strong>Despite better pain outcomes with conservative group, the present study revealed no significant differences in clinical outcomes between conservative treatment and surgical treatment in children and adolescents with acute patellar dislocation. Since there are no significant differences in clinical outcomes between the two groups, routine surgical treatment is not advocated for treating acute patellar dislocation in children and adolescents.</p>","PeriodicalId":17886,"journal":{"name":"Knee Surgery & Related Research","volume":"35 1","pages":"18"},"PeriodicalIF":4.1000,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10286373/pdf/","citationCount":"0","resultStr":"{\"title\":\"A systematic review and meta-analysis comparing conservative and surgical treatments for acute patellar dislocation in children and adolescents.\",\"authors\":\"Dong-Yeong Lee, Dong-Geun Kang, Ho-Seung Jo, Se-Joon Heo, Ji-Ho Bae, Sun-Chul Hwang\",\"doi\":\"10.1186/s43019-023-00189-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>This study sought to clarify treatment evidence to treat patellar dislocation by evaluating which treatment could yield better improvement of clinical outcomes for acute patellar dislocation in children and adolescents 18 years of age or younger.</p><p><strong>Materials and methods: </strong>MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials electronic databases were searched for relevant articles comparing clinical outcomes of conservative and surgical treatments for acute patellar dislocation in children and adolescents published from March 2008 to August 2022. Data searching, extraction, analysis, and quality assessment were performed on the basis of the Cochrane Collaboration guidelines. The quality assessment of each study was investigated using the Physiotherapy Evidence Database (PEDro) critical appraisal scoring system and Newcastle-Ottawa Quality Assessment Scale scores. To calculate the overall combined effect size for each outcome, Review Manager Version 5.3 (The Cochrane Collaboration, Software Update, Oxford) was employed.</p><p><strong>Results: </strong>Three randomized controlled trials (RCTs) and one prospective study were investigated. In terms of pain [mean difference (MD) 6.59, 95% confidence interval (CI) 1.73-11.45, I<sup>2</sup> 0%], there were significantly better outcomes in conservative group. Nevertheless, there were no significant differences in any evaluated outcomes such as redislocation [risk ratio (RR) 1.36, 95% CI 0.72-2.54, I<sup>2</sup> 65%], Kujala score (MD 3.92, 95% CI -0.17 to 8.01, I<sup>2</sup> 0%), Tegner score (MD 1.04, 95% CI -0.04 to 2.11, I<sup>2</sup> 71%), or subjective results (RR 0.99, 95% CI 0.74-1.34, I<sup>2</sup> 33%) between conservative and surgical treatment groups.</p><p><strong>Conclusions: </strong>Despite better pain outcomes with conservative group, the present study revealed no significant differences in clinical outcomes between conservative treatment and surgical treatment in children and adolescents with acute patellar dislocation. Since there are no significant differences in clinical outcomes between the two groups, routine surgical treatment is not advocated for treating acute patellar dislocation in children and adolescents.</p>\",\"PeriodicalId\":17886,\"journal\":{\"name\":\"Knee Surgery & Related Research\",\"volume\":\"35 1\",\"pages\":\"18\"},\"PeriodicalIF\":4.1000,\"publicationDate\":\"2023-06-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10286373/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Knee Surgery & Related Research\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1186/s43019-023-00189-z\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee Surgery & Related Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s43019-023-00189-z","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的：本研究旨在通过评估哪种治疗方法能更好地改善 18 岁或以下儿童和青少年急性髌骨脱位的临床疗效，从而明确治疗髌骨脱位的证据：在 MEDLINE、EMBASE 和 Cochrane Central Register of Controlled Trials 电子数据库中搜索 2008 年 3 月至 2022 年 8 月期间发表的相关文章，比较儿童和青少年急性髌骨脱位保守治疗和手术治疗的临床疗效。数据搜索、提取、分析和质量评估均根据 Cochrane 协作指南进行。采用物理治疗证据数据库（PEDro）关键评估评分系统和纽卡斯尔-渥太华质量评估量表评分对每项研究进行质量评估。为了计算每项结果的总体综合效应大小，采用了Review Manager 5.3版（Cochrane Collaboration，软件更新版，牛津）：共调查了三项随机对照试验（RCT）和一项前瞻性研究。就疼痛而言[平均差异（MD）6.59，95% 置信区间（CI）1.73-11.45，I2 0%]，保守治疗组的疗效明显更好。尽管如此，保守治疗组和手术治疗组在重新脱位[风险比（RR）1.36，95% CI 0.72-2.54，I2 65%]、Kujala评分（MD 3.92，95% CI -0.17-8.01，I2 0%）、Tegner评分（MD 1.04，95% CI -0.04-2.11，I2 71%）或主观结果（RR 0.99，95% CI 0.74-1.34，I2 33%）等任何评估结果方面均无明显差异：结论：尽管保守治疗组的疼痛疗效更好，但本研究显示，在急性髌骨脱位的儿童和青少年患者中，保守治疗和手术治疗在临床疗效上没有显著差异。由于两组患者的临床疗效无明显差异，因此不主张采用常规手术治疗来治疗儿童和青少年的急性髌骨脱位。
A systematic review and meta-analysis comparing conservative and surgical treatments for acute patellar dislocation in children and adolescents.
Purpose: This study sought to clarify treatment evidence to treat patellar dislocation by evaluating which treatment could yield better improvement of clinical outcomes for acute patellar dislocation in children and adolescents 18 years of age or younger.
Materials and methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials electronic databases were searched for relevant articles comparing clinical outcomes of conservative and surgical treatments for acute patellar dislocation in children and adolescents published from March 2008 to August 2022. Data searching, extraction, analysis, and quality assessment were performed on the basis of the Cochrane Collaboration guidelines. The quality assessment of each study was investigated using the Physiotherapy Evidence Database (PEDro) critical appraisal scoring system and Newcastle-Ottawa Quality Assessment Scale scores. To calculate the overall combined effect size for each outcome, Review Manager Version 5.3 (The Cochrane Collaboration, Software Update, Oxford) was employed.
Results: Three randomized controlled trials (RCTs) and one prospective study were investigated. In terms of pain [mean difference (MD) 6.59, 95% confidence interval (CI) 1.73-11.45, I2 0%], there were significantly better outcomes in conservative group. Nevertheless, there were no significant differences in any evaluated outcomes such as redislocation [risk ratio (RR) 1.36, 95% CI 0.72-2.54, I2 65%], Kujala score (MD 3.92, 95% CI -0.17 to 8.01, I2 0%), Tegner score (MD 1.04, 95% CI -0.04 to 2.11, I2 71%), or subjective results (RR 0.99, 95% CI 0.74-1.34, I2 33%) between conservative and surgical treatment groups.
Conclusions: Despite better pain outcomes with conservative group, the present study revealed no significant differences in clinical outcomes between conservative treatment and surgical treatment in children and adolescents with acute patellar dislocation. Since there are no significant differences in clinical outcomes between the two groups, routine surgical treatment is not advocated for treating acute patellar dislocation in children and adolescents.
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