{"title":"一项比较保守和手术治疗儿童和青少年急性髌骨脱位的系统综述和荟萃分析。","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":null,"pages":null},"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":"1","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\":null,\"pages\":null},\"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\":\"1\",\"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: 1
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结果,来阐明治疗髌骨脱位的治疗证据。材料和方法:检索MEDLINE、EMBASE和Cochrane中央对照试验注册电子数据库,检索2008年3月至2022年8月发表的比较儿童和青少年急性髌骨脱位保守治疗和手术治疗临床结果的相关文章。根据Cochrane协作指南进行数据检索、提取、分析和质量评估。采用物理治疗证据数据库(PEDro)关键评价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。为了计算每个结果的总体综合效应大小,使用Review Manager Version 5.3 (the Cochrane Collaboration, Software Update, Oxford)。结果:共纳入3项随机对照试验(rct)和1项前瞻性研究。在疼痛方面[平均差异(MD) 6.59, 95%可信区间(CI) 1.73 ~ 11.45, I2 %],保守组明显优于保守组。然而,保守治疗组和手术治疗组在复位[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%)等任何评估结果上均无显著差异。结论:尽管保守治疗组疼痛预后较好,但本研究显示,儿童和青少年急性髌骨脱位保守治疗与手术治疗的临床结果无显著差异。由于两组临床结果无显著差异,不提倡常规手术治疗儿童及青少年急性髌骨脱位。
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.