Efficacy of early versus late reconstruction for anterior cruciate ligament rupture:a systematic review / 中国矫形外科杂志

[Objective]To determine the efficacy of early versus late reconstruction for anterior cruciate ligament rupture.[Method]The author searched MEDLINE(1950-2007.4),OVID(1950-2007.6),PUBMED(1950-2007.7),the CBM(1978-2007.6),WanFang(1981-2007.6),and hand-searched several related journals for randomized controlled trials(RCTs)and quasi-randomized controlled trials(quasi-RCTs)involving the efficacy of early versus late reconstruction for anterior cruciate ligament rupture,the quality of the included trials was assessed.RevMan 4.2.8 software was used for statistical analysis.[Result]Ten studies were included(1RCT,9 CCT).The results of meta-analysis indicated that the huge heterogeneity consist in as follows:intraarticular meniscus tears of the knee,extension deficit of the knee,comparison of lysholm of the knee after the operation.No statistically significant differences between the two operative procedures were observed as follows:including the result of incidence of intraarticular chondral damage of the knee,comparison of Lachman test of the knee found after the operation as well as the result of incidence of comparison of Pivot test of the knee found after the operation.Statistically significant differences were more observed in the late reconstruction in the clinical outcome of both intraarticular arthofibrosis and flexion deficit of the knee found after the operation than that of early reconstruction.[Conclusion]Although result obtained on the basis of CCT with a lager bias and one RCT,the author still conclude that statistically significant differences are more observed in the late reconstruction in the clinical outcome of both intraarticular arthofibrosis and flexion deficit of the knee found after the operation than that of early reconstruction.More high quality,large-scale randomized controlled trials are required for the accurate conclusion in treating it.

Analysis of Outcome in Relation to the Timing of Surgery in Aneurysmal Subarachnoid Hemorrhagic Patients

The purpose of this study was to investigate whether early surgery benefits in the treatment of the patients with ruptured aneurysm by comparing the outcome in relation to the timing of surgery. The autho rs analyzed 81 patients with ruptured aneurysm who underwent operation during one year from January 1996 through December 1996. Among these, sixty patients(74%) underwent operation within 72 hours after first bleeding, and 21 patients (26%) after 72 hours following first bleeding. Thirtysix patients(82%) recovered without se rious neurological deficits in 44 patients with initial Hunt and Hess g rade I to III who were operated upon in early period, and four out of 16 patients with initial Hunt and Hess grade IV to V. Sixteen patients (84%) recovered without serious neurological deficits in 19 patients with initial Hunt and Hess grade I to III who received late operation but none in 2 patients in Hunt and Hess grade IV to V. Seven out of 60 (12%) patients died after early operation, one of 21(5%) patient died after late operation. The causes of morbidity were vasospasm (19 cases), rebleeding (5 cases), hydrocephalus (1 case) in early operation and vasospasm (2 cases), hydrocephalus (1 case) in late operation. It is concluded that early operation is mandatory even in the patients with poor clinical status prior to surgery since early aneurysmal surgery can minimize the chance of rebleeding, permit more aggressive treatment against vaso-spasm and improve the clinical outcome.