前交叉韧带重建取腘绳肌腱时斜切口与纵切口相比感觉缺失率更低：系统评价与Meta分析
简介
一项系统评价与Meta分析纳入8项随机对照试验（共626例患者），比较前交叉韧带（ACL）重建术中腘绳肌腱取腱采用斜切口与纵切口对术后感觉丧失的影响。关键发现：斜切口组切口周围感觉丧失发生率显著低于纵切口组（RR 0.64，95% CI 0.49-0.84），感觉丧失面积也更小（MD -29 cm²，95% CI -46至-13）。两组在Lysholm和IK…
英文摘要
IMPORTANCE: The infrapatellar branch of the saphenous nerve (IPBSN) is commonly injured during hamstring tendon harvest for anterior cruciate ligament (ACL) reconstruction, leading to peri-incisional sensory loss and patient dissatisfaction. Incision orientation may influence this risk. OBJECTIVE: To systematically review and meta-analyze randomized controlled trials (RCTs) comparing oblique versus vertical skin incisions for hamstring tendon harvest in primary ACL reconstruction with respect to postoperative sensory loss and functional outcomes. EVIDENCE REVIEW: A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to September 2025. Eligible studies were RCTs comparing oblique versus vertical incisions for hamstring harvest in primary ACL reconstruction. The primary outcome was incidence of peri-incisional sensory loss. Secondary outcomes included area of sensory loss and patient-reported outcome measures, including Lysholm and International Knee Documentation Committee (IKDC) scores. Outcomes were pooled using random-effects meta-analysis and expressed as risk ratios (RR) or mean differences (MD) with 95% confidence interval (CI); heterogeneity was assessed with I2. FINDINGS: Eight RCTs involving 626 patients were included. Oblique incisions were associated with a significantly lower incidence of sensory loss compared with vertical incisions (RR 0.64, 95% CI 0.49-0.84; I2=73.6%). The area of sensory loss was also reduced with oblique incisions (MD -29 cm2, 95% CI -46 to -13; I2=96.6%). Two trials reported functional outcomes using Lysholm or IKDC scores and none demonstrated statistically significant differences between incision types. CONCLUSION AND RELEVANCE: Oblique skin incision for hamstring tendon harvest in ACL reconstruction appears to be associated with a lower incidence and smaller area of peri-incisional sensory loss compared with vertical incision, without clear differences in functional outcomes. However, the certainty of evidence is low due to substantial heterogeneity and methodological limitations among included trials. Oblique incision may be considered a preferred technique to reduce sensory morbidity. LEVEL OF EVIDENCE: Level I, systematic review and meta-analysis of randomized controlled trials.