膝关节保留手术中的生物增强：基于手术方式的系统评价证据综述
简介
该研究系统综述了生物增强技术在半月板修复、半月板移植、胫骨高位截骨术及软骨修复等保膝手术中的应用证据，共纳入23项临床研究。结果显示19项研究报道了总体有利效果，其中细胞类生物增强在HTO联合软骨再生场景中证据最为集中，但整体证据质量有限。目前生物增强不应被视为保膝手术的常规策略，半月板修复中的选择性应用可能获益，而其他术式的证据尚不足以支持常规采用。
英文摘要
BACKGROUND: Biologic augmentation is increasingly used across knee-preservation procedures, but evidence remains fragmented by procedure and biologic type. This review synthesised the available clinical evidence for biologic augmentation in meniscal repair, meniscus allograft transplantation (MAT), high tibial osteotomy (HTO), cartilage restoration, and osteochondral allograft (OCA) transplantation, with procedure-specific clinical interpretation. METHODS: A systematic review on Ovid MEDLINE and OVID EMBASE was performed (PROSPERO CRD420261342726). Eligible studies were human clinical investigations evaluating a biologic adjunct used concurrently with knee-preservation surgery. Risk of bias was assessed using RoB 2 for randomised trials and MINORS for non-randomised studies. Because outcome measures were heterogeneous, formal pooled meta-analyses was not undertaken, and an exploratory study-level quantitative analysis was performed. RESULTS: Twenty-three clinical studies were included: 5 meniscal repair studies, 1 MAT study, 10 HTO-based studies, and 7 cartilage restoration or OCA studies. Nineteen of 23 studies reported an overall favourable effect, although this proportion should be interpreted cautiously because uncontrolled study designs and selective publication of positive studies were common. Among 16 comparative studies, 12 (75.0%) showed favourable comparative outcomes. Cell-based comparative studies were more often favourable than non-cell-based strategies (8/9 [88.9%] vs 4/7 [57.1%]; odds ratio 6.0, 95% CI 0.46-77.75; Fisher exact p = 0.262). Formal risk-of-bias assessment identified 1 low-risk RCT and 4 with some concerns. CONCLUSION: Biologic augmentation should not currently be regarded as a routine strategy across knee-preservation surgery as a whole. The most coherent but still preliminary is selective use of cell-based augmentation in high tibial osteotomy-based cartilage-regeneration settings. Meniscal repair demonstrates a selective but inconsistent benefit, while evidence for meniscal allograft transplantation, focal cartilage restoration, and osteochondral allograft augmentation remains insufficient to support routine adoption. Future research should prioritise procedure-specific randomised trials, standardised reporting of biologic preparation and delivery methods, and greater emphasis on patient reported outcome measures alongside structural endpoints.