单髁置换术与胫骨高位截骨术治疗膝关节内侧间室骨关节炎的Meta分析

Meta analysis of unilateral condylar replacement and high tibial osteotomy in the treatment of medial compartment osteoarthritis of the knee

目的:用Meta分析的方法对国内外已发表较高质量的有关比较胫骨高位截骨治疗(HTO)与单髁置换治疗(UKA)内侧间室骨关节炎患者的临床疗效进行综合定量分析,为内侧间室骨关节炎患者提供一种较好的外科选择方法。方法:计算机检索Cochrane图书馆(2017年6期)、PubMed、Ovid、ELSIVE、CNKI及万方等数据库。检索1970年1月1日至2017年6月30日有关胫骨高位截骨治疗(HTO)与单髁置换治疗(UKA)内侧间室骨关节炎患者包括并发症、膝关节评分、膝关节活动度、翻修率及优良率等文献,筛选出符合纳入标准的文献,并对其进行严格的质量评价。利用Cochrane协作网提供的RevMan 5.0软件对纳入研究结果进行Meta分析,并对数据进行异质性检验。结果:符合纳入标准的文献13篇,总样本量1 043例。其中HTO治疗组462例,UKA治疗组581例。HTO治疗组与UKA治疗组进行比较,两组在对侧间室关节退变率[WMD=3.21,95%CI (1.13,9.10)],膝关节活动度(ROM)[WMD=6.55,95%CI(1.44,11.66)],膝关节Lysholm评分[WMD=-3.15,95%CI(-4.77,-1.53)],并发症[WMD=2.78,95%CI(1.52,5.11)],翻修率[WMD=1.81,95%,CI (1.17,2.80)],优良率[WMD=0.49,95%CI (0.30,0.80)],胫股角度改变(FTA)[WMD=-2.37,95%CI(-3.63,-1.11)]有明显差异(P<0.05);HTO治疗组与UKA治疗组在髌股关节退变率[WMD=1.59,95%CI(0.65,3.84)]及膝关节运动速度[WMD=-0.02,95%CI(-0.09,0.04)]中无明显差异(P>0.05)。结论:基于有限的资料,在中短期临床效果比较中,胫骨高位截骨术治疗内侧间室骨关节炎患者是一种比较好的选择方式,而长期临床效果可能需进一步研究。

Objective:Meta-analysis was used to compare the clinical efficacy of high tibial osteotomy(HTO) and unicondylar arthroplasty(UKA) in the treatment of medial compartment osteoarthritis(MIOA) and provide a better surgical choice for patients with MIOA. Methods:The Cochrane Library(Issue 6,2017),PubMed,Ovid,ELSIVE,CNKI and Wanfang databases were searched by a computer. Literatures on HTO and UKA for MIOA from January 1,1970 to June 30,2017,including complications,knee joint score,knee mobility,revision rate and excellent and good rate,were searched and screened out according to the inclusion criteria,and strict quality evaluation was carried out. RevMan 5.0 software provided by Cochrane collaboration network was used to conduct the meta analysis of the included research results and to test the heterogeneity of the data. Results:Total 13 articles met the inclusion criteria,and the total sample size was 1 043. Among them,462 were HTO treatment group and 581 were UKA treatment group. By comparison between HTO treatment group and UKA treatment group,there were significant differences in the contralateral deterioration rate [WMD=3.21,95%CI(1.13,9.10)],pre-operative knee range of motion[WMD=6.55,95%CI(1.44,11.66)],Lysholm knee score[WMD=-3.15,95%CI(-4.77,-1.53)],complications[WMD=2.78,95%CI(1.52,5.11],revision rate [WMD=1.81,95%CI(1.17,2.80)],the rate of excellent and good [WMD=0.49,95%CI(0.30,0.80)],and femorotibial angle changes [WMD=-2.37,95%CI,(-3.63,-1.11)](P<0.05). There were no significant differences between the HTO treatment group and the UKA treatment group in patellofemoral deterioration rate[WMD=1.59,95%CI(0.65,3.84)]and the free walking speed [WMD=-0.02,95% CI(-0.09,0.04)](P >0.05). Conclusion:Based on the limited data,high tibial osteotomy is a better choice for the treatment of medial compartment osteoarthritis in the comparison of short and medium-term clinical outcomes,and long term clinical outcomes may need further study.