胫骨高位截骨与单髁置换治疗膝关节内侧间室骨关节炎的Meta分析

A meta-analysis of high tibial osteotomy and monocondylar replacement for treating medial interventricular osteoarthritis of the knee

背景:治疗膝关节内侧间室骨性关节炎最常见的手术方式是胫骨高位截骨和单髁置换,而两者之间的疗效是否存在差异仍缺乏系统评价。目的:采用Meta分析比较胫骨高位截骨和单髁置换治疗膝关节内侧间室骨性关节炎临床疗效的差异。方法:计算机检索PubMed、The Cochrane library、EMBASE、ScienceDirect、CNKI、万方、维普等数据库,搜集有关比较胫骨高位截骨/单髁置换治疗膝关节内侧间室骨性关节炎的病例对照研究或随机对照试验的文献,检索年限为2000至2019年。2人独立完成阅读筛选文献,提取数据和评价研究质量,采用RevMan5.3进行数据分析。结果与结论:①共纳入13项研究,共711例患者;②Meta分析结果显示,胫骨高位截骨组膝关节活动范围(MD=-5.47,95%CI:-9.53至-1.41,P=0.008)显著优于单髁置换组,单髁置换组末次随访时Lysholm膝关节评分(MD=0.84,95%CI:0.29-1.39,P=0.003)优于胫骨高位截骨组;③术后并发症发生率、术后全膝关节置换术翻修率、术后感染率、髌股关节软骨退变率、外侧间室退变率、手术优良率、术后胫股角等方面,2组相比差异无显著性意义(P>0.05);④提示在治疗符合手术指征的膝关节内侧间室骨关节炎时,采用胫骨高位截骨术可获得与单髁置换相似的并发症发生率、术后全膝关节置换术翻修率、术后感染率、髌股关节软骨退变率、外侧间室退变率、手术优良率及术后胫股角,但是胫骨高位截骨术后关节活动范围优于单髁置换,而单髁置换后可以使膝关节获得较好的功能。

BACKGROUND:The most common surgical methods for the treatment of medial interventricular osteoarthritis of the knee are high tibial osteotomy and monocondylar replacement,and systematic evaluation of the difference in efficacy between the two is still lacking.OBJECTIVE:To compare the clinical efficacy of high tibial osteotomy and monocondylar replacement in the treatment of medial interventricular osteoarthritis of the knee.METHODS:PubMed,The Cochrane library,EMBASE,ScienceDirect,CNKI,Wanfang,and VIP were searched by computer.Literature was collected on observational cohort studies or randomized controlled trials comparing high tibial osteotomy/monocondylar replacement in the treatment of medial interventricular osteoarthritis of the knee,with a retrieval period from 2000 to 2019.Two people independently read and screened literature,extracted data and evaluated the quality of the study.RevMan 5.3 software was used for data analysis.RESULTS AND CONCLUSION:(1)A total of 13 studies were included,with 711 patients.(2)Meta-analysis results showed that the knee range of motion of high tibial osteotomy group(MD=-5.47,95%CI:-9.53 to-1.41,P=0.008)was significantly better than that of monocondylar replacement group.Lysholm knee score(MD=0.84,95%CI:0.29 to 1.39,P=0.003)in the monocondylar replacement group at the last follow-up was significantly better than that of the high tibial osteotomy group.(3)There were no significant differences between the two groups in the incidence of postoperative complications,revision rate of total knee replacement,postoperative infection rate,degeneration rate of patellofemoral articular cartilage,degeneration rate of lateral compartment,excellent and good rate,and tibiofemoral angle after surgery(P>0.05).(4)It is concluded that in the treatment of medial interventricular osteoarthritis of the knee according to the indications of operation,high tibial osteotomy can obtain similar complications,postoperative revision rate of total knee arthroplasty,postoperative infection,degeneration rate of patellofemoral articular cartilage,degeneration rate of the lateral compartment,excellent and good rate,postoperative tibial angle as monocondylar replacement,but the postoperative motion range of high tibial osteotomy is better than that of monocondylar replacement,while monocondylar replacement enables better knee function.