胫骨高位开放截骨与闭合截骨临床疗效的Meta分析

Meta-analysis on clinical results of open versus closed wedge osteotomies in treatment of medial compartment osteoarthritis

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内侧开放胫骨高位楔形截骨(OWHTO)与外侧闭合胫骨高位楔形截骨(CWHTO)治疗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)、Pudmed、Ovid、Spinger Link、Elsevier、Medline等数据库。检索从1970年1月1日至2017年6月30日,有关胫骨高位开放截骨治疗(OWHTO)与闭合截骨治疗(CWHTO)治疗内侧间室骨关节炎患者包括并发症、手术时间、膝关节HSS评分、髌骨下降、平均矫正角度、胫骨平台后倾角及机械轴等文献,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1237例。其中OWHTO治疗组666例,CWHTO治疗组571例。OWHTO治疗组与CWHTO治疗组的比较,OWHTO治疗组在术后髌骨高度Caton-Deschamps(CD)测量指数、术后胫骨平台后倾角度及手术时间差异有统计学意义[标准化加权均数差(WMD)=-0.11,95%置信区间(CI)(-0.17,-0.05),P<0.0001,WMD=2.61,95%CI(2.13,3.10),P<0.0001],CWHTO治疗组在术前机械轴角度改变差异有统计学意义[WMD=0.82,95%CI(0.04,1.59),P=0.04],OWHTO治疗组与CWHTO治疗组在并发症[WMD=1.5595%CI(0.35,6.93),P=0.57]、视觉模拟评分法(VAS)[WMD=0.46,95%CI(-0.15,1.06),P=0.14]、术前美国特种外科医院膝关节评分(HSS)[WMD=1.72,95%CI(-1.27,4.71),P=0.26]、HSS[WMD=0.70,95%CI(-1.48,2.89),P=0.69]、术后平均矫正角度[WMD=2.61,95%CI(2.13,3.10),P<0.0001]、术后机械轴[WMD=0.21,95%CI(-0.67,1.09),P=0.64)、术前髌骨高度Blackburne-Peel(BP)测量指数[WMD=0.03,95%CI(-0.01,0.07),P=0.12]、术后髌骨高度BP测量指数[WMD=-0.03,95%CI(-0.02,0.07),P=0.31]、术前髌骨高度Insall-Salvati测量指数(ISI)[WMD=0.02,95%CI(-0.08,0.02),P=0.31]、术后髌骨高度ISI[WMD=-0.02,95%CI(-0.06,0.02),P=0.31]及术前胫骨平台后倾角度[WMD=0.58,95%CI(-0.06,1.23),P=0.08]中差异无统计学意义。结论与CWHTO相比,OWHTO治疗内侧间室骨关节炎能增加胫骨平台后倾角,降低髌骨高度和矫正机械轴角度及缩短手术时间,在治疗单间室骨关节炎方面是一种较好的选择。

Objective To evaluate the clinical efficacy of open wedge high tibial osteotomy(OWHTO)and closed wedge high tibial osteotomy(CWHTO)in the medial compartment osteoarthritis of patients with high quality by meta-analysis,in order to give some evidences for the choice of method dealing with the medial compartment osteoarthritis of patients.Methods Cochrane Central Register of Controlled Trials(Issue 62017),Pubmed,Ovid,Spinger Link,Elsevier,Medline were searched(time range:1970-01-01 to 2017-6-30).OWHTO and the CWHTO were used in treating the medial compartment osteoarthritis of patients in the literature.The related literatures including complications,operating time,Hospital for Special Surgery(HSS)knee score,patellar height,mean correction angle,posterior tibial slope angle and hip-knee-ankle angle were explored.A strict quality assessment was performed to screen the literatures which met the inclusion criteria.The analysis was performed with software RevMan5.0 from the Cochrane collaboration.Additionally,the heterogeneity of data was also checked.Results Thirteen relevant articles were included in the standard,and the total sample size was 1237 cases,including OWHTO group of 666 cases,571 cases of the CWHTO group.Comparing the OWHTO group with the CWHTO group,there were significant differences in the postoperative patellar height Caton-Deschamps measurement index,postoperative posterior tibial slope angle and operation time[weighted mean difference(WMD)=0.11,95%confidence interval(CI)(-0.17,-0.05),P<0.0001],[WMD=2.61,95%CI(2.13,3.10),P<0.0001].There was significant difference in the peroperative hip-knee-ankle angle changes of the CWHTO group[WMD=0.82,95%CI(0.04,1.59),P=0.04].There was no significant difference between the OWHTO group and the CWHTO group in complications[WMD=1.5595%CI(0.35,6.93),P=0.57],visual analogue scale(VAS)[WMD=0.46,95%CI(-0.15,1.06),P=0.14],preoperative HSS score[WMD=1.72,95%CI(-1.27,4.71),P=0.26]and postoperative HSS score[WMD=0.70,95%CI(-1.48,2.89),P=0.69],postoperative mean correction angle[WMD=2.61,95%CI(2.13,3.10),P<0.0001],postoperative hip-knee-ankle angle[WMD=0.21,95%CI(-0.67,1.09),P=0.64],preoperative patellar height Blackburne-Peel(BP)measurement index[WMD=0.03,95%CI(-0.01,0.07),P=0.12]and postoperative patellar height BP measurement index[WMD=-0.03,95%CI(-0.02,0.07),P=0.31],preoperative patellar height Insall-Salvati measurement index(ISI)[WMD=0.02,95%CI(-0.08,0.02),P=0.31]and postoperative patellar height ISI[WMD=-0.02,95%CI(-0.06,0.02),P=0.31]and preoperative posterior tibial slope angle[WMD=0.58,95%CI(-0.06,1.23),P=0.08].Conclusion Compared with CWHTO,in the treatment of medial compartment osteoarthritis,OWHTO can increase the posterior tibial slope angle,reduce patella height and correct hip-knee-ankle angle and shorten operation time,which is a better choice for treatment of medial compartment osteoarthritis.