胫骨结节上与胫骨结节下内侧开放楔形胫骨高位截骨术治疗内侧间室膝骨关节炎有效性和安全性的Meta分析

Clinical outcome and safety of medial open-wedge high tibial osteotomy above and below the tibial tuberosity for treatment of medial compartment knee osteoarthritis:a meta-analysis

目的:系统评价胫骨结节上与胫骨结节下内侧开放楔形胫骨高位截骨术(open-wedge high tibial osteotomy,OWHTO)治疗内侧间室膝骨关节炎(knee osteoarthritis,KOA)的有效性和安全性。方法:通过计算机检索PubMed、Cochrane Library、Embase、中国知网、万方数据库、维普网2000年1月1日至2020年12月31日收录的比较胫骨结节上(试验组)与胫骨结节下(对照组)内侧OWHTO治疗内侧间室KOA的有效性和安全性的随机对照临床研究和回顾性临床研究文献。由2名研究者独立按照统一的评价指标及文献信息提取表进行文献筛选和数据提取,采用纽卡斯尔-渥太华量表对纳入的文献进行质量评价,采用Cochrane协作网提供的RevMan5.2软件进行Meta分析。结果:共检索到257篇文献,经过逐层筛选,最终纳入12篇文献,共涉及752例内侧间室KOA患者,其中试验组416例、对照组336例。Meta分析结果显示,试验组术后髌骨高度(Caton-Deschamps法、Blackburne-Peel法和Insall-Salvati法)、并发症发生率均小于对照组[I^(2)=0%,P=0.610,MD=-0.05,95%CI(-0.07,-0.02),P=0.001;I^(2)=22%,P=0.280,MD=-0.06,95%CI(-0.10,-0.03),P=0.003;I^(2)=88%,P=0.000,MD=-0.08,95%CI(-0.11,-0.05),P=0.000;I^(2)=0%,P=0.960,MD=0.24,95%CI(0.07,0.83),P=0.020];试验组术后美国特种外科医院膝关节功能评分、胫骨后倾角与对照组比较,差异无统计学意义[I^(2)=73%,P=0.030,MD=1.01,95%CI(-1.24,3.25),P=0.380;I^(2)=0%,P=0.600,MD=0.16,95%CI(-0.22,0.54),P=0.420]。结论:胫骨结节上与胫骨结节下内侧OWHTO治疗内侧间室KOA的疗效相当;前者较后者更易导致术后低位髌骨,但其安全性高于后者。

Objective:To systematically review the clinical outcome and safety of medial open-wedge high tibial osteotomy(MOWHTO)above versus below the tibial tuberosity for treatment of medial compartment knee osteoarthritis(KOA).Methods:All the randomized controlled trial(RCT)articles and retrospective clinical trial articles about the clinical efficacy and safety of MOWHTO above the tibial tuberosity(experimental group)versus MOWHTO below the tibial tuberosity(control group)for treatment of medial compartment KOA included from January 1,2000 to December 31,2020 were retrieved from the PubMed,Cochrane Library,Embase,China National Knowledge Internet,Wanfang Database and Vip Database through computer.The articles were screened and the information was extracted independently by two researchers according to unified evaluation index and literature information extraction table.The methodological quality of research in the articles was evaluated according to the Newcastle-Ottawa scale(NOS)and a Meta-analysis was conducted by using RevMan5.2 software provided by Cochrane Collaboration.Results:Two hundred and fifty-seven articles were searched out.After screening,12 articles(752 patients)were included in the final analysis,416 patients in experimental group and 336 patients in control group.The results of Meta-analysis revealed that the postoperative patellar height(measured by Caton-Deschamps method,Blackburne-Peel method and Insall-Salvati method)and the postoperative complication incidence were lower in experimental group compared to control group(I^(2)=0%,P=0.610,MD=-0.05,95%CI(-0.07,-0.02),P=0.001;I^(2)=22%,P=0.280,MD=-0.06,95%CI(-0.10,-0.03),P=0.003;I^(2)=88%,P=0.000,MD=-0.08,95%CI(-0.11,-0.05),P=0.000;I^(2)=0%,P=0.960,MD=0.24,95%CI(0.07,0.83),P=0.020).There was no statistical difference in postoperative Hospital for Special Surgery(HSS)knee function score and posterior tibial slope between experimental group and control group(I^(2)=73%,P=0.030,MD=1.01,95%CI(-1.24,3.25),P=0.380;I^(2)=0%,P=0.600,MD=0.16,95%CI(-0.22,0.54),P=0.420).Conclusion:MOWHTO above the tibial tuberosity is similar to MOW HTO below the tibial tuberosity in clinical outcome in treatment of medial compartment KOA,however,the former displays the advantage as higher safety and the disadvantage as more likely to cause postoperative patella baJa compared to the latter.