膝关节清理术联合腓骨截骨术对比单用膝关节清理术治疗膝骨关节炎的Meta分析

Knee debridement combined with fibular osteotomy and knee debridement alone in the treatment of knee osteoarthritis:a Meta analysis

目的系统评价膝关节清理术联合腓骨截骨术对比单用膝关节清理术治疗膝骨关节炎的临床疗效,以期为膝骨关节炎的临床治疗提供循证医学依据。方法利用计算机检索PubMed、web of science、EMBase、Cochrane图书馆、中国生物医学文献数据库、中国知网、维普全文数据库、万方知识服务平台等数据库,检索时间为建库至2021年10月,筛选关于膝关节清理术联合腓骨截骨术对比单用膝关节清理术治疗膝骨关节炎的临床研究。采用Revman 5.3.0进行Meta分析;基于不同观察时间进行亚组分析,观察不同时间点对于研究结果的影响。结果最终纳入13篇相关文献,文献质量中等,共计924例患者。Meta分析结果显示:膝关节清理术联合腓骨截骨术患者VAS评分、TNF-ɑ、IL-6显著低于单用膝关节清理术,差异有统计学意义(P<0.05);膝关节清理术联合腓骨截骨术患者HSS评分、KSS评分显著高于单用膝关节清理术,差异有统计学意义(P<0.05)。亚组分析结果显示:膝关节清理术联合腓骨截骨术患者VAS评分在术后1个月、3个月、6个月均显著低于单用膝关节清理术,差异有统计学意义(P<0.05);膝关节清理术联合腓骨截骨术患者HSS评分在术后3个月、6个月与单用膝关节清理术相比,差异有统计学意义(P<0.05);膝关节清理术联合腓骨截骨术患者KSS评分在术后6个月与单用膝关节清理术相比,差异有统计学意义(P<0.05)。结论膝关节清理术联合腓骨截骨术治疗膝骨关节炎的近期疗效优于单用膝关节清理术,且手术安全性高。

Objective To systematically evaluate the clinical efficacy of knee debridement combined with fibular osteotomy and knee debridement alone in the treatment of knee osteoarthritis,in order to provide evidence based basis for the treatment of knee osteoarthritis.Methods PubMed,web of science,MBASE,Cochrane Library,CBM,CNKI,VIP and Wanfang knowledge service platform were searched by computer.The retrieval time was from the establishment of the database to October 2021,the clinical studies of knee debridement combined with fibular osteotomy and knee debridement alone in the treatment of knee osteoarthritis were screened.The meta-analysis was carried out by Revman 5.3.0.Subgroup analysis was carried out based on different observation time to observe the impact of different time points on the research results.Results A total of 13 related literatures were included,with medium quality,a total of 924 patients.Meta analysis showed that VAS score,TNF-ɑ,IL-6 in patients with knee debridement combined with fibular osteotomy were significantly lower than those with knee debridement alone(P<0.05).The HSS score and KSS score of patients with knee debridement combined with fibular osteotomy were significantly higher than those with knee debridement alone(P<0.05).Subgroup analysis showed that the VAS score of patients with knee debridement combined with fibular osteotomy was significantly lower than that of patients with knee debridement alone at 1 month,3 months and 6 months after operation(P<0.05).The HSS score of patients with knee debridement combined with fibular osteotomy was significantly different from that of patients with knee debridement alone at 3 and 6 months after operation(P<0.05).There was significant difference in KSS score between knee debridement combined with fibular osteotomy and knee debridement alone at 6 months after operation(P<0.05).Conclusion The short-term effect of knee debridement combined with fibular osteotomy in the treatment of knee osteoarthritis is better than that of knee debridement alone,and the operation is safe.