胫骨高位截骨与单髁置换的荟萃分析

High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee:a me-ta-analysis

[目的]系统评价膝内侧室骨性关节炎胫骨高位截骨(high tibial osteotomy,HTO)与单髁置换(unicompartmental knee arthroplasty,UKA)的临床疗效.[方法]检索2000年1月—2020年12月Cochrane Library、PubMed、EMBASE、中国知网、万方、维普及中国生物医学(CBM)数据库,收集关于膝内侧室骨性关节炎HTO与UKA治疗的研究文献.根据纳入与排除标准独立进行文献筛选、质量评价及资料提取,使用Revman5.3软件对结局指标进行荟萃分析.[结果]共纳入17项研究,包括1549例膝关节,其中HTO组688膝,UKA组861膝.荟萃分析结果显示:UKA组在术后并发症[OR=4.52,95%CI(2.30,8.90),P<0.001],Lysholm评分[MD=-5.53,95%CI(-11.11,0.05),P=0.05],翻修率[OR=1.67,95%CI(1.01,2.76),P=0.05],显著优于HTO组;而在手术时间、失血量、其他膝关节功能评分、关节活动度、临床结果优良率、下肢力线、软骨退变等方面两组间差异均无统计学意义(P>0.05).[结论]HTO和UKA治疗膝内侧室骨性关节炎可取得相似满意的临床效果,相比之下,UKA在术后并发症、Lysholm评分和翻修率方面均优于HTO.

[Objective]To compare the clinical outcomes of the high tibial osteotomy(HTO)versus unicompartmental knee arthroplasty(UKA)for medial compartment osteoarthritis of the knee.[Methods]The Cochrane Library,PubMed,EMBASE,CNKI,Wanfang,VIP and CBM database were searched for the clinical outcomes of HTO versus UKA for medial compartment osteoarthritis of the knee from January 2000 to December 2020.Literature screening,quality assessment,and data extraction were conducted based on inclusion and exclusion criteria.RevMan5.3 was used to perform the meta-analysis of parameters related to the consequences.[Results]A total of 17 studies were included,involving 1549 knee,including 688 knees in the HTO group and 861 knees in the UKA group.As results of meta-analysis,the UKA group proved significantly superior to the HTO group in terms of postoperative complications[OR=4.52,95%Cl(2.30,8.90),P<0.0001],Lysholm score[MD=-5.53,95%CI(-11.11,0.05),P=0.05],revision rate[OR=1.67,95%CI(1.01,2.76),P=0.05].However,there were no significant differences between the two groups in terms of operation time,blood loss,other knee functional scroes,range of motion,excellent and good rates of clinical consequences,as well as mechanical axis of the lower limb and cartilage degeneration measured on radiographs(P>0.05).[Conclusion]Both HTO and UKA achieve similarly satisfactory clinical outcomes for medial compartment osteoarthritis of the knee,whereas the UKA has advantages in terms of postoperative complications,Lysholm score and revision rate over the HTO.