3D打印导板辅助胫骨高位截骨术治疗内翻性膝骨关节炎疗效的Meta分析

Meta-analysis of the Effect of 3D Printed Guide Plate Assisted High Tibial Osteotomy on Varus Knee Osteoarthritis

目的:系统评价3D打印导板辅助胫骨高位截骨术治疗内翻性膝骨关节炎的疗效。方法:计算机检索中国知网(CNKI)、万方(WanFang)、维普(VIP)、PubMed、Embase、The Cochrane Library、Web of Science和中国生物医学文献数据库(CBM)等数据库,搜集3D打印导板辅助胫骨高位截骨术治疗内翻性膝骨关节炎的随机对照试验或队列研究,检索时限均从建库至2021年3月。由2名研究人员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 14.1和Review Manager 5.3软件进行Meta分析。疗效指标包括治疗前后美国特种外科医院膝关节评分(HSS评分)、股骨胫骨角(FTA)、下肢负重线比率(WBL)、胫骨近端内侧角(MPTA)和胫骨后倾角(PTS),采用随机效应模型分析。结果:初次检索获得文献1549篇,按照纳入及排除标准,最终纳入13篇文献333例患者。Meta分析结果显示,8篇文献报道了治疗前后HSS评分,治疗前HSS评分为61.32分(95%CI=[54.97,67.66],P < 0.001,I^(2)=99.0%),治疗后HSS评分为87.10分(95%CI=[84.46,89.73],P < 0.001,I^(2)=96.4%)。6篇文献报道了治疗前后FTA,治疗前FTA为177.52°(95%CI=[170.62,184.43],P < 0.001,I^(2)=99.4%),治疗后FTA为174.06°(95%CI=[170.12,178.00],P < 0.001,I^(2)=99.6%)。5篇文献报道了治疗前后WBL,治疗前WBL为14.39%(95%CI=[8.19,20.59],P < 0.001,I^(2)=81.6%),治疗后WBL为61.47%(95%CI=[59.92,63.03],P < 0.001,I^(2)=91.3%)。7篇文献报道了治疗前后MPTA,治疗前MPTA为81.62°(95%CI=[80.70,82.53],P < 0.001,I^(2)=86.3%),治疗后MPTA为89.80°(95%CI=[88.56,91.05],P < 0.001,I^(2)=97.6%)。7篇文献报道了治疗前后PTS,治疗前PTS为9.01°(95%CI=[7.90,10.12],P < 0.001,I^(2)=93.1%),治疗后PTS为8.64°(95%CI=[7.71,9.57],P < 0.001,I^(2)=98.1%)。结论:3D打印导板辅助胫骨高位截骨术治疗内翻性膝骨关节炎疗效肯定,术后膝关节功能恢复良好,矫正力线效果佳。

Objective:To systematically evaluate the efficacy of 3D printed guide plate assisted high tibial osteotomy in the treatment of varus knee osteoarthritis.Methods:The databases such as CNKI,WanFang,VIP,PubMed,Embase,the Cochrane Library,Web of Science and CBM were searched by computer to collect randomized controlled trials or cohort studies of 3D printed guide plate assisted high tibial osteotomy for the treatment of varus knee osteoarthritis.The search time was limited from the establishment of the databases to March 2021.After two researchers independently screened the literature,extracted data and evaluated the risk of bias in the included studies,they used softwares Stata 14.1 and Review Manager 5.3 for Meta-analysis.The efficacy indicators included the knee joint score of HSS,FTA,WBL,MPTA and PTS)before and after treatment,which were analyzed by random effect model.Results:1549 articles were obtained in the initial search.According to the inclusion and exclusion criteria,13 articles were finally included,with a total of 333 patients.The results of meta-analysis showed that 8 articles reported HSS scores before and after treatment,and the HSS score before treatment was 61.32(95% CI=[54.97,67.66],P < 0.001,I^(2)=99.0%);The HSS score after treatment was 87.10(95%CI=[84.46,89.73],P < 0.001,I^(2)=96.4%).Six articles reported the FTA before and after treatment,and the FTA before treatment was 177.52°(95% CI=[170.62,184.43],P < 0.001,I^(2)=99.4%);FTA after treatment was 174.06°(95% CI=[170.12,178.00],P < 0.001,I^(2)=99.6%).Five articles reported WBL before and after treatment,and the WBL before treatment was 14.39%(95% CI=[8.19,20.59],P < 0.001,I^(2)=81.6%);WBL after treatment was 61.47%(95% CI=[59.92,63.03],P < 0.001,I^(2)=91.3%).Seven articles reported MPTA before and after treatment,and the MPTA before treatment was 81.62°(95% CI=[80.70,82.53],P < 0.001,I^(2)=86.3%);MPTA after treatment was 89.80°(95% CI=[88.56,91.05],P < 0.001,I^(2)=97.6%).Seven articles reported PTS before and after treatment,and the PTS before treatment was 9.01°(95% CI=[7.90,10.12],P < 0.001,I^(2)=93.1%);PTS after treatment was 8.64°(95% CI=[7.71,9.57],P < 0.001,I^(2)=98.1%).Conclusion:3D printed guide plate assisted high tibial osteotomy is effective in the treatment of varus knee osteoarthritis,with good recovery of knee function and good effect of force line correction.