开放楔形胫骨高位截骨与单髁置换治疗膝关节内侧间室骨关节炎疗效的Meta分析

目的:系统评价开放楔形胫骨高位截骨(OWHTO)与单髁置换(UKA)治疗膝关节内侧间室骨关节炎的疗效。方法:按照Cochran协作网制定的检索策略进行检索,计算机检索Medline,Pubmed,EMbase,Cochrane Library,中国生物医学数据库,中文科技期刊数据库,万方数据库,手工检索相关的中英文骨科杂志和会议论文,检索时间截止为2018年3月。纳入OWHTO和UKA治疗膝关节内侧骨性关节炎的对照研究,对文献质量进行评价,对文献报道的术后膝关节功能、术后并发症、术后全膝关节置换术(TKA)翻修率、术后疼痛等数据进行提取,采用RevMan 5.0软件对数据进行Meta分析。结果:纳入符合标准的文献共8篇,共675例患者。Meta分析结果显示,OWHTO组与UKA组在术后膝关节HSS评分、膝评分、功能评分、Lysholm评分差异无统计学意义(P=0.32,P=0.87,P=0.22,P=0.53),OWHTO组术后关节活动度优于UKA组,差异有统计学意义(P=0.009);两组术后并发症及术后TKA翻修率差异无统计学意义(P=0.81,P=0.23)。两组患者术后膝关节疼痛无差异。结论:在治疗符合手术指征的膝关节内侧间室骨关节炎时,采用OWHTO可获得与UKA相似的膝关节评分、术后并发症和术后TKA翻修率,但是OWHTO术后关节活动度更好。

Open-wedge high tibial osteotomy and unicomartmental knee arthroplasty in treating medial compartment osteoarthritis of the knee:a Meta analysis

Objective:To systematic evaluate the outcome of open-wedge high tibial osteotomy(OWHTO) and unicomartmental knee arthroplasty (UKA) in treating medial compartment osteoarthritis of the knee.Methods:According to the retrieval strategy made by the Cochrane collaboration,a computer-base research of Medline,Pubmed,EMbase,Cochrane Library,CBM,CNKI,and Wanfang databases was performed and search deadline was March 2018. Related Chinese and English orthopedic journals and conference papers were manually searched. Controlled studies of OWHTO and UKA in the treatment of medial knee osteoarthritis were included. The quality of included researches was evaluated,and the data of postoperative knee function,complications,total knee arthroplasty(TKA) revision rates,and postoperative pain were extracted. Meta analysis was performed using the RevMan 5.0 software.Results:A total of 8 articles that met the criteria were included containing a total of 675 patients. Meta-analysis showed that there was no significant difference in postoperative HSS score,knee score,functional score,and Lysholm score between the OWHTO and UKA groups(P=0.32,P=0.87,P=0.22,P=0.53). The range of joint motion in the OWHTO group was better than that in the UKA group,and the difference was statistically significant(P=0.009). There was no significant difference in postoperative complications and the rates of revision to TKA between the two groups(P=0.81,P=0.23). There was no difference in postoperative knee pain between the two groups.Conclusion:In the treatment of medial compartmental osteoarthritis of the knee that meets the surgical indications,OWHTO had better postoperative joint mobility. The results were similar in postoperative knee score,postoperative complications,and postoperative TKA revision rates between OWHTO and UKA groups.