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

摘要:

［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 1 549 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。

Abstract:

[Objective] To compare the clinical outcomes of the high tibial osteotomy (HTO) versus unicompartmental knee arthroplas- ty (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 Janu- ary 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 1 549 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%CI (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 mo- tion, 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 osteoar- thritis of the knee, whereas the UKA has advantages in terms of postoperative complications, Lysholm score and revision rate over the HTO.