膝骨关节炎胫骨高位截骨是否关节镜清理的荟萃分析△

A meta-analysis on high tibial osteotomy with or without arthroscopic debridement for knee osteoarthritis

摘要:

[目的] 采用荟萃分析评价胫骨高位截骨术（high tibial osteotomy, HTO） 与胫骨高位截骨术联合关节镜下清理术（high tibial osteotomy combined with arthroscopy, HTO-A） 治疗膝骨关节炎的临床疗效。[方法] 检索建库至2024 年1 月在PubMed、Web of Science、Embase、Cochrane Library、中国知网、万方和维普数据库中的文献，采用Revman 5.4 软件对纳入文献进行荟萃分析。[结果] 共纳入8 篇文献，3 篇随机对照试验，5 篇回顾性队列研究。共纳入患者547 例，其中HTOA组290 例，HTO 组257 例。荟萃分析表明：HTO-A 组术后膝关节活动度（MD=4.61, 95%CI 1.28~7.94, P=0.007）、术后1 个月（MD=-0.97, 95%CI -1.79~-0.15, P=0.02）、3 个月（MD=-0.51, 95%CI -0.62~-0.40, P＜0.001）、6 个月（MD=-0.38, 95%CI -0.46~-0.31, P＜0.001） 的VAS 评分及术后1 个月（MD=4.94, 95%CI 3.15~6.73, P＜0.001）、3 个月（MD=4.30, 95%CI 1.07~7.54, P=0.009）、6 个月（MD=3.54, 95%CI 2.47~4.61, P＜0.001）、12 个月（MD=4.26, 95%CI 3.30~5.21, P＜0.001） 的HSS 评分均优于HTO 组，但两组术后并发症发生率（OR=0.58, 95%CI 0.24~1.43, P=0.24） 及术后12 个月VAS 评分（MD=0.00, 95%CI -0.23~0.22, P=0.98） 的差异无统计学意义。[结论] 相较于单纯HTO，HTO-A 术后具有更大的膝关节活动度、更好的膝关节功能和短期内更轻的疼痛症状，但术后并发症发生率和远期疼痛症状两者无明显差别。

Abstract:

[Objective] To evaluate clinical efficacy of high tibial osteotomy with arthroscopic debridement (HTO-A) verusus high tibialosteotomy without arthroscopic debridement (HTO) by a meta-analysis. [Methods] The related literatures were searched in PubMed, Web ofScience, Embase, Cochrane Library, CNKI, Wanfang and PP databases from January 2024, and a meta-analysis of the included literatureswas performed using Revman 5.4 software. [Results] A total of 8 literatures were enrolled into this study, including 3 randomized controlledtrials and 5 retrospective cohort studies, with 547 patients included, involving 290 in the HTO-A group and 257 in the HTO group. As re-sults of the meta-analysis, the HTO-A group was significantly superior to the HTO group in terms of postoperative knee range of motion(MD=4.61, 95%CI 1.28-7.94, P=0.007), VAS score (MD=-0.97, 95%CI -1.79~0.15, P=0.02) 1 month, (MD=-0.51, 95%CI -0.62~0.40, P＜0.001) 3 months, (MD=-0.38, 95%CI -0.46~-0.31, P＜0.001) 6 months postoperatively, and HSS score (MD=4.94, 95%CI 3.15~6.73, P＜0.001) 1 month, (MD=4.30, 95%CI 1.07~7.54, P=0.009) 3 months, (MD=3.54, 95%CI 2.47~4.61, P＜0.001) 6 months and (MD=4.26, 95%CI 3.30~5.21, P＜0.001) 12 months postoperatively. However, there were no significant differences in postoperative complication rate (OR=0.58, 95%CI 0.24-1.43, P=0.24) and VAS score 12 months after surgery (MD=0.00, 95%CI -0.23~0.22, P=0.98) between the two groups.[Conclusion] Compared with HTO alone, the HTO combined arthroscopic debridement has greater knee range of motion, better knee jointfunction and less pain symptoms in the short term, but there is no significant difference in the incidence of postoperative complications andlong-term pain symptoms.