宋伟;朱振国;徐进;殷明;

• 1:南昌大学第二附属医院骨科

摘要(Abstract)：

[目的]通过荟萃分析系统评价单髁置换术与胫骨高位截骨术治疗膝关节骨性关节炎的疗效。[方法]检索Pubmed,web of science,Medline,Cochrane library,中国知网,中国生物医学数据库等数据库自建库至2017年11月份的文献,手工检索中华系列杂志近5年的相关文献,收集所有单髁置换术及胫骨高位截骨术治疗膝关节骨性关节炎的随机对照研究文献,筛选出符合的文章,由2名研究员分别独立使用Cochrane 5.1.0风险偏倚评估工具对文献的方法学偏倚进行评价,提取文献数据并录入Revman 5.3软件行荟萃分析。[结果]共纳入18篇文献,1 416例,其中单髁置换术组733例,胫骨高位截骨术组683例。荟萃分析结果显示,单髁置换术在术后关节功能优良率方面高于胫骨高位截骨术,差异具有统计学意义(OR=2.57,95%CI 1.68～3.93,P<0.001);单髁置换术术后患者正常行走速度与胫骨高位截骨术相比,单髁置换术较快,差异具有统计学意义(OR=0.05,95%CI 0.00～0.11,P=0.003);单髁置换术的术后并发症发病率比胫骨高位截骨术低,差异具有统计学意义(OR=0.38,95%CI 0.20～0.70,P=0.002);在术后翻修率方面,单髁置换术组的翻修率低于胫骨高位截骨术组,差异具有统计学意义(OR=0.39,95%CI 0.25～0.60,P<0.001)。[结论]单髁置换术在膝关节功能优良率及术后正常行走速度方面高于胫骨高位截骨术,且并发症及翻修率低于胫骨高位截骨术。

关键词(KeyWords)： 单髁置换术;胫骨高位截骨术;膝关节骨性关节炎;荟萃分析

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 宋伟;朱振国;徐进;殷明;

Email:

DOI:

参考文献(References)：

• [1]Loeser RF.Aging and osteoarthritis:the role of chondrocyte senescence and aging changes in the cartilage matrix[J].Osteoarthritis Cartilage,2009,17(8):971-979.
• [2]Nasi S,Ea HK,So A,et al.Revisiting the role of interleukin-1pathway in osteoarthritis:interleukin-1αand-1β,and nlrp3 inflammasome are not involved in the pathological features of the murine menisectomy model of osteoarthritis[J].Frontiers Pharmacol,2017,8(2):282.
• [3]Habouri L,El Mansouri FE,Ouhaddi Y,et al.Deletion of 12/15-lipoxygenase accelerates the development of aging-associated and instability-induced osteoarthritis[J].Osteoarthritis Cartilage,2017,25(10):1719-1728.
• [4]Tootsi K,M?rtson A,Kals J,et al.Metabolic factors and oxidative stress in osteoarthritis:a case-control study[J].Scandinavian JClin Laboratory Investigation,2017,77(7):1-7.
• [5]Jeon YS,Ahn CH,Kim MK.Comparison of HTO with articular cartilage surgery and UKA in unicompartmental OA[J].J Orthop Surg,2017,25(1):2309499016684092.
• [6]Krych AJ,Reardon P,Sousa P,et al.Unicompartmental knee arthroplasty provides higher activity and durability than valgus-producing proximal tibial osteotomy at 5 to 7 years[J].J Bone Joint Surg Am,2017,99(2):113.
• [7]Petersen W,Metzlaff S.Open wedge high tibial osteotomy(HTO)versus mobile bearing unicondylar medial joint replacement:five years results[J].Archives Orthop Trauma Surg,2016,136(7):983-989.
• [8]Tuncay I,Bilsel K,Elmadag M,et al.Evaluation of mobile bearing unicompartmental knee arthroplasty,opening wedge,and dometype high tibial osteotomies for knee arthritis[J].Acta Orthop Et Traumatol Turcica,2015,49(3):280-287.
• [9]丁勇,李钊,胡运生,等.单髁置换术与胫骨高位截骨术治疗膝骨性关节炎疗效比较[J].生物骨科材料与临床研究,2015,12(2):75-77.
• [10]Karamitev SS,Stavrev VP,Chifligarov AG.Comparative analysis of the results obtained after unicondylar knee arthroplasty and high tibial osteotomy in isolated gonarthrosis[J].Folia Med,2014,56(1):11.
• [11]赵加松,扶世杰,汪国友,等.关节镜下单髁置换与胫骨高位截骨治疗中重度膝关节单间室骨关节炎的疗效比较[J].中华创伤骨科杂志,2014,16(2):179-181.
• [12]Yim JH,Song EK,Seo HY,et al.Comparison of high tibial osteotomy and unicompartmental knee arthroplasty at a minimum followup of 3 years[J].J Arthroplasty,2013,28(2):243.
• [13]Takeuchi R,Umemoto Y,Aratake M,et al.A mid term comparison of open wedge high tibial osteotomy vs unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee[J].JOrthop Surg Res,2010,5(1):65.
• [14]B?rjesson M,Weidenhielm L,Mattsson E,et al.Gait and clinical measurements in patients with knee osteoarthritis after surgery:a prospective 5-year follow-up study[J].Knee,2005,12(2):121-127.
• [15]Stukenborg-Colsman C,Wirth CJ,Lazovic D,et al.High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis:7-10-year follow-up prospective randomised study[J].Knee,2001,8(3):187-194.
• [16]Weale AE,Newman JH.Unicompartmental arthroplasty and high tibial osteotomy for osteoarthrosis of the knee.A comparative study with a 12-to 17-year follow-up period[J].Clin Orthop,1994302(302):134-137.
• [17]Weidenhielm L,Olsson E,Brostr?m LA,et al.Improvement in gait one year after surgery for knee osteoarthrosis:a comparison between high tibial osteotomy and prosthetic replacement in a prospective randomized study[J].Scandinavian J Rehabilitation Med1993,25(1):25.
• [18]Weidenhielm L,Svensson OK,Brostr?m L?,et al.Change in adduction moment about the knee after high tibial osteotomy and prosthetic replacement in osteoarthrosis of the knee[J].Clin Biomechanics,1992,7(7):91-96.
• [19]Ivarsson I,Gillquist J.Rehabilitation after high tibial osteotomy and unicompartmental arthroplasty.A comparative study[J].Clin Orthop,1991,266(266):139-144.
• [20]Jefferson RJ,Whittle MW.Biomechanical assessment of unicompartmental knee arthroplasty,total condylar arthroplasty and tibial osteotom[J].Clin Biomech,1989,4(4):232-242.
• [21]Broughton NS,Newman JH,Baily RA.Unicompartmental replacement and high tibial osteotomy for osteoarthritis of the knee.Acomparative study after 5~10 years'follow-up[J].J Bone Joint Surg Br,1986,68(3):447-452.
• [22]Karpman RR,Volz RG.Osteotomy versus unicompartmental prosthetic replacement in the treatment of unicompartmental arthritis of the knee[J].Orthopedics,1982,5(8):989-991.
• [23]Sharma L.Osteoarthritis year in review 2015:clinical[J].Osteoarthritis Cartilage,2016,24(1):36-48.
• [24]Ledingham J,Regan M,Jones A,et al.Radiographic patterns and associations of osteoarthritis of the knee in patients referred to hospital[J].Ann Rheumatic Dis,1993,52(7):520-526.
• [25]Jackson JP,Waugh W.Tibial osteotomy for osteoar hrits of the knee[J].J Bone Joint Surg Br,1961,43:746.
• [26]Rossi R,Bonasia DE,Amendola A.The role of high tibial osteotomy in the varus knee[J].J Am Acad Orthop Surg,2011,19(10):590-599.
• [27]Jamali AA,Scott RD,Rubash HE,et al.Unicompartmental knee arthroplasty:past,present,and future[J].Am J Orthop(Belle Mead NJ),2009,38(1):17-23.
• [28]Isaac SM,Barker KL,Danial IN,et al.Does arthroplasty type influence knee joint proprioception?A longitudinal prospective study comparing total and unicompartmental arthroplasty[J].Knee,2007,14(3):212-217.
• [29]Fu D,Li G,Chen K,et al.Comparison of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of unicompartmental osteoarthritis:a meta-analysis[J].J Arthroplasty,2013,28(5):759-765.2018-05-17