Slevin Omer, Ayeni Olufemi R, Hinterwimmer Stefan, Tischer Thomas, Feucht Matthias J, Hirschmann Michael T
Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel.
Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2016 Nov;24(11):3584-3598. doi: 10.1007/s00167-016-4297-5. Epub 2016 Aug 24.
A variety of bone void filling materials and methods are available in opening medial wedge HTO (OWHTO). The pertinent question revolves around if and when bone void fillers are needed. The primary purpose of this study was to systematically review outcomes and complications after OWHTO with and without the use of bone void fillers.
The EMBASE, PubMed\MEDLINE, Cochrane Library and Google Scholar databases were searched to identify articles that reported OWHTO results using different bone void fillers until March 2016. Only articles reporting the exact bone void filler type, the opening gap size and the fixation method were included. The extracted data included the study design, demographic data, the radiological and clinical results and complication rates. Outcomes were analysed with regard to bone void filler type, and comparison was made between the groups (allograft, autograft, synthetic bone void filler and OWHTO without bone void filling).
Twenty-two articles reporting the results of 1421 OWHTO met the inclusion criteria. In total, 647 osteotomies were completed with allogeneic graft as bone void filler, 367 with synthetic materials, 199 with autograft and 208 without any bone void filling material. The maximum opening gap size was similar in all groups with mean of 9.8 mm (range 4-17.5 mm). Locking plate fixation was used in 90 % of the osteotomies that were completed without bone void filler, while all allograft cases and more then 90 % of the autograft cases were done with non-locking systems. The highest rates of non-union (1.1 %) were seen in the synthetic group, compared to 0.5 % in the all the other groups.
This systematic review showed no definitive advantages for OWHTO with any bone void filler in terms of union rates and loss of correction. Moreover, the use of autografts or allografts showed more favourable outcomes than synthetic bone substitutes. OWHTO with gaps smaller then 10 mm and rigid fixation might be successfully managed without bone grafting. However, when bone grafting is needed, autograft bone provides higher rates of clinical and radiographic union. The use of synthetic bone substitutes in OWHTO cannot be recommended.
III.
在开放性内侧楔形高位胫骨截骨术（OWHTO）中，有多种骨缺损填充材料和方法可供选择。相关问题围绕是否以及何时需要使用骨缺损填充材料展开。本研究的主要目的是系统回顾使用和不使用骨缺损填充材料的OWHTO术后的疗效和并发症。
检索EMBASE、PubMed\MEDLINE、Cochrane图书馆和谷歌学术数据库，以识别截至2016年3月报道使用不同骨缺损填充材料的OWHTO结果的文章。仅纳入报告确切骨缺损填充材料类型、开口间隙大小和固定方法的文章。提取的数据包括研究设计、人口统计学数据、放射学和临床结果以及并发症发生率。根据骨缺损填充材料类型分析结果，并在各组（同种异体骨移植、自体骨移植、合成骨缺损填充材料和无骨缺损填充的OWHTO）之间进行比较。
22篇报告1421例OWHTO结果的文章符合纳入标准。总共647例截骨术使用同种异体移植物作为骨缺损填充材料完成，367例使用合成材料，199例使用自体骨移植，208例未使用任何骨缺损填充材料。所有组的最大开口间隙大小相似，平均为9.8毫米（范围4-17.5毫米）。在未使用骨缺损填充材料完成的截骨术中，90%使用锁定钢板固定，而所有同种异体骨移植病例和90%以上的自体骨移植病例使用非锁定系统。合成材料组的不愈合率最高（1.1%），而其他所有组为0.5%。
该系统评价表明，在愈合率和矫正丢失方面，使用任何骨缺损填充材料的OWHTO均无明确优势。此外，使用自体骨移植或同种异体骨移植的疗效优于合成骨替代物。间隙小于10毫米且固定牢固的OWHTO可能无需植骨即可成功治疗。然而，当需要植骨时，自体骨移植的临床和影像学愈合率更高。不推荐在OWHTO中使用合成骨替代物。
III级。
Zotero 插件