Lee O-Sung, Ahn Soyeon, Lee Yong Seuk
Department of Orthopaedic Surgery, Seoul National University School of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-Si, Gyeonggi-do, 463-707, South Korea.
Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
Arch Orthop Trauma Surg. 2017 Jul;137(7):903-911. doi: 10.1007/s00402-017-2703-1. Epub 2017 Apr 25.
The purpose of this systematic review and meta-analysis was to evaluate the effectiveness and safety of early weight-bearing by comparing clinical and radiological outcomes between early and traditional delayed weight-bearing after OWHTO.
A rigorous and systematic approach was used. The methodological quality was also assessed. Results that are possible to be compared in two or more than two articles were presented as forest plots. A 95% confidence interval was calculated for each effect size, and we calculated the I statistic, which presents the percentage of total variation attributable to the heterogeneity among studies. The random-effects model was used to calculate the effect size.
Six articles were included in the final analysis. All case groups were composed of early full weight-bearing within 2 weeks. All control groups were composed of late full weight-bearing between 6 weeks and 2 months. Pooled analysis was possible for the improvement in Lysholm score, but there was no statistically significant difference shown between groups. Other clinical results were also similar between groups. Four studies reported mechanical femorotibial angle (mFTA) and this result showed no statistically significant difference between groups in the pooled analysis. Furthermore, early weight-bearing showed more favorable results in some radiologic results (osseointegration and patellar height) and complications (thrombophlebitis and recurrence).
Our analysis supports that early full weight-bearing after OWHTO using a locking plate leads to improvement in outcomes and was comparable to the delayed weight-bearing in terms of clinical and radiological outcomes. On the contrary, early weight-bearing was more favorable with respect to some radiologic parameters and complications compared with delayed weight-bearing.
本系统评价和荟萃分析的目的是通过比较开放性楔形高位胫骨截骨术（OWHTO）后早期负重与传统延迟负重的临床和影像学结果，评估早期负重的有效性和安全性。
采用严谨且系统的方法。还评估了方法学质量。将两篇或两篇以上文章中可比较的结果以森林图形式呈现。为每个效应量计算95%置信区间，并计算I²统计量，其表示研究间异质性所致总变异的百分比。采用随机效应模型计算效应量。
最终分析纳入6篇文章。所有病例组均为在2周内早期完全负重。所有对照组均为在6周和2个月之间晚期完全负重。对Lysholm评分的改善进行汇总分析是可行的，但组间未显示出统计学显著差异。其他临床结果在组间也相似。四项研究报告了机械性股胫角（mFTA），该结果在汇总分析中组间未显示出统计学显著差异。此外，早期负重在一些影像学结果（骨整合和髌腱高度）和并发症（血栓性静脉炎和复发）方面显示出更有利的结果。
我们的分析支持，使用锁定钢板的OWHTO术后早期完全负重可改善结果，在临床和影像学结果方面与延迟负重相当。相反，与延迟负重相比，早期负重在一些影像学参数和并发症方面更具优势。
