Lee O-Sung, Ahn Soyeon, Lee Yong Seuk
Department of Orthopaedic Surgery, Mediplex Sejong Hospital, Incheon-si, Gyonggi-do, South Korea.
Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul, Korea.
J Knee Surg. 2019 Apr;32(4):372-379. doi: 10.1055/s-0038-1641176. Epub 2018 Apr 4.
The aim of this meta-analysis was to compare the effects of closing-wedge (CW) and opening-wedge (OW) high tibial osteotomies (HTOs) on the change in leg length. Our hypotheses were that leg length will increase after OW HTO and decrease after CW HTO, and the magnitude of the change in leg length would be negligible in both techniques. Multiple databases including MEDLINE, Embase, and Cochrane were searched for studies comparing the change in leg length after HTO with that before HTO. After testing for publication bias and heterogeneity, we aggregated variables by using the random-effects model. The weighted mean differences of leg length were estimated before and after OW and CW HTOs with 95% confidence intervals (CIs). Four studies that analyzed 127 OW HTOs and 175 CW HTOs were included in this meta-analysis. Leg length increased by 6.96 mm after OW HTO (95% CI: -3.43 to 17.36) and decreased by 1.95 mm after CW HTO (95% CI: -10.89 to 7). Additionally, the change in leg length after OW HTO had a positive correlation with the degree of correction. The leg length increased after OW HTO, and the increase was sufficiently large to cause clinical concerns. The change in leg length after CW HTO was negligible despite the decrease in length. Therefore, CW HTO seems to be a better treatment option than OW HTO if a large correction is required.
本荟萃分析的目的是比较闭合楔形（CW）和开放楔形（OW）高位胫骨截骨术（HTO）对腿长变化的影响。我们的假设是，OW HTO术后腿长会增加，CW HTO术后腿长会缩短，并且两种技术中腿长变化的幅度都可以忽略不计。检索了包括MEDLINE、Embase和Cochrane在内的多个数据库，以查找比较HTO术后与术前腿长变化的研究。在检测发表偏倚和异质性后，我们使用随机效应模型汇总变量。估计了OW和CW HTO术前和术后腿长的加权平均差及95%置信区间（CI）。本荟萃分析纳入了四项分析127例OW HTO和175例CW HTO的研究。OW HTO术后腿长增加6.96 mm（95% CI：-3.43至17.36），CW HTO术后腿长减少1.95 mm（95% CI：-10.89至7）。此外，OW HTO术后腿长的变化与矫正程度呈正相关。OW HTO术后腿长增加，且增加幅度足以引起临床关注。尽管CW HTO术后腿长有所缩短，但变化可忽略不计。因此，如果需要进行较大矫正，CW HTO似乎是比OW HTO更好的治疗选择。
