Kim Jun-Ho, Kim Hyun-Jung, Celik Haluk, Kim Joo-Hwan, Lee Dae-Hee
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Preventive medicine, Korea University College of Medicine, Seoul, South Korea.
BMC Musculoskelet Disord. 2019 Mar 6;20(1):102. doi: 10.1186/s12891-019-2472-9.
This meta-analysis was designed to quantify adduction moment loss, to evaluate the relationship between changes in mechanical axis alignment and adduction moment, and to assess whether sagittal plane moment is altered after medial open wedge high tibial osteotomy (HTO).
Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, all studies reporting preoperative and postoperative peak knee adduction moment or change in peak knee adduction moment from before to after surgery in patients who underwent medial open wedge HTO were included.
Nine studies were included in the meta-analysis. The pooled mean difference in adduction moment from before to after medial open wedge HTO was 1.44% Nm/body weight (BW)xheight (HT) (95% confidence interval [CI]: 1.33 to 1.55% Nm/BWxHT; P < 0.001; I = 4%). However, flexion (0.18% Nm/BWxHT, 95% CI: -0.50 to 0.86% Nm/BWxHT; P = 0.61; I = 79%) and extension (0.15% Nm/BWxHT, 95% CI, - 0.37 to 0.68% Nm/BWxHT; P = 0.56; I = 46%) moments did not differ significantly from before to after surgery. Alignment correction amount and postoperative final valgus alignment were not significantly associated with difference in adduction moment from before to after surgery.
Knee adduction moment after medial open wedge HTO decreased to 60% of the preoperative level. However, this adduction moment decrement was not affected by the magnitude of alignment correction. In addition, there was no change in sagittal plane knee moment, including flexion and extension moments, from before to after medial open wedge HTO.
Meta-analysis (Level II).
本荟萃分析旨在量化内收力矩损失，评估机械轴对线变化与内收力矩之间的关系，并评估内侧开放楔形高位胫骨截骨术（HTO）后矢状面力矩是否改变。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，纳入所有报告接受内侧开放楔形HTO患者术前和术后膝关节内收力矩峰值或手术前后膝关节内收力矩峰值变化的研究。
荟萃分析纳入了9项研究。内侧开放楔形HTO前后内收力矩的合并平均差异为1.44% Nm/体重（BW）×身高（HT）（95%置信区间[CI]：1.33至1.55% Nm/BW×HT；P < 0.001；I = 4%）。然而，屈曲（0.18% Nm/BW×HT，95% CI：−0.50至0.86% Nm/BW×HT；P = 0.61；I = 79%）和伸展（0.15% Nm/BW×HT，95% CI，−0.37至0.68% Nm/BW×HT；P = 0.56；I = 46%）力矩在手术前后无显著差异。对线矫正量和术后最终外翻对线与手术前后内收力矩差异无显著相关性。
内侧开放楔形HTO后膝关节内收力矩降至术前水平的60%。然而，这种内收力矩的降低不受对线矫正幅度的影响。此外，内侧开放楔形HTO前后膝关节矢状面力矩（包括屈曲和伸展力矩）没有变化。
荟萃分析（II级）。
