Chinese Journal of Tissue Engineering Research ›› 2023, Vol. 27 ›› Issue (4): 632-639.doi: 10.12307/2022.988
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Yu Jiaan, Liu Xinwei, Lian Hongyu, Liu Kexin, Li Zitao
Received:
2022-01-08
Accepted:
2022-02-12
Online:
2023-02-08
Published:
2022-06-23
Contact:
Li Zitao, Master, Chief physician, Professor, Master’s supervisor, Second Department of Orthopedics, Hongqi Hospital Affiliated to Mudanjiang Medical College, Mudanjiang 157011, Heilongjiang Province, China
About author:
Yu Jiaan, Master candidate, Second Department of Orthopedics, Hongqi Hospital Affiliated to Mudanjiang Medical College, Mudanjiang 157011, Heilongjiang Province, China
Supported by:
CLC Number:
Yu Jiaan, Liu Xinwei, Lian Hongyu, Liu Kexin, Li Zitao. Medial open-wedge tibial osteotomy versus lateral closed-wedge tibial osteotomy for unicompartmental knee osteoarthritis: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(4): 632-639.
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2.3.2 各组矫正角度的差异 有5项研究报道了两组的矫正角度[11,14,16,18,20],异质性分析结果显示:P=0.03,I2=62%,各研究间异质性明显(MD=0.28,95%CI:-0.64-1.20,P=0.55)。敏感性分析显示,异质性来源可能与LUITES等[16]患者术后角度测量方法不规范有关,剔除文献后异质性明显下降(P=0.97,I2=0%),使用固定效应模型进行分析,结果显示两组间术后矫正角度无显著差异(MD=-0.16,95%CI:-0.75-0.43,P=0.60),见图6。将固定效应模型更换为随机效应模型,结果无变化(MD=-0.16,95%CI:-0.75-0.43,P=0.60),说明结果稳定佳。"
有2项研究报道了两组术后膝关节Lysholm评分[16,18],各研究结果间无统计学异质性(P=0.21,I2=37%),使用固定效应模型分析,结果显示术后Lysholm评分两组间无显著差异(MD=-0.17,95%CI:-2.53-2.19,P=0.89)。将固定效应模型更换为随机效应模型,结果无显著差异(MD=0.89,95%CI:-4.41-6.19,P=0.74),说明结果有良好稳定性。 2.3.4 各组疼痛评分的差异 有4项研究报道了两组术后目测类比评分[12-14,23],各研究结果间无统计学异质性(P=0.20,I2=35%),使用固定效应模型分析,结果显示术后目测类比评分两组间无显著差异(MD=0.12,95%CI:-0.24-0.48,P=0.51),见图8。将固定效应模型更换为随机效应模型,结果无显著差异(MD=0.22,95%CI:-0.37-0.81,P=0.46),说明结果有良好稳定性。 "
2.3.5 胫骨平台后倾角的差异 有9项研究报道了两组术后胫骨平台后倾角[11,14-15,17-22],各研究结果间具有明显统计学异质性(P < 0.000 01,I2=92%),敏感性分析认为各研究间年龄、性别无显著差异,并逐一去除研究,异质性无显著差异。分析认为不同研究者对于影像学阅片的主观差异以及不同医生手术技术的差别是异质性来源,遂使用随机效应模型分析,结果显示术后胫骨平台后倾角两组间有显著差异(MD=2.82,95%CI:1.31-4.33,P=0.000 2),内侧开放截骨组术后胫骨平台后倾角更大,见图9。将随机效应模型更换为固定效应模型,结果无显著差异 (MD=3.47,95%CI:3.09-3.85,P < 0.000 01),说明结果有良好稳定性。 "
2.3.6 各组髌骨高度变化的差异 有2项研究报道了两组术后髌骨高度的Caton-Deschamps指数(CDI) [12,21],各研究结果间无统计学异质性(P=0.31,I2=2%),选择固定效应模型分析,结果显示两组术后髌骨高度CDI有较大差异(MD=-0.16,95%CI:-0.21至-0.11,P < 0.000 01),内侧开放截骨术后髌骨高度较低。将固定效应模型更换为随机效应模型,结果无变化,说明结果稳定。 有5项研究报道了两组术后髌骨高度的Insall-Salvati指数(ISI) [11,15,17-18,21],异质性分析:P < 0.000 01,I2=91%,各研究间异质性较大(MD=-0.03,95%CI:-0.12-0.05,P=0.48)。敏感性分析认为异质性可能来源于人种差异,并剔除文献。剔除文献[18]后异质性明显下降(P=0.26,I2=25%),使用固定效应模型进行分析,结果显示两组间术后ISI有显著差异(MD=-0.05,95%CI:-0.09至-0.02,P=0.005),内侧开放截骨术后髌骨位置较低,见图10。将固定效应模型更换为随机效应模型,结果无显著差异(MD=-0.06,95%CI:-0.10至-0.01,P=0.01),说明结果较稳定。 "
2.3.7 各组手术时间差异 有2项研究报道了两组手术时间[12,15],各研究结果间有统计学异质性(P=0.06,I2=71%),选择随机效应模型分析,结果显示两组手术时间有显著差异(MD=-19.48,95%CI:-31.02至-7.94,P=0.000 9)。内侧开放截骨相比外侧闭合截骨手术时间更短。将随机效应模型更换为固定效应模型,结果无显著差异(MD=-20.43,95%CI:-26.45至-14.41,P < 0.000 01),说明结果较稳定。 2.3.8 各组术后并发症差异 有5项研究报道了两组术后并发症[12-14,18,23],异质性分析:P=0.01,I2=68%,各研究间异质性较大(OR=1.54,95%CI:0.32-7.29,P=0.59)。进行敏感性分析后,发现年龄、性别等均不是异质性来源,可能与医生的手术操作有关。剔除文献[13]后异质性明显下降(P=0.51,I2=0%),使用固定效应模型进行分析,结果显示两组间术后并发症发生率没有显著差异(OR=0.68,95%CI:0.25-1.82,P=0.44),见图12。"
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