Abstract：
OBJECTIVE: Medial opening wedge high tibial osteotomy (MOWHTO) is a mainstream surgical method for treating early medial compartment knee osteoarthritis. Undesirable sequelae such as patella infera may happen following tuberosity osteotomy. We conducted this systematic review and meta-analysis to compare the change in patellar position after proximal tibial tubercle osteotomy (PTO) versus distal tibial tubercle osteotomy (DTO) intervention.
METHODS: The 11 studies were acquired from PubMed, Medline, Embase and Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed by RevMan5.3. Mean differences, odds ratios and 95% confidence intervals were calculated. Cochrane Collaboration\'s Risk of Bias Tool and Newcastle-Ottawa Scale were used to assess risk of bias.
RESULTS: Eleven observational studies were assessed. The methodological quality of the trials ranged from moderate to high. The pooled results of postoperative patellar height (Caton-Deschamps index and Blackburne-Peel index) and postoperative complications showed that the differences were statistically significant between PTO and DTO interventions. Patellar index ratios decreased significantly in the PTO groups, and 12 (9.2%) complications under DTO surgery and 2 (1.6%) complications under PTO surgery were reported. The differences of postoperative posterior tibial slope (angle) was not statistically significant, but postoperative posterior tibial slope of both groups increased. Sensitivity analysis proved the stability of the pooled results and the publication bias was not apparent.
CONCLUSIONS: DTO in MOWHTO maintained the postoperative patellar height, and clinically, for patients with serious patellofemoral osteoarthritis, DTO can be preferred. Postoperative complications are easily preventable with caution. In view of the heterogeneity and small sample size, whether these conclusions are applicable should be further determined in future studies.
METHODS: The 11 studies were acquired from PubMed, Medline, Embase and Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed by RevMan5.3. Mean differences, odds ratios and 95% confidence intervals were calculated. Cochrane Collaboration\'s Risk of Bias Tool and Newcastle-Ottawa Scale were used to assess risk of bias.
RESULTS: Eleven observational studies were assessed. The methodological quality of the trials ranged from moderate to high. The pooled results of postoperative patellar height (Caton-Deschamps index and Blackburne-Peel index) and postoperative complications showed that the differences were statistically significant between PTO and DTO interventions. Patellar index ratios decreased significantly in the PTO groups, and 12 (9.2%) complications under DTO surgery and 2 (1.6%) complications under PTO surgery were reported. The differences of postoperative posterior tibial slope (angle) was not statistically significant, but postoperative posterior tibial slope of both groups increased. Sensitivity analysis proved the stability of the pooled results and the publication bias was not apparent.
CONCLUSIONS: DTO in MOWHTO maintained the postoperative patellar height, and clinically, for patients with serious patellofemoral osteoarthritis, DTO can be preferred. Postoperative complications are easily preventable with caution. In view of the heterogeneity and small sample size, whether these conclusions are applicable should be further determined in future studies.
摘要：
目的：内侧开口楔形胫骨高位截骨术（MOWHTO）是治疗早期内侧间室膝骨关节炎的主流手术方法。结节截骨后可能会出现不理想的后遗症，例如髌骨。我们进行了这项系统评价和荟萃分析，以比较胫骨结节近端截骨（PTO）和胫骨结节远端截骨（DTO）介入治疗后髌骨位置的变化。
方法：11项研究来自PubMed，Medline,Embase和Cochrane图书馆。数据由两位共同作者独立提取，并通过RevMan5.3进行分析。平均差异，计算比值比和95%置信区间.使用CochraneCollaboration的偏差风险工具和纽卡斯尔-渥太华量表评估偏差风险。
结果：评估了11项观察性研究。试验的方法学质量从中等到高不等。术后髌骨高度（Caton-Deschamps指数和Blackburne-Peel指数）和术后并发症的汇总结果显示，PTO和DTO干预之间的差异有统计学意义。PTO组髌骨指数比率显著下降，并报告了12例(9.2%)DTO手术并发症和2例(1.6%)PTO手术并发症.术后胫骨后斜率(角度)差异无统计学意义,但两组术后胫骨后斜度均增加。敏感性分析证明了合并结果的稳定性，发表偏倚不明显。
结论：MOWHTO的DTO维持术后髌骨高度，临床上，对于严重的髌股骨关节炎患者，DTO可以是首选。术后并发症很容易谨慎预防。鉴于异质性和样本量小，这些结论是否适用应在未来的研究中进一步确定.
方法：11项研究来自PubMed，Medline,Embase和Cochrane图书馆。数据由两位共同作者独立提取，并通过RevMan5.3进行分析。平均差异，计算比值比和95%置信区间.使用CochraneCollaboration的偏差风险工具和纽卡斯尔-渥太华量表评估偏差风险。
结果：评估了11项观察性研究。试验的方法学质量从中等到高不等。术后髌骨高度（Caton-Deschamps指数和Blackburne-Peel指数）和术后并发症的汇总结果显示，PTO和DTO干预之间的差异有统计学意义。PTO组髌骨指数比率显著下降，并报告了12例(9.2%)DTO手术并发症和2例(1.6%)PTO手术并发症.术后胫骨后斜率(角度)差异无统计学意义,但两组术后胫骨后斜度均增加。敏感性分析证明了合并结果的稳定性，发表偏倚不明显。
结论：MOWHTO的DTO维持术后髌骨高度，临床上，对于严重的髌股骨关节炎患者，DTO可以是首选。术后并发症很容易谨慎预防。鉴于异质性和样本量小，这些结论是否适用应在未来的研究中进一步确定.
