目前开放性楔形胫骨高位截骨术已被广泛应用于内侧膝关节骨关节炎的治疗，并取得了较好的临床疗效，但开放性楔形胫骨高位截骨术中植入自体骨与其他植骨材料的对比疗效尚缺乏循证医学证据。系统评价开放性楔形胫骨高位截骨术中植入自体骨与其他植骨材料的疗效。

检索中国生物医学文献、中国知网、万方、维普、荷兰医学文摘(Embase)、PubMed、Cochrane图书馆、Web of Science、中国生物医学文献数据库(CBM)，检索时间均为建库至2022年11月。查找所有开放性楔形胫骨高位截骨术中植入自体骨与其他植骨材料的对照研究。对文献的研究类型、研究对象、干预措施及评价指标等进行综合筛选、质量评价和数据提取，并应用Revman Manager 5.4软件进行Meta分析。主要分析的指标是胫骨高位截骨术的手术时间、愈合时间、术后股骨胫骨角[股骨解剖轴与胫骨解剖轴的外侧夹角(FTA)]、术后膝关节协会评分(KSS)、术后特种外科医院(HSS)膝关节功能评分、延迟愈合率、术后外侧铰链骨折和并发症。

共纳入9篇文献，共437例胫骨高位截骨术膝关节病例，其中203例行自体骨植骨，234例行同种异体骨或人工骨植骨。Meta分析结果显示：自体骨组手术时间[均数差(MD)＝13.94，95%置信区间(CI)(11.39，16.50)，P<0. 001]长于其他植骨材料组。自体组的愈合时间[标准化均数差(SMD)＝－0.45，95% CI(－0.87，－0.02)，Z＝2.04，P＝0. 04]短于其他植骨材料组。术后FTA(股骨胫骨角)[MD＝0.02，95% CI(－0.33，0.37)，Z＝0.11，P＝0. 91]、术后KSS膝关节评分[MD＝2.16，95% CI(－3.17，7.49)，P＝0.43]、术后HSS膝关节功能评分[MD＝0.25，95% CI(－0.38，0.87)，P＝0.44]、延迟愈合率[RD＝－0.02，95% CI(－0.08，0.05)，Z ＝0.51，P＝0.61]、术后外侧铰链骨折[RR＝0.72，95% CI(0.42，1.23)，P＝0.23]和并发症[RD＝－0.00，95% CI(－0.06，0.06)，P＝0.98]两组差异均无统计学意义。

自体骨在开放性楔形胫骨高位截骨术中能够更好地促进截骨端的愈合，且不会增加并发症的发生，但术中手术时间也相应增加，建议常规使用自体骨植骨更好地促进合页端的愈合。但由于本研究纳入文献的数量和质量有限，上述结论仍需大样本、高质量的前瞻性随机对照研究进一步验证。

By correcting the lower extremity alignment of the proximal tibial osteotomy, the force of the knee osteoarthritis can be redistributed to the healthy part of the knee joint, so as to slow down the degenerative changes of the knee joint, which is beneficial to the bone joint with malalignment. inflammation treatment. It is an important method for the treatment of knee osteoarthritis.

By searching Chinese biomedical literature, China national knowledge infrastructure(CNKI), Wanfang, Database for Chinese Technical Periodicals(VIP), Excerpta Medica Database(Embase), PubMed, Cochrane Library, Web of Science and China Biology Medicine disc(CBM), the retrieval time was from the establishment of the database to November 2022. All comparative studies comparing autogenous bone graft with other bone graft materials in open wedge high tibial osteotomy were searched. The research types, subjects, interventions and evaluation indicators of the literature were comprehensively screened, the quality of the literature was evaluated and the data were extracted. Revman Manager5.4 software was used for meta-analysis. The primary outcome measures were operation time, healing time, postoperative femoro tibial angle (FTA), postoperative Knee Society score (KSS) knee score, postoperative Hospital for Special Surgery (HSS) knee function score, delayed union rate, postoperative lateral hinge fracture, and complications.

A total of nine articles were included, with a total of 437 cases of knee joints undergoing high tibial osteotomy, of which 203 cases underwent autograft and 234 cases underwent allograft or artificial bone graft. The results of meta-analysis showed that the operative time of the autogenous bone group was longer than that of the other bone graft groups[mean difference(MD)=13.94, 95% confidence interval(CI) (11.39, 16.50), P< 0.001]. The healing time of autogenous group was shorter than that of other bone graft groups[standardized mean difference(SMD)=-0.45, 95%CI (-0.87, -0.02), Z =2.04, P=0.04]. Postoperative FTA [MD=0.02, 95%CI: (-0.33, 0.37), Z=0.11, P=0.91], postoperative KSS knee score [MD=2.16, 95%CI (-3.17, 7.49), P=0.43], postoperative HSS knee function score [MD=0.25, 95%CI (-0.38, 0.87), P=0.44], delayed healing rate [risk difference(RD) =-0.02, 95%CI(-0.08, 0.05), Z=0.51, P=0.61], postoperative lateral hinge fracture [risk ratio(RR)=0.72, 95%CI(0.42, 1.23), P=0.23] and complications [RD=-0.00, 95%CI(-0.06, 0.06), P=0.98], showed no statistically significant difference between the two groups.

Autologous bone can better promote the healing of the osteotomy end without increasing the occurrence of complications in the open cuneiform high tibial osteotomy, but the intraoperative time is also increased accordingly. It is recommended to routinely use autologous bone graft to better promote the healing of the hinge end. However, due to the limited quantity and quality of literature included in this study, the conclusions still need to be further verified by large-sample/high-quality prospective randomized controlled studies.