计算机导航人工全膝关节置换与传统手术临床效果比较的Meta分析

Clinical outcomes after computer-assisted TKA as compared with traditional techniques. A meta-analysis of randomized controlled trials

[目的]系统评价计算机导航辅助人工全膝关节置换(CASTKA)与传统TKA技术临床效果的差异。[方法]计算机检索MEDLINE、Cochrane、EMbase、CNKI数字图书馆等数据库,并手工检索查找有关比较CASTKA与传统术式的临床试验研究报道。由2名评价员独立筛查试验、提取资料和评估方法学质量,采用Cochrane协作网提供的RevMan5.0软件进行Meta分析。[结果]共纳入符合本研究设计标准的临床随机对照试验16篇,计算机导航组1003膝,传统方法组917膝。导航组下肢力线内翻或外翻3°以内的发生率高于传统组;胫骨和股骨假体冠状位对线内翻或外翻角在3°以内的发生率,导航组亦优于传统组。导航组在胫骨假体后倾角、股骨假体外旋角和深静脉血栓发生率与传统组比较差异无统计学意义。[结论]与传统技术相比计算机辅助系统能带来更佳的下肢力线和假体位置,但长期的临床疗效和CAS系统的临床效价比尚需更多研究。

[Objective]To compare the clinical outcomes between the CAS（computer-assisted surgery） and conventional total knee arthroplasty（TKA）.[Methods]Randomized controlled trials about the comparison of conventional and navigated total knee arthroplasties were searched in MEDLINE,Cochrane Library,EMbase,and CNKI.Some published and unpublished references were also hand-searched.Study selection and assessment,data collection and analyses were undertaken by two reviewers independently.The Cochrane Collaboration’s RevMan 5.0 was used for data analyses.[Results]After a comprehensive search,16 original randomized controlled trials（involving 1920 knees） were included in this analysis.The computer-navigation group consisted of 1 003 knees,and the conventional group consisted of 917 knees.All trails were identified as meeting all the eligibility criteria.The mechanical axis alignment of the lower limb was significantly better in the computer-assisted group compared with the conventional group.The coronal alignment of the tibial and femoral component alignment was also more accurate in the computer-assisted group.The meta-analysis did not find a significant difference in the posterior slope of the tibial component,axial（rotational） alignment of the femoral component and deep-venous thrombosis.[Conclusion]Computer-assisted TKA gives a better correction of alignment of the leg and orientation of the components compared with the conventional technique.Long-term clinical outcomes and cost-effectiveness of using computer-assisted systems in TKAs require further investigation.