导航技术与传统方法膝关节置换后力线测量的Meta分析

Comparing the Total Knee Arthroplasty Implant Placement Using Computer Navigation Versus Conventional Technique:A Systematic Review

目的分析计算机导航技术与传统方法进行膝关节置换术后力线测量的评价。方法我们检索了Cochrane liabrary(CCTR)以及Cochrane协作网肌骨组专业试验数据库,MEDLINE(1966-2009年),EMBASE(1980-2009年),收集计算机导航技术与传统方法进行膝关节置换术后力线测量的临床随机对照试验,并评价纳入研究的方法学质量。统计软件采用Cochrane协作网提供的RevMan 4.2.8。结果纳入计算机导航技术与传统方法进行膝关节置换术后力线测量的临床随机对照试验9篇共1 083例病人。Meta分析表明,计算机导航技术比较传统方法进行膝关节置换手术:其下肢机械轴的测量较精确[WMD=-0.56,95%CI(-0.74,-0.38),P<0.00001],而股骨冠状轴和矢状轴及旋转角度的测量无明显差异[WMD=-0.29,95%CI(-0.58,0.00),P=0.05]、[WMD=-1.64,95%CI(-3.49,0.21),P=0.08]及[WMD=-0.11,95%CI(-0.87,0.66),P=0.79]。胫骨冠状轴的测量无明显差异[WMD=-0.31,95%CI(-0.69,0.06),P=0.10],而矢状轴的测量有明显差异[WMD=-0.69,95%CI(-1.10,-0.28),P=0.001]。胫股冠状角的测量两者无明显差异[WMD=0.03,95%CI(-0.78,0.84),P=0.95]。而对髌骨倾斜角及髌骨旋转角度的评价,两者亦无明显差异[WMD=-1.45,95%CI(-3.12,0.22),P=0.09]及[WMD=-0.34,95%CI(-0.71,0.02),P=0.06]。结论与传统方法相比较,计算机导航技术进行膝关节置换手术:在下肢机械轴的测量及胫骨矢状轴的测量上两者有显著差异,而在股骨冠状轴和矢状轴及旋转角度的测量、胫骨冠状轴及胫股冠状角的测量以及髌骨倾斜角及髌骨旋转角度的测量上,两者无明显差异。

Obiectve The analysis of computer navigation and traditional methods carry on the total knee arthroplasty.Methods We searched the specialized trials registered in Cochrane muscle group,Cochraneliabrary（CCTR）,MEDLINE（1966-2009）,EMBASE（1980-2009）,Data were extracted and evaluated by two reviewers independently of each other.Randomized controlled trials of computer navigation and traditional methods carry on the total knee arthroplasty were included.The quality of trials was critical assessed.RevMan 4.2.8 software was used for data analysis.Results Nine RCTS of computer navigation and traditional methods carry on the total knee arthroplasty were included.Nine studies including a total of 1083 patients met the inclusion criteria for the review.The results showed that,computer navigation versus traditional methods carry on the total knee arthroplasty：in radiography：the lower limbs of mechanical axis is preciser,[WMD=-0.56,95%CI（-0.74,-0.38）,P0.00001],but the femoral frontal axis and sagittal axis and angle of rotation have no obvious difference[WMD=-0.29,95%CI（-0.58,0.00）,P=0.05],and[WMD=-1.64,95%CI（-3.49,0.21）,P=0.08]and[WMD=0.11,95%CI（-0.87,0.66）,P=0.79].the tibial frontal axis have no obvious difference[WMD=-0.31,95%CI（-0.69,0.06）,P=0.10]and the tibial sagittal axis have obvious difference[WMD=-0.69,95%CI（-1.10,-0.28）,P=0.001].the tibiafemoral angle has no obvious difference[WMD=0.03,95%CI（-0.78,0.84）,P=0.95].But patella tilt and patella shift have no obvi-ous difference[ WMD=-1.45,95%CI（-3.12,0.22）,P=0.09]and[ WMD=-0.34,95%CI（-0.71,0.02）,P=0.06].Conclusion Comparing with traditional methods,computer navigation carry on the total knee arthroplasty：the lower limbs of mechanical axis is more accurate,but the femoral frontal axis and sagittal axis and angle of rotation,the tibial frontal axis and sagittal axis,the tibiafemoral angle and the patella tilt and patella shift have no obvious difference.