3D个性化截骨板辅助全膝关节置换术精准度的荟萃分析

Meta-analysis of accuracy following total knee arthroplasty assisted by three-dimensional patient-specific instrumentation

目的比较3D个性化截骨板与传统截骨对膝关节置换术后下肢重建力线和假体组件安放的精准度。方法通过Pub Med、Embase、Cochrane图书馆、中国知网、万方医学数据库等电子期刊数据库检索已发表的比较个性化截骨板(PSI)与传统截骨对膝关节置换术后下肢力线及临床疗效影响的随机对照试验。严格按照研究类型为随机对照研究、研究对象为符合初次膝关节置换的终末期骨关节炎或类风湿关节炎患者、干预与对照措施分别为个性化截骨板与传统截骨、结局评价指标至少包括下肢力线离群值等纳入标准和不符合以上条件的排除标准筛选文献,进行质量评价,提取数据,采用Review Manager 5.3软件对提取的数据进行Meta分析,对于下肢力线、假体组件离群值等计数资料评估其相对危险度(RR)及95%可信区间(CI),对膝关节功能评分、手术时间等连续型变量计算其均值差(mean difference,MD)及95%CI,对统计结果进行综述。结果共纳入11篇文献,包括12项研究。Meta分析显示:PSI组与传统组术后下肢力线(髋-膝-踝角)离群值比较:[RR=0.88,95%CI(0.65,1.19),P>0.05];PSI组与传统组术后冠状位股骨组件离群值比较:[RR=0.76,95%CI(0.57,1.02),P>0.05];PSI组与传统组术后冠状位胫骨组件离群值比较:[RR=1.19,95%CI(0.68,2.09),P>0.05];PSI组与传统组术后3个月牛津大学膝关节评分(OKS)比较:[MD=0.04,95%CI(-1.63,1.72),P>0.05],以上结果差异均无统计学意义。术后股骨组件旋转对合离群值[RR=0.55,95%CI(0.33,0.94),P<0.05],差异有统计学意义。结论在术后股骨组件旋转对合方面,个性化截骨板比传统截骨更精准。

Objective To compare the accuracy of three-dimensional（3 D） patient-specific instrumentation（PSI） with conventional instrumentation concerning re-established lower limb alignment and prosthetic component positioning after total knee arthroplasty（TKA）. Methods The randomized controlled trials that comparing 3 D PSI with conventional osteotomy instrumentation concerning the lower limb alignment and clinical efficacy following TKA were searched through Pub Med,Embase,Co Chrane Library,CNKI,Chinainfo and other accessible electronic databases. The articles were precisely screened according to the inclusion criteria（the research types were randomized controlled studies,the research objects were end period osteoarthritis or rheumatoid arthritis patients who met primary TKA,the intervention and control measures were PSI or conventional instrumentation,the outcome measures included at least lower limb mechanical axis outliers） and exclusion criteria（the studies that did not meet the criteria mentioned above）; the quality was assessed on the basis of the Jadad rating scale. Related data were extracted and analyzed by Review Manager5. 3,the relative risk（RR） and 95% confidence interval（CI） were evaluated for count data such as lower limb mechanical axis and prosthetic component outliers,the mean difference（MD） and 95% CI were calculate for continuous variables such as knee function score and operation time. The statistical results were reviewed in the end. Results Eleven articles,including 12 trials were enrolled in this study. There was no statistically significant difference between PSI and conventional instrumentation in the post-operative hip-knee-ankle axis（lower limb mechanical axis） outliers[RR = 0. 88,95% CI（0. 65,1. 19）,P 〉 0. 05]; the coronal femoral component outliers[RR = 0. 76,95% CI（0. 57,1. 02）,P 〉 0. 05]; the coronal tibial component outliers[RR =1. 19,95% CI（0. 68,2. 09）,P 〉 0. 05]; the OKS scores at 3-month follow-up[MD = 0. 04,95% CI（-1. 63,1. 72）,P 〉 0. 05] after TKA between PSI and conventional instrumentation. The post-operative femoral component rotation outliers indeed showed statistical difference [RR = 0. 55,95% CI（0. 33,0. 94）,P 〈 0. 05].Conclusion PSI is more accurate than conventional osteotomy instrumentation in femoral component rotation after TKA.