计算机导航技术在前交叉韧带重建术中应用效果的meta分析

Application effect of computer navigation technique in anterior cruciate ligament reconstruction:a meta-analysis

目的系统性评价计算机导航技术在前交叉韧带重建术(ACLR)中骨隧道位置定位中的准确性及对术后功能恢复的效果。方法计算机检索Cochrane Library、PubMed、Embase、中国知网、万方、维普数据库中有关计算机导航技术辅助ACLR的对照试验,检索时限从建库至2023年9月。根据纳入和排除标准,运用NoteExpress V3.0软件筛选文献,采用Cochrane风险偏倚评估工具评估纳入文献质量,采用RevMan5.4软件进行meta分析。结果最终纳入10项研究,共705例患者,其中导航组354例,常规组351例。meta分析结果显示,与常规组比较,导航组骨隧道位置定位明显改善[股骨侧(MD=5.59,95%CI:1.21~9.97,P=0.01)、胫骨侧(MD=1.32,95%CI:0.20~2.43,P=0.02)];但两组国际膝关节文件编制委员会(IKDC)评分(MD=1.76,95%CI:-0.17~3.70,P=0.07)、Lysholm评分(MD=0.49,95%CI:-0.16~1.14,P=0.14)、Tegner评分(MD=-0.08,95%CI:-0.35~0.20,P=0.58)、KT-1000前移距离(MD=0.01,95%CI:-0.49~0.52,P=0.96)、拉赫曼试验阳性率(RD=-0.01,95%CI:-0.09~0.07,P=0.75)及轴移试验阳性率(RD=-0.09,95%CI:-0.22~0.04,P=0.20)差异无统计学意义。结论计算机导航技术有助于提升ACLR中胫骨、股骨骨隧道位置定位的准确性,然而并不能改善患者术后功能恢复。

Objective To systematically evaluate the accuracy of computer navigation technique in the positioning of bone tunnel location of anterior cruciate ligament reconstruction(ACLR)and its effect on postoperative functional recovery.Methods The controlled trials of computer navigation-assisted ACLR in the databases of Cochrane Library,PubMed,Embase,CNKI,Wanfang and VIP Database were retrieved.The retrieval time limit was from the establishment of the database to August 2023.According to the inclusion and exclusion criteria,the NoteExpress V3.0 software was used to screen the literatures,the Cochrane risk bias assessment tool was used to evaluate the quality of the included literatures,and the RevMan5.4 software was used for conducting the meta analysis.Results A total of 10 trials involving 705 patients were included,including 354 cases in the navigation group and 351 cases in the conventional group.The meta analysis results showed that compared with the conventional group,the location positioning of bone tunnel in the navigation group was significantly improved in femoral side(MD=5.59,95%CI:1.21-9.97,P=0.01)and tibial side(MD=1.32,95%CI:0.20-2.43,P=0.02).However there were no statistically significant differences in the IKDC scores(MD=1.76,95%CI:-0.17 to 3.70,P=0.07),Lysholm scores(MD=0.49,95%CI:-0.16 to 1.14,P=0.14),Tegner scores(MD=-0.08,95%CI:-0.35 to 0.20,P=0.58),KT-1000 anterior shift distance(MD=0.01,95%CI:-0.49 to 0.52,P=0.96),the positive rate of Lachman test(RD=-0.01,95%CI:-0.09 to 0.07,P=0.75)and the positive rate of axial shift test(RD=-0.09,95%CI:-0.22 to 0.04,P=0.20).Conclusion The computer navigation technology is conducive to elevate the accuracy of tibial and femoral tunnel positioning in ACLR,but could not improve the postoperative functional recovery of the patients.