切换至 "中华医学电子期刊资源库"

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (01) : 86 -92. doi: 10.3877/cma.j.issn.1674-134X.2019.01.016

所属专题: 文献

荟萃研究

便携式导航辅助全膝关节置换术力线校准的Meta分析
吴德胜1, 邓仲豪1, 廖哲霆1, 陈宇璠1, 冯舒皓1, 陈纳淳1, 赵亮1,()   
  1. 1. 510515 广州,南方医科大学南方医院关节与骨病外科
  • 收稿日期:2018-06-23 出版日期:2019-02-01
  • 通信作者: 赵亮

Meta-analysis on alignment outcomes of total knee arthroplasty with portable navigation

Desheng Wu1, Zhonghao Deng1, Zheting Liao1, Yufan Chen1, Shuhao Feng1, Nachun Chen1, Liang Zhao1,()   

  1. 1. Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
  • Received:2018-06-23 Published:2019-02-01
  • Corresponding author: Liang Zhao
  • About author:
    Corresponding author: Zhao Liang, Email:
引用本文:

吴德胜, 邓仲豪, 廖哲霆, 陈宇璠, 冯舒皓, 陈纳淳, 赵亮. 便携式导航辅助全膝关节置换术力线校准的Meta分析[J/OL]. 中华关节外科杂志(电子版), 2019, 13(01): 86-92.

Desheng Wu, Zhonghao Deng, Zheting Liao, Yufan Chen, Shuhao Feng, Nachun Chen, Liang Zhao. Meta-analysis on alignment outcomes of total knee arthroplasty with portable navigation[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(01): 86-92.

目的

应用Meta分析的方法评价便携式导航辅助全膝关节置换术(TKA)与常规人工TKA对术后下肢机械轴线和假体力线的影响。

方法

检索Cochrane图书馆、PubMed、EMbase、Web of Science、中国期刊全文数据库、维普咨迅数据库及万方数据库等数据库,根据纳入标准(测量了下肢力线的便携式导航辅助和常规初次TKA临床研究)和排除标准(膝关节内外翻畸形大于15°、术侧髋关节异常),收集所有相关的随机对照试验和非随机对照试验,检索截止日期为2018年5月,由两名评价员独立筛查文献、提取资料和方法学质量评估,采用Cochrane协作网提供的软件Rev Man 5.3.0软件进行Meta分析。

结果

一共纳入11篇临床文献(4篇随机对照试验,7篇非随机对照试验),分析1 334膝,其中导航组641膝,常规组693膝。Meta分析结果显示:导航组下肢机械轴线偏离±3°离群个数少于常规组,差异有统计学意义[RR =0.57,95%CI(0.43,0.76),P<0.05],而冠状面股骨假体力线[RR =0.45,95%CI(0.20,1.06),P =0.07]、冠状面胫骨假体力线[RR =0.67,95%CI(0.41,1.11),P =0.12]、矢状面股骨假体力线[RR =1.03,95%CI(0.72,1.46),P =0.89]、矢状面胫骨假体力线[RR =1.13,95%CI(0.62,2.07),P =0.69]两组间差异均无统计学意义。

结论

便携式导航辅助TKA恢复下肢机械轴线的精准性优于常规人工TKA,但两者在恢复冠状面和矢状面假体植入位置准确性方面无差异;上述结果尚需要更多高质量、大样本及多中心随机试验来进一步验证。

Objective

To conduct a meta-analysis of published studies comparing accelerometer-based navigation(ABN) and conventional instrumentation(CON) in total knee arthroplasty (TKA).

Methods

The Cochrane Library, PubMed, EMBASE, Web of Science, China National Knowledge Internet(CNKI), VIP and WanFang data bases were searched to identify randomized controlled trials (RCTs) and non-randomized controlled trials(nRCTs) articles comparing the ABN with CON in primary TKA up to May 2018; severe knee deformity and hip abnormity on the operation side were excluded. Study selection and assessment, data collection and analysis were undertaken by two authors independently. The meta-analysis was performed using Review Manager 5.3.0.

Results

Eleven studies were included, involving four RCTs and seven nRCTs. A total of 1 334 knees were compared between the navigated group (n=641) and the conventional group (n=693). Meta-analysis suggested that the outliers from mechanical axis in navigated group was less than that of conventional group[RR=0.57, 95%CI: (0.43, 0.76), P<0.05]. There was no significant difference between the two groups in coronal femoral component outliers[RR=0.45, 95%CI (0.20, 1.06), P=0.07], coronal tibial component outliers[RR=0.67, 95%CI (0.41, 1.11), P=0.12], sagittal femoral component outliers [RR=1.03, 95%CI (0.72, 1.46), P=0.89], sagittal tibial component outliers[RR=1.13, 95%CI (0.62, 2.07), P=0.69].

Conclusion

Total knee arthroplasty with hand-held, portable navigation is more accurate than conventional surgery in achieving a neutral mechanical axis, but there is no difference in coronal and sagittal implant positioning; more high-quality, large-sample, multicenter RCTs are required for further investigation.

图1 文献纳入和排除流程图
表1 纳入研究的一般资料
表2 纳入研究的Cochrane风险偏倚评估
表3 纳入研究的NOQAS量表评分
图2 导航组和常规组下肢机械轴线偏离±3°的离群个数比较
图3 导航组和常规组冠状面股骨假体力线偏离±3°的离群个数比较
图4 导航组和常规组冠状面胫骨假体力线偏离±3°的离群个数比较
图5 导航组和常规组矢状面股骨假体力线偏离±3°的离群个数比较
图6 导航组和常规组矢状面胫骨假体力线偏离±3°的离群个数比较
[1]
Moreland JR. Mechanisms of failure in total knee arthroplasty[J]. Clin Orthop Relat Res, 1988, (226): 49-64.
[2]
Figgie HE, Goldberg VM, Figgie MP, et al. The effect of alignment of the implant on fractures of the patella after condylar total knee arthroplasty[J]. J Bone Joint Surg Am, 1989, 71(7): 1031-1039.
[3]
Wasielewski RC, Galante JO, Leighty RM, et al. Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty[J]. Clin Orthop Relat Res, 1994, (299):31-43.
[4]
Anderson KC, Buehler KC, Markel DC. Computer assisted navigation in total knee arthroplasty: comparison with conventional methods[J]. J Arthroplasty, 2005, 20(7 Suppl 3): 132-138.
[5]
Bardakos N, Cil A, Thompson B, et al. Mechanical axis cannot be restored in total knee arthroplasty with a fixed valgus resection angle:a radiographic study[J]. J Arthroplasty, 2007, 22(6 Suppl 2): 85-89.
[6]
Mason JB, Fehring TK, Estok R, et al. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery[J]. J Arthroplasty, 2007, 22(8): 1097-1106.
[7]
Jones CW, Jerabek SA. Current role of computer navigation in total knee arthroplasty[J]. J Arthroplasty, 2018, 33(7): 1989-1993.
[8]
Goh GS, Liow MH, Tay DK, et al. Accelerometer-based and Computer-Assisted navigation in total knee arthroplasty: a reduction in mechanical axis outliers does not Lead to improvement in functional outcomes or quality of Life when compared to conventional total knee arthroplasty[J]. J Arthroplasty, 2018, 33(2): 379-385.
[9]
Gharaibeh MA, Solayar GN, Harris IA, et al. Accelerometer-based, portable navigation (KneeAlign) vs conventional instrumentation for total knee arthroplasty: a prospective randomized comparative trial[J]. J Arthroplasty, 2017, 32(3): 777-782.
[10]
Matsumoto K, Ogawa H, Fukuta M, et al. Comparative study for alignment of extramedullary guides versus portable, Accelerometer-Based navigation in total knee arthroplasty[J]. J Knee Surg, 2018, 31(1): 92-98.
[11]
Kawaguchi K, Michishita K, Manabe T, et al. Comparison of an Accelerometer-Based portable navigation system, Patient-Specific instrumentation, and conventional instrumentation for femoral alignment in total knee arthroplasty[J]. Knee Surg Relat Res, 2017, 29(4): 269-275.
[12]
Kinney MC, Cidambi KR, Severns DL. Comparison of the iAssist handheld guidance system to conventional instruments for mechanical axis restoration in total knee arthroplasty[J]. J Arthroplasty, 2018, 33(1): 61-66.
[13]
Liow MH, Goh GS, Pang H, et al. Computer-assisted stereotaxic navigation improves the accuracy of mechanical alignment and component positioning in total knee arthroplasty[J]. Arch Orthop Trauma Surg, 2016, 136(8): 1173-1180.
[14]
Nam D, Cody EA, Nguyen JT, et al. Extramedullary guides versus portable, accelerometer-based navigation for tibial alignment in total knee arthroplasty: a randomized, controlled trial: winner of the 2013 HAP PAUL award[J]. J Arthroplasty, 2014, 29(2): 288-294.
[15]
Moo IH, Chen JY, Chau DH, et al. Similar radiological results with accelerometer-based navigation versus conventional technique in total knee arthroplasty[J/OL]. J Orthop Surg (Hong Kong), 2018, 26(2). doi: 10.1177/2309499018772374.
[16]
Fujimoto E, Sasashige Y, Nakata K, et al. Technical considerations and accuracy improvement of Accelerometer-Based portable computer navigation for performing distal femoral resection in total knee arthroplasty[J]. J Arthroplasty, 2017, 32(1): 53-60.
[17]
Ikawa T, Takemura S, Kim M, et al. Usefulness of an accelerometer-based portable navigation system in total knee arthroplasty[J]. Bone Joint J, 2017, 99-B(8): 1047-1052.
[18]
Ueyama H, Matsui Y, Minoda Y, et al. Using Accelerometer-based portable navigation to perform accurate total knee arthroplasty bone resection in Asian patients[J/OL]. Orthopedics, 2017, 40(3): e465-e472. doi:10.3928/01477447-20170223-01.
[19]
Goh GS, Liow MH, Lim WS, et al. Accelerometer-based navigation is as accurate as optical computer navigation in restoring the joint line and mechanical axis after total knee arthroplasty: a prospective matched study[J]. J Arthroplasty, 2016, 31(1): 92-97.
[20]
Desseaux A, Graf P, Dubrana F, et al. Radiographic outcomes in the coronal plane with iASSIST (TM) versus optical navigation for total knee arthroplasty: A preliminary case-control study[J]. Orthop Traumatol Surg Res, 2016, 102(3): 363-368.
[21]
Schroer WC, Berend KR, Lombardi AV, et al. Why are total knees failing today? Etiology of total knee revision in 2010 and 2011[J]. J Arthroplasty, 2013, 28(8 Suppl): 116-119
[22]
Gromov K, Korchi M, Thomsen MG, et al. What is the optimal alignment of the tibial and femoral components in knee arthroplasty?[J]. Acta Orthop, 2014, 85(5): 480-487.
[23]
Bathis H, Perlick L, Tingart M, et al. Alignment in total knee arthroplasty.A comparison of computer-assisted surgery with the conventional technique[J]. J Bone Joint Surg Br, 2004, 86(5): 682-687.
[24]
Nam D, Weeks KD, Reinhardt KR, et al. Accelerometer-based, portable navigation vs image less, large-console computer-assisted navigation in total knee arthroplasty: a comparison of radiographic results[J]. J Arthroplasty, 2013, 28(2): 255-261.
[1] 蚁淳, 袁冬生, 熊学军. 系统免疫炎症指数与骨密度降低和骨质疏松的关联[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 609-617.
[2] 庄若语, 杭明辉, 李文华, 张霆, 侯炜. 膝骨关节炎半定量磁共振评分研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 545-552.
[3] 丁莹莹, 宋恺, 金姬延, 田华. 机器人辅助膝髋关节置换术后精细化临床护理[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 553-557.
[4] 任俊筱, 浦路桥, 王志豪, 施洪鑫, 刘爱峰, 齐保闯, 徐永清, 李川. 机器人辅助全膝关节置换术的临床疗效对照研究[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 469-476.
[5] 李志文, 李远志, 李华, 方志远. 糖皮质激素治疗膝骨关节炎疗效的网状Meta分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 484-496.
[6] 许亚龙, 巩栋, 陈晓涛. 超前镇痛在全膝关节置换术中的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 517-523.
[7] 吴姗姗, 潘裕民, 刘晋, 张劲松, 乔莉. 睡眠呼吸暂停综合征患者静脉血栓栓塞症发生率的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 312-317.
[8] 沈皓, 张驰, 韩旻轩, 陆晓庆, 周愉, 周莉丽. 骨皮质切开术对正畸治疗牙根吸收影响的Meta分析[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(03): 175-184.
[9] 朱俊佳, 孙琦, 徐文龙, 陆天宇, 冯强, 储涛, 邢春根, 高春冬, 俞一峰, 赵振国. 永久性结肠造口预防性补片置入对预防造口旁疝价值的Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 336-342.
[10] 王招荐, 曹桢, 郭小双, 靳小雷, 刘子文. 加速康复外科理念应用于腹壁重建手术的系统评价及Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 343-350.
[11] 马振威, 宋润夫, 王兵. ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 807-812.
[12] 龚财芳, 赵俊宇, 游川. 围手术期肠内营养在肝癌肝切除患者中有效性及安全性的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 551-556.
[13] 郁凯, 曾保起, 杨剑, 杨杰, 张殿英, 孙凤. 全关节镜与切开手术治疗肩袖撕裂疗效比较的系统综述与Meta分析[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 238-245.
[14] 王芳, 刘达, 左智炜, 盛金平, 陈庭进, 蒋锐. 定量CT与双能X线骨密度仪对骨质疏松诊断效能比较的Meta分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 363-371.
[15] 周倩妹, 王宪娥, 徐筱, 老慧琳, 赵欣悦, 胡菁颖. 多元化系统护理对老年人群牙周健康指标影响的系统评价[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 500-506.
阅读次数
全文


摘要