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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 554 -561. doi: 10.3877/cma.j.issn.1674-134X.2021.05.006

荟萃分析

机器人辅助与传统手工全髋置换术疗效的Meta分析
王波1, 周楚乔1, 彭正午1, 黄添隆1, 毛新展1, 李辉1,†()   
  1. 1. 410011　长沙，中南大学湘雅二医院骨科
  • 收稿日期:2020-10-09 出版日期:2021-10-01
  • 通信作者: 李辉

Meta-analysis of efficacy of robot-assisted versus conventional manual total hip arthroplasties

Bo Wang1, Chuqiao Zhou1, Zhengwu Peng1, Tianlong Huang1, Xinzhan Mao1, Hui Li1,†()   

  1. 1. Department of orthopedics, Second Xiangya Hospital of Central South University, Changsha 410011, China
  • Received:2020-10-09 Published:2021-10-01
  • Corresponding author: Hui Li
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引用本文：

王波, 周楚乔, 彭正午, 黄添隆, 毛新展, 李辉. 机器人辅助与传统手工全髋置换术疗效的Meta分析[J]. 中华关节外科杂志(电子版), 2021, 15(05): 554-561.

Bo Wang, Chuqiao Zhou, Zhengwu Peng, Tianlong Huang, Xinzhan Mao, Hui Li. Meta-analysis of efficacy of robot-assisted versus conventional manual total hip arthroplasties[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(05): 554-561.

目的

比较机器人辅助(RA)和传统手工(CM)在全髋关节置换(THA)术的临床疗效。

方法

对PubMed，荷兰医学文摘数据库(Embase)，威科集团下的Ovid数据库，Web of Science和Cochrane Library共5个数据库进行检索，选择使用机器人辅助和传统手工进行全髋关节置换的随机对照试验(RCTs)提取相关资料(纳入比较机器人辅助和传统手工手术的随机临床试验)。采用RevMan 5.3软件对纳入数据进行异质性检验和Meta分析。

结果

最终纳入6篇RCTs文献，共686例全髋关节置换(686位患者)。RA与CM进行全髋关节置换术相比较，在Harris评分[加权均数差(WMD)＝1.76，95%置信区间(CI)(-1.10，4.62)]、西安大略和麦克马斯特大学(WOMAC)骨关节炎指数评分[WMD＝-1.71，95% CI(-5.42，1.99)]、下肢肢体长度差异(LLD)[OR＝0.97，95% CI(0.51，1.82)]和异位骨化(HO)[OR＝1.18，95% CI(0.49，0.85)]等方面差异无统计学意义(均为P>0.05)。而RA辅助下的全髋关节置换术在提高髋关节Merie D′ Aubigne评分[WMD＝0.56, 95% CI(0.05，1.06)]，柄的力线[WMD＝-0.68，95% CI(-0.94，-0.43)]及减少术中并发症[OR＝0.34，95% CI(0.12，0.96)]和减轻术后大腿疼痛[OR＝0.30，95% CI(0.11，0.86)]明显优于CM组(均为P<0.05)，但相较于CM组，RA组手术时间较长且术后脱位风险较高。

结论

机器人辅助下全髋关节置换术(RA组)在提高髋关节Merie D′ Aubigne评分，柄的力线及减少术中并发症和术后大腿疼痛明显优于CM组，但是手术时间较长且术后脱位风险较高。

关键词: 机器人手术过程, 关节成形术，置换，髋, Meta分析
Objective

To compare the clinical effects of robot-assisted (RA) and conventional manual (CM) in total hip arthroplasty(THA).

Methods

Published clinical studies on the treatment of robot-assisted and conventional manual in total hip arthroplasty were searched by five databases, including PubMed, Excerpta Medica Database(Embase), Ovid database, Web of Science and Cochrane Library. The literatures including randomized controlled trials (RCTs) comparing RA versus CM in THA were obtained. The meta-analysis and heterogeneity test were performed with RevMan 5.3 software.

Results

Six RCTs reporting 686 patients underwent total hip arthroplasty were included. Meta analysis results showed there was no significant statistical difference in Harris score[weighted mean difference(WMD)=1.76, 95% (CI)(-1.10, -4.62)], the Western Ontario and Mcmaster Universities(WOMAC) osteoarthritis index score[WMD=-1.71, 95% CI(-5.42, 1.99)], leg length discrepancy (LLD) [OR=0.97, 95% CI(0.51, 1.82)] or heterotopic ossification[OR=1.18, 95% CI(0.49, 0.85)] (all P> 0.05). However, RA THA was significantly better in improving the MerieD′Aubigne score[WMD=0.56, 95% CI(0.05, 1.06)], the stem alignment [WMD=-0.68, 95% CI(-0.94, -0.43)]and reducing intraoperative complications [OR=0.34, 95% CI(0.12, 0.96)] and postoperative thigh pain[OR=0.30, 95% CI(0.11, 0.86)] comparing with CM THA(all P<0.05). Compared with the CM group, the RA group showed longer operation time and higher risk of postoperative dislocation.

Conclusion

RA total hip arthroplasty was significantly better in improving the MerieD′Aubigne score, the stem alignment and reducing intraoperative complications and postoperative thigh pain comparing with CM, but compared with CM group, RA group has longer operation time and higher risk of postoperative dislocation.

Key words: Robotic surgical procedures, Arthroplasty, replacement, hip, Meta-analysis
表1 Meta分析中所包含文献的基本资料
作者 研究类型 国家 机器人类型 RA CM 性别(女/男) 年龄(岁) 随访时间(月) 结局指标1 结局指标2 结局指标3
RA CM RA CM
Bargar[7] RCT 德国 Robodoc 65 62 n/s n/s n/s n/s 24 并发症 - -
Honl[8] RCT 德国 Robodoc 61 80 24/37 24/56 71.5 70.7 24 Harris Merie D′ Aubigne 假体柄力线
Nishihara[9] RCT 日本 Orthodoc 78 78 14/64 14/64 58.0 58.0 24 Merie D′ Aubigne 假体柄力线 并发症
Nakamura[10] RCT 日本 Orthodoc 75 71 13/56 10/51 57.0 58.0 60 LLD 并发症 -
Lim[11] RCT 韩国 Robodoc 24 25 11/13 13/22 51.2 45.6 24 Harris WOMAC 假体柄力线
Bargar[12] RCT 美国 Robodoc 45 22 35/10 12/10 59.1 59.8 168 Harris WOMAC 并发症
总计/平均       348 338 97/180 73/203 59.4 58.4 54±58      
图1 文献筛选流程图
图2 RCTs(随机对照试验)的风险偏倚图。图A为单篇文章偏倚风险图；图B为整体纳入文章的偏倚风险图
图3 RA(机器人辅助)与CM(传统手工)组手术时间比较的森林图
图4 RA(机器人辅助)与CM(传统手工)组患者术后功能比较的森林图
图5 RA(机器人辅助)与CM(传统手工)组患者术后假体柄力线比较的森林图
图6 RA(机器人辅助)与CM(传统手工)组患者术后LLD(下肢肢体长度差异)比较的森林图
图7 RA(机器人辅助)与CM(传统手工)组患者术后并发症比较的森林图
图8 RA(机器人辅助)与CM(传统手工)组手术时间比较的漏斗图
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