切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 329 -336. doi: 10.3877/cma.j.issn.1674-134X.2022.03.011

荟萃分析

机器人辅助与传统全髋关节置换术疗效比较的Meta分析
马鹏程1, 张思平1, 柴浩1, 姜侃1,†()   
  1. 1. 830000　乌鲁木齐，新疆医科大学第六附属医院关节外科
  • 收稿日期:2021-09-18 出版日期:2022-06-01
  • 通信作者: 姜侃

Meta analysis on therapeutic effects of robot-assisted total hip arthroplasty versus traditional surgery

Pengcheng Ma1, Siping Zhang1, Hao Chai1, Kan Jiang1,†()   

  1. 1. The sixth affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China
  • Received:2021-09-18 Published:2022-06-01
  • Corresponding author: Kan Jiang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

马鹏程, 张思平, 柴浩, 姜侃. 机器人辅助与传统全髋关节置换术疗效比较的Meta分析[J]. 中华关节外科杂志(电子版), 2022, 16(03): 329-336.

Pengcheng Ma, Siping Zhang, Hao Chai, Kan Jiang. Meta analysis on therapeutic effects of robot-assisted total hip arthroplasty versus traditional surgery[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(03): 329-336.

目的

本篇Meta分析汇总相关研究结果，评价机器人辅助全髋关节置换术(THA)和传统全髋关节置换术疗效的差异。

方法

检索PubMed、Cochrane Library、荷兰医学文摘(Embase)以及万方、维普、中国知网。纳入标准包括研究对象为初次接受THA的患者、干预措施包含机器人辅助THA和传统THA等。排除标准包括单独的病例报告、结局指标没有量化或数据不完整的研究等。纳入比较机器人辅助THA和传统THA疗效的队列研究和随机对照试验，分别使用Newcastle-Ottawa Scale(NOS)量表和Jadad量表进行质量评价，利用Revman 5.3软件进行Meta分析。

结果

共纳入19篇文献，其中3篇为随机对照试验，16篇为队列研究，文献质量均较高。分析结果显示机器人辅助THA比传统THA手术时间更长[均数差(MD)＝15.23，95%置信区间(CI)(8.02，22.44)，P<0.001]，髋臼假体置入Lewinnek安全区的概率更高[比值比(OR)＝5.47，95%CI(3.96，7.57)，P<0.001]，髋关节偏心距的差异更小[MD＝-0.76，95%CI(-1.10，-0.43)，P<0.001]，下肢长度的差异也更小[MD＝-1.47，95%CI(-2.12，-0.82)，P<0.001]。而在并发症(P＝0.10)以及髋臼假体的前倾角(P＝0.40)与外展角(P＝0.43)两个方面两组结果相似。

结论

机器人辅助THA增加了手术时间，但未增加并发症发生率。机器人辅助THA可提高髋臼假体置入的安全性，使下肢位置更合理，效果优于传统THA。

关键词: 关节成形术，置换，髋, 机器人手术, 手术后并发症, Meta分析
Objective

To summearize the relevant research results and to evaluate the efficacy difference between robot-assisted total hip arthroplasty (THA) and traditional total hip arthroplasty.

Methods

PubMed, the Cochrane Library, Excerpta Medica Database (Embase), China Online Journals(Wanfang), China Science and Technology Journal Database(VIP), and China National Knowledge Infrastructure(CNKI) were adopted in the information retrieval. the inclusion criteria were research objects receiving THA for the first time, and interventions containing robot-assisted THA and traditional THA, etc. The exclusion criteria were separate case reports, studies without quantified outcome indicators or data integrity, etc. Cohort studies and randomized controlled trials were included to conduct the efficacy comparison between robot-assisted THA and traditional THA, with the application of the Newcastle-Ottawa Scale (NOS) and Jadad scale for quality evaluation respectively. Revman 5.3 software was applied for meta-analysis.

Results

Nineteen literatures were included in the total, in which three literatures were randomized controlled trials and 16 literatures were cohort studies, all literatures being with high quality. The results suggested that robot-assisted THA exhibited longer operation time than that of traditional THA [mean difference(MD)=15.23, 95% confidence interval(CI)(8.02, 22.44), P<0.001], higher probability of acetabular prosthesis implantation into Lewinnek safety zone [odds ratio (OR) =5.47, 95%CI(3.96, 7.57), P<0.001], smaller difference of global offset [MD=-0.76, 95%CI (-1.10, -0.43), P<0.001] and smaller difference of lower leg-length discrepancy [MD=-1.47, 95%CI (-2.12, -0.82), P<0.001]. Results of the two groups showed similarity in complications (P=0.10), anteversion angle (P=0.40), and abduction angle (P=0.43) of the acetabular prosthesis.

Conclusions

Robot-assisted THA extends the operation time, without leading to an increase of complication's incidence. Robot-assisted THA enables the improvement of acetabular prosthesis implantation safety, and enhancement in the position reasonability of lower limbs, with superiority over the traditional THA.

Key words: Arthroplasty, replacement, hip, Robotic surgical procedures, Postoperative complications, Meta-analysis
图1 文献纳入过程
表1 纳入文献基本特征
作者与年份 国家 试验类型 机器人平台 传统入路 组别 样本量 平均年龄(岁) 随访时间 结局指标 文献质量
Nakamura[11]2018 日本 随机对照 ROBDOC 后外侧 RO/CO 64/64 57/57 10年 2 6分
Bargar[12]2018 美国 随机对照 ROBDOC 后外侧 RO/CO 45/22 59/60 14年 2 6分
Lim[10]2015 韩国 随机对照 ROBDOC 后外侧 RO/CO 24/25 51/46 24个月 1 2 6分
Hananouchi[9]2007 日本 队列研究 ROBDOC NA RO/CO 31/27 57/57 24个月 2 7分
Peters[13]2021 美国 队列研究 MAKO 后外侧或前侧 RO/CO 85/85 57/57 24个月 2 4 5 6 7分
Domb[7]2020 美国 队列研究 MAKO 后外侧或前侧 RO/CO 66/66 59/58 5年 2 3 4 5 6 7分
Kayani[14]2021 英国 队列研究 MAKO 后外侧 RO/CO 50/50 67/68 3个月 4 8分
Clement[15]2021 英国 队列研究 MAKO 后外侧 RO/CO 40/80 60/60 10个月12个月 2 4 6 8分
Chai[16]2020 中国 队列研究 MAKO 后外侧 RO/CO 22/23 42/35 3个月 1 2 3 4 8分
Kong[17]2020 中国 队列研究 MAKO 后外侧 RO/CO 53/62 43/40 3个月 3 8分
Illgen[18]2017 美国 队列研究 MAKO 后外侧 RO/CO 100/100 62/63 24个月 2 4 6 8分
Kamara[19]2017 美国 队列研究 MAKO 后外侧 RO/CO 98/198 NA NA 2 3 4 6分
Remily[20]2021 美国 队列研究 NA NA RO/CO 4 630/4 630 64/64 5年以上 2 7分
Kong[21]2020 中国 队列研究 MAKO 后外侧 RO/CO 86/100 52/52 3个月 1 3 4 5 6 8分
Singh[22]2021 美国 队列研究 MAKO 后外侧或前侧 RO/CO 135/929 62/64 3个月以上 1 2 8分
李俊成[23]2021 中国 队列研究 MAKO 后外侧 RO/CO 38/38 54/52 3.4个月 1 2 6 8分
崔可赜[24]2020 中国 队列研究 MAKO 后外侧 RO/CO 35/35 72/74 8个月 1 2 3 6 8分
张卓[25]2020 中国 队列研究 MAKO 后外侧 RO/CO 100/100 53/52 3个月以上 1 3 4 5 6 8分
郭人文[26]2020 中国 队列研究 MAKO 后外侧 RO/CO 32/32 53/51 17个月 1 3 4 5 6 7分
图2 手术时间对比森林图注：RO-机器人辅助手术组；CO-传统手术组
图3 并发症对比森林图注：RO-机器人辅助手术组；CO-传统手术组
图4 髋臼假体的前倾角与外展角对比森林图注：RO-机器人辅助手术组；CO-传统手术组
图5 髋臼假体置入Lewinnek安全区的数量对比森林图注：RO-机器人辅助手术组；CO-传统手术组
图6 髋关节偏心距差异的对比森林图注：RO-机器人辅助手术组；CO-传统手术组
图7 下肢长度差异的对比森林图注：RO-机器人辅助手术组；CO-传统手术组
[1]
Ferguson RJ, Palmer AJ, Taylor A, et al. Hip replacement[J]. Lancet, 2018, 392(1158): 1662-1671.
[2]
边焱焱，程开源，常晓，等.2011至2019年中国人工髋膝关节置换手术量的初步统计与分析[J]．中华骨科杂志，2020，40(21)：1453-1460.
[3]
Bayliss LE, Culliford D, Monk AP, et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study[J]. Lancet, 2017, 389(177): 1424-1430.
[4]
Schultz K, Ewbank ML, Pandit HG. Changing practice for hip arthroplasty and its implications[J]. Br J Nurs, 2017, 26(22): 1238-1244.
[5]
Han PF, Chen CL, Zhang ZL, et al. Robotics-assisted versus conventional manual approaches for total hip arthroplasty: a systematic review and meta-analysis of comparative studies[J/OL]. Int J Med Robot, 2019, 15(3): e1990. DOI: 10.1002/rcs.1990.
[6]
Chen X, Xiong J, Wang P, et al. Robotic-assisted compared with conventional total hip arthroplasty: systematic review and meta-analysis[J]. Postgrad Med J, 2018, 94(1112): 335-341.
[7]
Domb BG, Chen JW, Lall AC, et al. Minimum 5-Year outcomes of robotic-assisted primary total hip arthroplasty with a nested comparison against manual primary total hip arthroplasty: a propensity Score-Matched study[J]. J Am Acad Orthop Surg, 2020, 28(20): 847-856.
[8]
Parratte S, Ollivier M, Lunebourg A, et al. No benefit after THA performed with computer-assisted cup placement: 10-year results of a randomized controlled study[J]. Clin Orthop Relat Res, 2016, 474(10): 2085-2093.
[9]
Hananouchi T, Sugano N, Nishii T, et al. Effect of robotic milling on periprosthetic bone remodeling[J]. J Orthop Res, 2007, 25(8): 1062-1069.
[10]
Lim SJ, Ko KR, Park CW, et al. Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study[J]. Comput Aided Surg, 2015, 20(1): 41-46.
[11]
Nakamura N, Sugano N, Sakai T, et al. Does robotic milling for stem implantation in cementless THA result in improved outcomes scores or survivorship compared with hand rasping? Results of a randomized trial at 10 years[J]. Clin Orthop Relat Res, 2018, 476(11): 2169-2173.
[12]
Bargar WL, Parise C, Hankins A, et al. Fourteen year follow-up of randomized clinical trials of active robotic-assisted total hip arthroplasty[J]. J Arthroplasty, 2018, 33(3): 810-814.
[13]
Perets I, Walsh JP, Mu BH, et al. Short-term clinical outcomes of robotic-arm assisted total hip arthroplasty: a pair-matched controlled study[J]. Orthopedics, 2021, 44(2): e236-e242.
[14]
Kayani B, Konan S, Huq SS, et al. The learning curve of robotic-arm assisted acetabular cup positioning during total hip arthroplasty[J]. Hip Int, 2021, 31(3): 311-319.
[15]
Clement ND, Gaston P, Bell A, et al. Robotic arm-assisted versus manual total hip arthroplasty[J]. Bone Joint Res, 2021, 10(1): 22-30.
[16]
Chai W, Kong X, Yang M, et al. Robot-assisted total hip arthroplasty for arthrodesed Hips[J]. Ther Clin Risk Manag, 2020, 16: 357-368.
[17]
Kong X, Yang M, Li X, et al. Impact of surgeon handedness in manual and robot-assisted total hip arthroplasty[J/OL]. J Orthop Surg Res, 2020, 15(1): 159. DOI：10.1186/s13018-020-01671-0.
[18]
Illgen RN, Bukowski BR, Abiola R, et al. Robotic-Assisted total hip arthroplasty: outcomes at minimum two-year follow-up[J]. Surg Technol Int, 2017, 30: 365-372.
[19]
Kamara E, Robinson J, Bas MA, et al. Adoption of robotic vs fluoroscopic guidance in total hip arthroplasty: is acetabular positioning improved in the learning curve？[J]. J Arthroplasty, 2017, 32(1): 125-130.
[20]
Remily EA, Nabet A, Sax OC, et al. Impact of robotic assisted surgery on outcomes in total hip arthroplasty[J]. Arthroplast Today, 2021, 9: 46-49.
[21]
Kong X, Yang M, Jerabek S, et al. A retrospective study comparing a single surgeon′s experience on manual versus robot-assisted total hip arthroplasty after the learning curve of the latter procedure - a cohort study[J]. Int J Surg, 2020, 77: 174-180.
[22]
Singh V, Realyvasquez J, Simcox T, et al. Robotics versus navigation versus conventional total hip arthroplasty: does the use of technology yield superior outcomes？[J]. J Arthroplasty, 2021, 36(8): 2801-2807.
[23]
李俊成，倪明，冀全博，等．机器人辅助与传统方法行全髋关节置换术后下肢长度差异比较[J]．中华骨科杂志，2021，41(8)：480-487.
[24]
崔可赜，郭祥，陈元良，等．后外侧入路人工全髋关节置换术中MAKO机器人手臂辅助与传统人工方法的比较研究[J]．中国修复重建外科杂志，2020，34(7)：883-888.
[25]
张卓，孔祥朋，杨敏之，等．机器人辅助人工全髋关节置换的短期疗效分析[J]．骨科，2020，11(4)：269-273.
[26]
郭人文，柴伟，李想，等．机器人辅助在股骨头坏死全髋关节置换术中的应用[J]．中华骨科杂志，2020，40(13)：819-827.
[27]
Picard F, Deakin AH, Riches PE, et al. Computer assisted orthopaedic surgery: past, present and future[J]. Med Eng Phys, 2019, 72: 55-65.
[28]
Perets I, Walsh JP, Close MR, et al. Robot-assisted total hip arthroplasty: clinical outcomes and complication rate[J/OL]. Int J Med Robot, 2018, 14(4): e1912. DOI：10.1002/rcs.1912.
[29]
Honl M, Dierk O, Gauck C, et al. Comparison of robotic-assisted and manual implantation of a primary total hip replacement. A prospective study[J]. J Bone Joint Surg Am, 2003, 85-A(8): 1470-1478.
[30]
李正疆，李永奎，班照楠，等．直接前入路与常规后路人工全髋关节置换术的对比研究[J/CD]．中华关节外科杂志(电子版)，2019，13(1)：29-32, 121.
[31]
Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties[J]. J Bone Joint Surg Am, 1978, 60(2): 217-220.
[32]
于德家，李树锋，闫新峰，等．髋臼横韧带可作为臼杯前倾角安放的参考[J/CD]．中华关节外科杂志(电子版)，2020，14(6)：703-708.
[33]
Ledford CK, Perry KI, Hanssen AD, et al. What are the contemporary etiologies for revision surgery and revision after primary, noncemented total hip arthroplasty？[J]. J Am Acad Orthop Surg, 2019, 27(24): 933-938.
[34]
Elkins JM, Callaghan JJ, Brown TD. The 2014 frank stinchfield award: the ′landing zone′ for wear and stability in total hip arthroplasty is smaller than we thought: a computational analysis[J]. Clin Orthop Relat Res, 2015, 473(2): 441-452.
[35]
谭兵，冯敬，范斌，等．初次全髋关节置换术后股骨偏心距大小与髋关节功能重建的临床研究[J]．中国伤残医学，2021，29(4)：5-8.
[36]
崔可赜，郭祥，韩贵斌，等．MAKO机器人辅助后外侧入路全髋关节置换的学习曲线及临床早期效果[J]．中国组织工程研究，2020，24(9)：1313-1317.
[37]
Moschetti WE, Konopka JF, Rubash HE, et al. Can robot-assisted unicompartmental knee arthroplasty be cost-effective? A markov decision analysis[J]. J Arthroplasty, 2016, 31(4): 759-765.
[38]
Maldonado DR, Go CC, Kyin C, et al. Robotic arm-assisted total hip arthroplasty is more cost-effective than manual total hip arthroplasty: a markov model analysis[J]. J Am Acad Orthop Surg, 2021, 29(4): e168-e177.
[1] 孟繁宇, 周新社, 赵志, 裴立家, 刘犇. 侧位直接前方入路髋关节置换治疗偏瘫肢体股骨颈骨折[J]. 中华关节外科杂志(电子版), 2023, 17(06): 865-870.
[2] 金鑫, 谢卯, 刘芸, 杨操, 杨述华, 许伟华. 个性化股骨导向器辅助初次全髋关节置换的随机对照研究[J]. 中华关节外科杂志(电子版), 2023, 17(06): 780-787.
[3] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[4] 罗旺林, 杨传军, 许国星, 俞建国, 孙伟东, 颜文娟, 冯志. 开放性楔形胫骨高位截骨术不同植入材料的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 818-826.
[5] 李雄雄, 周灿, 徐婷, 任予, 尚进. 初诊导管原位癌伴微浸润腋窝淋巴结转移率的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 466-474.
[6] 张再博, 王冰雨, 焦志凯, 檀碧波. 胃癌术后下肢深静脉血栓危险因素的Meta分析[J]. 中华普通外科学文献(电子版), 2023, 17(06): 475-480.
[7] 李建美, 邓静娟, 杨倩. 两种术式联合治疗肝癌合并肝硬化门静脉高压的安全性及随访评价[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 41-44.
[8] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[9] 杨体飞, 杨传虎, 陆振如. 改良无充气经腋窝入路全腔镜下甲状腺手术对喉返神经功能的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 74-77.
[10] 陈大敏, 曹晓刚, 曹能琦. 肥胖对胃癌患者手术治疗效果的影响研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 651-653.
[11] 莫闲, 杨闯. 肝硬化患者并发门静脉血栓危险因素的Meta分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 678-683.
[12] 罗佳, 赵晶晶, 曹小珍, 钟玲, 范林军, 曾令娟. 单侧腋窝双侧乳晕入路机器人甲状腺术后局部加压预防皮下隧道出血的对照研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 603-606.
[13] 陈垚, 徐伯群, 高志慧. 改良式中间上入路根治术治疗甲状腺癌的有效性安全性研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 619-622.
[14] 潘冰, 吕少诚, 赵昕, 李立新, 郎韧, 贺强. 淋巴结清扫数目对远端胆管癌胰十二指肠切除手术疗效的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 608-612.
[15] 段文忠, 白延霞, 徐文亭, 祁虹霞, 吕志坚. 七氟烷和丙泊酚在肝切除术中麻醉效果比较Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 640-645.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号