計算機導航治療與傳統方法進行膝關節置換手術效果比較的系統評價_《中國循證醫學雜志》

作者：

李斌 , 瓦熱斯江尼亞孜 , 趙喜濱 , 王利 , 孫俊剛 ,  袁宏

新疆維吾爾自治區人民醫院骨一科（烏魯木齊 830001）;

關鍵詞：

計算機導航治療膝關節置換傳統方法隨機對照試驗系統評價 Meta分析

DOI：

10.7507/1672-2531.20100582

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目的　對計算機導航治療與傳統方法進行膝關節置換手術的放射學及術后功能評價進行Meta分析。
方法　計算機檢索Cochrane Library（CCTR）及Cochrane 協作網肌骨組專業試驗數據庫、MEDLINE（1966～2009）、EMbase（1980～2009）、PubMed、NRR（http://www.update-software.com/National/）、CCT（http://www.controlled-trials.com）和中國生物醫學文獻數據庫（CBM），手工檢索中文骨科文獻，收集計算機導航技術與傳統方法比較進行膝關節置換手術的臨床隨機對照試驗（RCT）。評價納入研究的方法學質量后，采用RevMan 4.2.8軟件進行Meta分析。
結果　共納入18個RCT，包括2 439例患者，其中A級5個，B級13個。Meta分析結果顯示：① 在放射學測量上，兩種方法：對下肢機械軸的測量精確性有差異［WMD= –?0.56，95%CI（–?0.74，–?0.38）］，對股骨冠狀軸和矢狀軸及旋轉角度的測量無明顯差異［WMD（95CI）分別為–?0.29（–?0.58，0.00）、–?1.64（–?3.49，0.21）及–?0.11（–?0.87，0.66）］；對脛骨冠狀軸的測量無明顯差異［WMD= –?0.31，95%CI（–?0.69，0.06）］，而對矢狀軸的測量有明顯差異［WMD= –?0.69，95%CI（–?1.10，–?0.28）］；對脛股冠狀角的測量無明顯差異［WMD= 0.03，95%CI（–?0.78，0.84）］，對髕骨傾斜角及髕骨旋轉角度也無明顯差異［WMD（95%CI）分別為–?1.45（–?3.12，0.22）及–?0.34（–?0.71，0.02）］。② 在操作時間上兩者有明顯差異［WMD= 13.31，95%CI（10.00，16.63）］，在并發癥及出血量方面兩者無明顯差異［RR及95%CI分別為1.65（0.87，3.13）及–?74.81（–?184.71，35.09）。③ 在術后功能評價上，納入研究均隨訪超過6個月，兩者在關節活動度、KSS 評分及OXFORD評分上無明顯差異［WMD（95%CI）分別為–?2.17（–?5.66，1.33）、6.28（–?3.69，16.25）、–?0.31（–?2.05，1.43）］。
結論　與傳統方法相比較，計算機導航技術進行膝關節置換手術：① 下肢機械軸的測量及脛骨矢狀軸的測量上兩者有顯著差異，而在股骨冠狀軸和矢狀軸及旋轉角度的測量上，脛骨冠狀軸及脛股冠狀角的測量上，以及髕骨傾斜角及髕骨旋轉角度的測量上，兩者無明顯差異。② 因計算機導航屬于新技術領域，操作不熟練，故在操作時間上，兩者差異較大，而并發癥及出血量方面，兩者無明顯差異。③ 在功能評價上（隨訪超過6個月），兩者無明顯差異，而長期隨訪效果有待進一步研究。

引用本文： 李斌,瓦熱斯江尼亞孜,趙喜濱,王利,孫俊剛,袁宏. 計算機導航治療與傳統方法進行膝關節置換手術效果比較的系統評價. 中國循證醫學雜志, 2010, 10(11): 1259-1268. doi: 10.7507/1672-2531.20100582 復制

1.	Park SE, Lee CT. Comparison of robotic-assisted and conventional manual implantation of a primary total knee arthroplasty. J Arthroplasty, 2007, 22(7): 1054-1059.
2.	Mullaji A, Kanna R, Marawar S, et al. Comparison of limb and component alignment using computer-assisted navigation versus image intensifier-guided conventional total knee arthroplasty: a prospective, randomized, single-surgeon study of 467 knees. J Arthroplasty, 2007, 22(7): 953-959.
3.	Luring C, Perlick L, Bäthis H, et al. The effect of femoral component rotation on patellar tracking in total knee arthroplasty. Orthopedics, 2007, 30(11): 965-967.
4.	Mombert M, Van Den Daelen L, Gunst P, et al. Navigated total knee arthroplasty: a radiological analysis of 42 randomised cases. Acta Orthop Belg, 2007, 73(1): 49-54.
5.	Maculé-Beneyto F, Hernández-Vaquero D, Segur-Vilalta JM, et al. Navigation in total knee arthroplasty. A multicenter study. Int Orthop, 2006, 30(6): 536-540.
6.	Seon JK, Song EK. Navigation-assisted less invasive total knee arthroplasty compared with conventional total knee arthroplasty: a randomized prospective trial. J Arthroplasty, 2006, 21(6): 777-782.
7.	Weinrauch P, Myers N, Wilkinson M, et al. Comparison of early postoperative rehabilitation outcome following total knee arthroplasty using different surgical approaches and instrumentation. J Orthop Surg (Hong Kong), 2006, 14(1): 47-52.
8.	Kalairajah Y, Cossey AJ, Verrall GM, et al. Are systemic emboli reduced in computer-assisted knee surgery? A prospective, randomised, clinical trial. J Bone Joint Surg Br, 2006, 88(2): 198-202.
9.	Chin PL, Yang KY, Yeo SJ, et al. Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty, 2005, 20(5): 618-626.
10.	Kalairajah Y, Simpson D, Cossey AJ, et al. Blood loss after total knee replacement : effects of computer-assisted surgery. J Bone Joint Surg, 2005, 87-B: 1480-1482.
11.	Decking R, Markmann Y, Fuchs J, et al. Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty, 2005, 20(3): 282-288.
12.	Sparmann M, Wolke B, Czupalla H, et al. Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br, 2003, 85-B: 830-835.
13.	Kim YH, Kim JS, Hong KS, et al. Prevalence of fat embolism after total knee arthroplasty performed with or without computer navigation. J Bone Joint Surg Am, 2008, 90(1): 123-128.
14.	Dutton AQ, Yeo SJ, Yang KY, et al. Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am, 2008, 90(1): 2-9.
15.	Ensini A, Catani F, Leardini A, et al. Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res, 2007, 457: 156-162.
16.	Matziolis G, Krocker D, Weiss U, et al. A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am, 2007, 89(2): 236-243.
17.	Victor J, Hoste D. Image-based computer-assisted total knee arthroplasty leads to lower variability in coronal alignment. Clin Orthop Relat Res, 2004, (428): 131-139.
18.	Stöckl B, Nogler M, Rosiek R, et al. Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res, 2004, (426): 180-186.

1. Park SE, Lee CT. Comparison of robotic-assisted and conventional manual implantation of a primary total knee arthroplasty. J Arthroplasty, 2007, 22(7): 1054-1059.
2. Mullaji A, Kanna R, Marawar S, et al. Comparison of limb and component alignment using computer-assisted navigation versus image intensifier-guided conventional total knee arthroplasty: a prospective, randomized, single-surgeon study of 467 knees. J Arthroplasty, 2007, 22(7): 953-959.
3. Luring C, Perlick L, Bäthis H, et al. The effect of femoral component rotation on patellar tracking in total knee arthroplasty. Orthopedics, 2007, 30(11): 965-967.
4. Mombert M, Van Den Daelen L, Gunst P, et al. Navigated total knee arthroplasty: a radiological analysis of 42 randomised cases. Acta Orthop Belg, 2007, 73(1): 49-54.
5. Maculé-Beneyto F, Hernández-Vaquero D, Segur-Vilalta JM, et al. Navigation in total knee arthroplasty. A multicenter study. Int Orthop, 2006, 30(6): 536-540.
6. Seon JK, Song EK. Navigation-assisted less invasive total knee arthroplasty compared with conventional total knee arthroplasty: a randomized prospective trial. J Arthroplasty, 2006, 21(6): 777-782.
7. Weinrauch P, Myers N, Wilkinson M, et al. Comparison of early postoperative rehabilitation outcome following total knee arthroplasty using different surgical approaches and instrumentation. J Orthop Surg (Hong Kong), 2006, 14(1): 47-52.
8. Kalairajah Y, Cossey AJ, Verrall GM, et al. Are systemic emboli reduced in computer-assisted knee surgery? A prospective, randomised, clinical trial. J Bone Joint Surg Br, 2006, 88(2): 198-202.
9. Chin PL, Yang KY, Yeo SJ, et al. Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty, 2005, 20(5): 618-626.
10. Kalairajah Y, Simpson D, Cossey AJ, et al. Blood loss after total knee replacement : effects of computer-assisted surgery. J Bone Joint Surg, 2005, 87-B: 1480-1482.
11. Decking R, Markmann Y, Fuchs J, et al. Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty, 2005, 20(3): 282-288.
12. Sparmann M, Wolke B, Czupalla H, et al. Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br, 2003, 85-B: 830-835.
13. Kim YH, Kim JS, Hong KS, et al. Prevalence of fat embolism after total knee arthroplasty performed with or without computer navigation. J Bone Joint Surg Am, 2008, 90(1): 123-128.
14. Dutton AQ, Yeo SJ, Yang KY, et al. Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am, 2008, 90(1): 2-9.
15. Ensini A, Catani F, Leardini A, et al. Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res, 2007, 457: 156-162.
16. Matziolis G, Krocker D, Weiss U, et al. A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am, 2007, 89(2): 236-243.
17. Victor J, Hoste D. Image-based computer-assisted total knee arthroplasty leads to lower variability in coronal alignment. Clin Orthop Relat Res, 2004, (428): 131-139.
18. Stöckl B, Nogler M, Rosiek R, et al. Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res, 2004, (426): 180-186.

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計算機導航治療與傳統方法進行膝關節置換手術效果比較的系統評價

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《中國循證醫學雜志》

計算機導航治療與傳統方法進行膝關節置換手術效果比較的系統評價

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