CAJ | 학술논문

背景：目前计算机辅助导航技术已经越来越多地应用于全膝关节置换中。计算机辅助导航全膝关节置换是否比传统全膝关节置换更具优势目前尚无定论。目的：系统评价计算机辅助导航和传统全膝关节置换后肢体和假体力线的恢复情况。方法：计算机检索2013年6月前PubMed/Medline、EMBASE、Cochrane CENTRAL、ScienceDirect数据库，纳入计算机辅助导航和传统全膝关节置换的随机对照试验，应用Cochrane协作网提供的RevMan 5.2.5软件进行Meta分析。选取髋-膝-踝机械轴或胫股关节角、股骨假体冠状角、股骨假体矢状角、胫骨假体冠状角、股骨假体矢状角5个指标进行比较，以偏离中线2°或3°确定为力线不良。结果与结论：共纳入19篇随机对照试验文献，共2654例(3392膝)。Meta分析结果显示，计算机辅助导航全膝关节置换后机械轴恢复精确率明显优于传统全膝关节置换，其中偏倚3°时，P<0.00001；偏倚2°时， P=0.0008。计算机辅助导航全膝关节置换后股骨假体冠状角恢复精确率(3°)明显优于传统全膝关节置换(P=0.002)；偏倚2°时两种方案差异无显著性意义(P=0.290)。计算机辅助导航全膝关节置换后股骨假体矢状角恢复精确率(3°)明显优于传统全膝关节置换(P=0.040)；偏倚2°时两种方案差异无显著性意义(P=0.950)。计算机辅助导航全膝关节置换后胫骨假体冠状角恢复精确率明显优于传统全膝关节置换，偏倚3°时，P=0.0007；偏倚2°时，P=0.002。计算机辅助导航全膝关节置换后股骨假体矢状角恢复精确率(3°)明显优于传统全膝关节置换(P=0.030)；偏倚2°时两种方案差异无显著性意义(P=0.260)。提示计算机辅助导航全膝关节置换后肢体力线、股骨/胫骨假体力线偏倚3°以内的精确率均优于传统全膝关节置换，但股骨假体冠状角、股骨假体矢状角、股骨假体矢状角偏倚2°以内的精确率两种方案无明显差异。揹景：目前計算機輔助導航技術已經越來越多地應用于全膝關節置換中。計算機輔助導航全膝關節置換是否比傳統全膝關節置換更具優勢目前尚無定論。目的：繫統評價計算機輔助導航和傳統全膝關節置換後肢體和假體力線的恢複情況。方法：計算機檢索2013年6月前PubMed/Medline、EMBASE、Cochrane CENTRAL、ScienceDirect數據庫，納入計算機輔助導航和傳統全膝關節置換的隨機對照試驗，應用Cochrane協作網提供的RevMan 5.2.5軟件進行Meta分析。選取髖-膝-踝機械軸或脛股關節角、股骨假體冠狀角、股骨假體矢狀角、脛骨假體冠狀角、股骨假體矢狀角5箇指標進行比較，以偏離中線2°或3°確定為力線不良。結果與結論：共納入19篇隨機對照試驗文獻，共2654例(3392膝)。Meta分析結果顯示，計算機輔助導航全膝關節置換後機械軸恢複精確率明顯優于傳統全膝關節置換，其中偏倚3°時，P<0.00001；偏倚2°時， P=0.0008。計算機輔助導航全膝關節置換後股骨假體冠狀角恢複精確率(3°)明顯優于傳統全膝關節置換(P=0.002)；偏倚2°時兩種方案差異無顯著性意義(P=0.290)。計算機輔助導航全膝關節置換後股骨假體矢狀角恢複精確率(3°)明顯優于傳統全膝關節置換(P=0.040)；偏倚2°時兩種方案差異無顯著性意義(P=0.950)。計算機輔助導航全膝關節置換後脛骨假體冠狀角恢複精確率明顯優于傳統全膝關節置換，偏倚3°時，P=0.0007；偏倚2°時，P=0.002。計算機輔助導航全膝關節置換後股骨假體矢狀角恢複精確率(3°)明顯優于傳統全膝關節置換(P=0.030)；偏倚2°時兩種方案差異無顯著性意義(P=0.260)。提示計算機輔助導航全膝關節置換後肢體力線、股骨/脛骨假體力線偏倚3°以內的精確率均優于傳統全膝關節置換，但股骨假體冠狀角、股骨假體矢狀角、股骨假體矢狀角偏倚2°以內的精確率兩種方案無明顯差異。
배경：목전계산궤보조도항기술이경월래월다지응용우전슬관절치환중。계산궤보조도항전슬관절치환시부비전통전슬관절치환경구우세목전상무정론。목적：계통평개계산궤보조도항화전통전슬관절치환후지체화가체력선적회복정황。방법：계산궤검색2013년6월전PubMed/Medline、EMBASE、Cochrane CENTRAL、ScienceDirect수거고，납입계산궤보조도항화전통전슬관절치환적수궤대조시험，응용Cochrane협작망제공적RevMan 5.2.5연건진행Meta분석。선취관-슬-과궤계축혹경고관절각、고골가체관상각、고골가체시상각、경골가체관상각、고골가체시상각5개지표진행비교，이편리중선2°혹3°학정위력선불량。결과여결론：공납입19편수궤대조시험문헌，공2654례(3392슬)。Meta분석결과현시，계산궤보조도항전슬관절치환후궤계축회복정학솔명현우우전통전슬관절치환，기중편의3°시，P<0.00001；편의2°시， P=0.0008。계산궤보조도항전슬관절치환후고골가체관상각회복정학솔(3°)명현우우전통전슬관절치환(P=0.002)；편의2°시량충방안차이무현저성의의(P=0.290)。계산궤보조도항전슬관절치환후고골가체시상각회복정학솔(3°)명현우우전통전슬관절치환(P=0.040)；편의2°시량충방안차이무현저성의의(P=0.950)。계산궤보조도항전슬관절치환후경골가체관상각회복정학솔명현우우전통전슬관절치환，편의3°시，P=0.0007；편의2°시，P=0.002。계산궤보조도항전슬관절치환후고골가체시상각회복정학솔(3°)명현우우전통전슬관절치환(P=0.030)；편의2°시량충방안차이무현저성의의(P=0.260)。제시계산궤보조도항전슬관절치환후지체력선、고골/경골가체력선편의3°이내적정학솔균우우전통전슬관절치환，단고골가체관상각、고골가체시상각、고골가체시상각편의2°이내적정학솔량충방안무명현차이。
BACKGROUND:Computer-assisted navigation technique has been widely applied in total knee arthroplasty. However, whether computer-assisted navigation total knee arthroplasty is better than traditional total knee arthroplasty remains unclear. OBJECTIVE:To systemical y evaluate and compare the limb and prosthesis alignment restoration post computer-assisted navigation and traditional total knee arthroplasty. METHODS:The PubMed/Medline, EMBASE, Cochrane CENTRAL, ScienceDirect database were searched from established to June 2013 and the randomized control ed trials about computer-assisted navigation and traditional total knee arthroplasty were selected. Meta analysis was performed with Rev Man 5.2 software. The evaluating data included the hip-knee-ankle mechanical axis or tibiofemoral angle, femoral prosthesis coronal angle, femoral prosthesis sagittal angle, tibial prosthesis coronal angle, and tibial prosthesis sagittal angle. The malalignment was defined as a deviation 2° or 3° from the natural line. RESULTS AND CONCLUSION:19 randomized control ed trials involving 2 654 cases (3 392 knees) were included in this study. Meta-analysis showed that, the limb alignment restoration post computer-assisted navigation was significantly better than traditional total knee arthroplasty (3°, P<0.000 01 and 2°, P=0.000 8). The 3° of femoral prosthesis coronal angle deviation post computer-assisted navigation was significantly superior to traditional total knee arthroplasty (P=0.002), while the 2° deviation had no significant difference between the two surgeries (P=0.290). The 3° deviation of femoral prosthesis sagittal angle post computer-assisted navigation was significantly better than traditional total knee arthroplasty (P=0.040);however, the 2° deviation had no significant difference between the two surgeries (P=0.950). 3° and 2°tibial prosthesis coronal angle deviation post computer-assisted navigation was significantly superior to traditional total knee arthroplasty (3°, P=0.030);the 2° deviation had no significant difference between the two surgeries (P=0.260). Computer-assisted navigation has better limb alignment, femoral and tibial prosthesis alignment 3° deviation than the traditional total knee arthroplasty, but the 2° deviation of femoral prosthesis coronal angle, femoral prosthesis sagittal angle, and tibial prosthesis sagittal angle had no significant difference between the two surgeries.