Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
J Surg Res. 2011 Dec;171(2):590-600. doi: 10.1016/j.jss.2010.05.006. Epub 2010 Oct 31.
The aim of computer-assisted surgery is to improve accuracy and limit the range of surgical variability. However, a worldwide debate exists regarding the importance and usefulness of computer-assisted navigation for total knee arthroplasty (TKA). The main purpose of this study is to summarize and compare the radiographic outcomes of TKA performed using imageless computer-assisted navigation compared with conventional techniques.
An electronic search of PubMed, EMBASE, Web of Science, and Cochrane library databases was made, in addition to manual search of major orthopedic journals. A meta-analysis of 29 quasi-randomized/randomized controlled trials (quasi-RCTs/RCTs) and 11 prospective comparative studies was conducted through a random effects model. Additional a priori sources of clinical heterogeneity were evaluated by subgroup analysis with regard to radiographic methods.
When the outlier cut-off value of lower limb axis was defined as ±2° or ±3° from the neutral, the postoperative full-length radiographs demonstrated that the risk ratio was 0.54 or 0.39, respectively, which were in favor of the navigated group. When the cut-off value used for the alignment in the coronal and sagittal plane was 2° or 3°, imageless navigation significantly reduced the outlier rate of the femoral and tibial components compared with the conventional group. Notably, computed tomography scans demonstrated no statistically significant differences between the two groups regarding the outliers in the rotational alignment of the femoral and tibial components; however, there was strong statistical heterogeneity.
Our results indicated that imageless computer-assisted navigation systems improve lower limb axis and component orientation in the coronal and sagittal planes, but not the rotational alignment in TKA. Further multiple-center clinical trials with long-term follow-up are needed to determine differences in the clinical and functional outcomes of knee arthroplasties performed using computer-assisted techniques.
计算机辅助手术的目的是提高准确性并限制手术变异性的范围。然而，关于计算机辅助导航在全膝关节置换术（TKA）中的重要性和有用性，存在全球性的争论。本研究的主要目的是总结和比较使用无图像计算机辅助导航与传统技术进行 TKA 的影像学结果。
对 PubMed、EMBASE、Web of Science 和 Cochrane 图书馆数据库进行电子检索，并对主要骨科杂志进行手工检索。通过随机效应模型对 29 项准随机/随机对照试验（quasi-RCTs/RCTs）和 11 项前瞻性对照研究进行了荟萃分析。通过亚组分析评估了与影像学方法相关的其他临床异质性的潜在来源。
当将下肢轴线的离群值定义为偏离中立位±2°或±3°时，术后全长 X 线片显示，风险比分别为 0.54 或 0.39，这有利于导航组。当冠状面和矢状面的对线的截距值为 2°或 3°时，无图像导航显著降低了与常规组相比，股骨和胫骨部件的离群率。值得注意的是，计算机断层扫描（CT）扫描显示，在股骨和胫骨部件的旋转对线的离群值方面，两组之间没有统计学上的显著差异；然而，存在很强的统计异质性。
我们的结果表明，无图像计算机辅助导航系统改善了 TKA 下肢轴线和冠状面与矢状面的组件方向，但不能改善旋转对线。需要进一步进行多中心临床试验，并进行长期随访，以确定使用计算机辅助技术进行膝关节置换的临床和功能结果的差异。
