Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yisan Road, Shanghai, 200233, People's Republic of China.
Knee Surg Sports Traumatol Arthrosc. 2012 Jul;20(7):1307-22. doi: 10.1007/s00167-011-1588-8. Epub 2011 Jul 6.
Computer-assisted surgery has been proposed as a technique to improve implant alignment during total knee arthroplasty (TKA). However, there is still a debate over the accuracy of placing the femoral and tibial components using computer-assisted systems in TKA. The aim of this study is to establish whether computer-assisted surgery leads to superior mechanical leg axis and implant positioning than conventional technique in patients with primary TKA.
Major electronic databases were systematically searched to identify relevant studies without language restriction. A meta-analysis of 41 randomized controlled trials (RCTs) or quasi-RCTs was performed in a random effects model. A subgroup analysis was conducted by type of navigation system to explore the clinical heterogeneity between these trials. The following radiographic parameters were used to compare computer-assisted surgery with conventional technique: (1) mechanical leg axis, (2) femoral component coronal alignment, (3) tibial component coronal alignment, (4) femoral component sagittal alignment, and (5) tibial component sagittal alignment.
For the mechanical leg axis and coronal positioning of femoral and tibial components, there are statistically significant reductions in the number of patients with malalignment in the CAS group if the outlier cutoff value is ±3 or 2° in the coronal and sagittal planes, respectively. Subgroup analysis demonstrates that CT-free navigation systems provide better alignment than conventional techniques in the coronal and sagittal alignment of femoral components within ±3 and 2°. If the outlier cutoff value for the tibial sagittal alignment is ±2°, the outlier percentages are higher in the CT-free navigation group than in the conventional group. However, there was no significant difference in the tibial sagittal alignment at ±3°.
Computer-assisted surgery does improve mechanical leg axis and component orientation in TKAs. However, high-quality RCTs are necessary to determine whether surgeons could use computer-assisted techniques to achieve a targeted tibial slope in TKA.
Therapeutic study (Systematic review of Level I/II studies), Level II.
计算机辅助手术已被提出作为一种提高全膝关节置换术（TKA）中植入物对准的技术。然而，在 TKA 中使用计算机辅助系统放置股骨和胫骨部件的准确性仍存在争议。本研究旨在确定计算机辅助手术是否比传统技术在初次 TKA 患者中导致更好的机械腿轴和植入物定位。
系统地搜索主要电子数据库，以确定无语言限制的相关研究。采用随机效应模型对 41 项随机对照试验（RCT）或准 RCT 进行荟萃分析。通过导航系统类型进行亚组分析，以探索这些试验之间的临床异质性。使用以下放射学参数比较计算机辅助手术与传统技术：（1）机械腿轴，（2）股骨部件冠状对准，（3）胫骨部件冠状对准，（4）股骨部件矢状对准，和（5）胫骨部件矢状对准。
对于机械腿轴和股骨及胫骨部件的冠状定位，如果在冠状和矢状平面上分别将离群值截止值设为±3 或 2°，则在 CAS 组中，存在畸形的患者数量在统计学上显著减少。亚组分析表明，在股骨部件的冠状和矢状对准方面，无 CT 导航系统比传统技术提供更好的对准，在±3 和 2°范围内。如果胫骨矢状对准的离群值截止值为±2°，则无 CT 导航组的离群百分比高于传统组。然而，在±3°处胫骨矢状对准没有显著差异。
计算机辅助手术确实改善了 TKA 中的机械腿轴和部件方向。然而，需要高质量的 RCT 来确定外科医生是否可以使用计算机辅助技术在 TKA 中实现目标胫骨斜率。
治疗性研究（I/II 级研究的系统评价），II 级。
