Cheng Tao, Pan Xiao-Yun, Mao Xin, Zhang Guo-You, Zhang Xian-Long
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. 2012 Aug;19(4):237-45. doi: 10.1016/j.knee.2011.10.001. Epub 2011 Nov 29.
Even though computer-assisted navigation systems have been shown to improve the accuracy of implantation of components into the femur and tibia, long-term results are lacking and there is little evidence yet that navigation techniques also improve functional outcomes and implant longevity following total knee arthroplasty (TKA). The aim of this study was to summarize and compare the clinical outcomes of total knee arthroplasties (TKAs) performed using navigation-assisted and conventional techniques.
The study was conducted according to the guidelines described in the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statements. Methodological features were rated independently by two reviewers. A meta-analysis of randomized controlled trials (RCTs) or quasi- randomized controlled trials (qRCTs) was carried out to evaluate the efficacy of CAS versus conventional TKA. Data were pooled in fixed and random effects models and the weighted mean difference (WMD) and odds ratio (OR) were calculated. Heterogeneity across studies was determined, and subgroup analyses by the type of navigation system (image-based or image-free navigation system) were conducted.
Twenty-one studies that included 2333 knees were collected from different countries. The surgical time was longer for CN TKA than for the conventional procedure. There was no significant difference in the Knee Society Score between the two groups at the 3-month and 6-month follow-up. The rates of postoperative complications in patients who had CN TKA were similar to those in the patients who had conventional TKA.
No significant differences in short-term clinical outcomes were found following TKAs performed with and without computer navigation system. However, there is clearly a need for additional high-quality clinical trials with long-term follow-up to confirm the clinical benefits of computer-assisted surgery.
尽管计算机辅助导航系统已被证明可提高组件植入股骨和胫骨的准确性，但长期结果尚缺，且几乎没有证据表明导航技术还能改善全膝关节置换术（TKA）后的功能结果和植入物使用寿命。本研究的目的是总结和比较使用导航辅助技术和传统技术进行的全膝关节置换术（TKA）的临床结果。
本研究按照《Cochrane干预措施系统评价手册》和《系统评价与Meta分析优先报告项目声明》中描述的指南进行。两名 reviewers 独立对方法学特征进行评分。对随机对照试验（RCT）或准随机对照试验（qRCT）进行荟萃分析，以评估计算机辅助手术（CAS）与传统TKA的疗效。数据采用固定效应模型和随机效应模型进行汇总，并计算加权平均差（WMD）和比值比（OR）。确定研究间的异质性，并按导航系统类型（基于图像或无图像导航系统）进行亚组分析。
从不同国家收集了21项研究，共纳入2333个膝关节。计算机导航全膝关节置换术（CN TKA）的手术时间比传统手术长。两组在3个月和6个月随访时的膝关节协会评分无显著差异。接受CN TKA的患者术后并发症发生率与接受传统TKA的患者相似（无显著差异）。
在有无计算机导航系统的情况下进行全膝关节置换术后，短期临床结果无显著差异。然而，显然需要更多高质量的长期随访临床试验来证实计算机辅助手术的临床益处。
