Cavaignac Etienne, Pailhé Regis, Laumond Gregoire, Murgier Jérôme, Reina Nicolas, Laffosse Jean Michel, Bérard Emilie, Chiron Philippe
Pôle Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, TSA 40031, 31059, Toulouse, France,
Int Orthop. 2015 Aug;39(8):1541-52. doi: 10.1007/s00264-014-2549-x. Epub 2014 Oct 10.
Because published studies on the accuracy achieved with patient-specific guides during total knee arthroplasty (TKA) contradict each other, this systematic review and meta-analysis sought to compare radiological TKA outcomes when patient-specific cutting blocks (PSCB) were used to the outcomes when standard manual instrumentation was used.
The meta-analysis was implemented according to PRISMA Statement Criteria. The primary endpoint was the hip-knee-ankle (HKA) angle, which represents the leg's mechanical axis. The accuracy of component placement in the coronal and sagittal planes, and the accuracy of femoral component rotation were also compiled. After testing for publication bias and heterogeneity across studies, data were aggregated random-effects modeling when necessary.
Fifteen articles were included: 916 total knee arthroplasty cases in the PSCB group and 998 in the MI group. The mechanical axis did not differ between the two groups (weighted mean difference 0.07°; 95 % CI, -0.5° to 0.65°; p = 0.8). Risk ratio analysis revealed no protective effect of using PSCB relative to the appearance of HKA angle outliers (RR = 0.88; 95 % CI, 0.68-1.13; p = 0.3). There was a trend towards a protective effect with PSCB for the risk of femoral component outliers, but the opposite was observed for the tibial component. The implantation procedure was stopped in 30 cases because the surgeon-authors found excessive discrepancies between the intra-operative observations and the pre-operative plan.
This meta-analysis found no evidence that using patient-specific cutting blocks provides superior accuracy to using manual instrumentation during TKA.
由于已发表的关于全膝关节置换术（TKA）中使用患者特异性导板所达到的准确性的研究相互矛盾，本系统评价和荟萃分析旨在比较使用患者特异性截骨模块（PSCB）与使用标准手动器械时TKA的放射学结果。
荟萃分析按照PRISMA声明标准实施。主要终点是髋-膝-踝（HKA）角，它代表下肢的机械轴。还汇总了冠状面和矢状面假体置入的准确性以及股骨假体旋转的准确性。在检验研究间的发表偏倚和异质性后，必要时采用随机效应模型汇总数据。
纳入15篇文章：PSCB组916例全膝关节置换病例，MI组998例。两组间机械轴无差异（加权平均差0.07°；95%CI，-0.5°至0.65°；p = 0.8）。风险比分析显示，相对于出现HKA角异常值，使用PSCB没有保护作用（RR = 0.88；95%CI，0.68 - 1.13；p = 0.3）。对于股骨假体异常值的风险，PSCB有保护作用的趋势，但胫骨假体情况则相反。30例手术因术者发现术中观察与术前计划存在过大差异而中止。
本荟萃分析未发现证据表明在TKA中使用患者特异性截骨模块比使用手动器械具有更高的准确性。
