Feeley Iain, Hegarty Aidan, Hickey Anne, Glynn Aaron
Department of Orthopaedics, Royal College of Surgeons in Ireland, Dublin, Ireland.
Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
J Knee Surg. 2016 Aug;29(6):487-96. doi: 10.1055/s-0035-1566732. Epub 2015 Nov 5.
Mechanical guides in total knee arthroplasty are divided into intramedullary and extramedullary systems, designed to give accurate reference, to enable the surgeon to perform a tibial cut which is perpendicular to the mechanical axis. We conducted a systematic review and meta-analysis of levels 1 and 2 published data which directly compares the two methods of alignment, with outcomes of interest being the mean tibial component angle to the mechanical axis and the number of outliers from the optimal range. The PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidance was followed. A search was conducted of online databases Medline PubMed; EMBASE; ISI Web of Science, and the Cochrane library, using the Boolean search string ([intramedullary OR extramedullary] AND knee AND [arthroplasty OR replacement]). Numerical data pertaining to tibial component alignment (TCA), the mechanical tibiofemoral angle, the tibial slope, and the number of outliers from optimal TCA were collated, and used to establish pooled results. No constraints on the search in terms of year of publication or language were instituted. Intrastudy bias was assessed using the Jadad score for randomized controlled trials and the Newcastle Ottawa score for prospective cohort studies. A total of 1,896 titles were reviewed. Following abstract review and full review of relevant articles, 10 publications were included for analysis, of which 8 were suitable to include for meta-analysis. No trials showed a significant difference in the mean TCA. Two trials showed an increased number of outliers in the extramedullary group and two studies showed an increased number of outliers in the intramedullary group. Pooled data from studies which included these outcomes showed no advantage for either system in limiting the number of outliers from the optimal TCA (relative risk, 0.99; 95% confidence interval [CI], 0.87-1.14; p = 0.004), and no significant difference in mean TCA (standardized mean difference, -0.07; 95% CI, -0.22 to 0.08; p = 0.000). Based on our results, no advantage can be attributed to the type of mechanical guide used in obtaining an adequate tibial cut.
全膝关节置换术中的机械导向装置分为髓内和髓外系统，旨在提供准确的参考，使外科医生能够进行垂直于机械轴的胫骨截骨。我们对1级和2级已发表数据进行了系统评价和荟萃分析，直接比较这两种对线方法，感兴趣的结果是胫骨假体相对于机械轴的平均角度以及超出最佳范围的异常值数量。遵循PRISMA（系统评价和荟萃分析的首选报告项目）指南。使用布尔搜索字符串（[髓内或髓外] AND 膝关节 AND [关节成形术或置换术]）在在线数据库Medline PubMed、EMBASE、ISI Web of Science和Cochrane图书馆中进行搜索。整理了与胫骨假体对线（TCA）、机械性胫股角、胫骨坡度以及超出最佳TCA的异常值数量相关的数值数据，并用于建立汇总结果。在出版年份或语言方面对搜索没有限制。使用随机对照试验的Jadad评分和前瞻性队列研究的纽卡斯尔渥太华评分评估研究内偏倚。共审查了1896个标题。在对相关文章进行摘要审查和全文审查后，纳入10篇出版物进行分析，其中8篇适合纳入荟萃分析。没有试验显示平均TCA有显著差异。两项试验显示髓外组的异常值数量增加，两项研究显示髓内组的异常值数量增加。纳入这些结果的研究的汇总数据显示，在限制超出最佳TCA的异常值数量方面，两种系统均无优势（相对风险，0.99；95%置信区间[CI]，0.87 - 1.14；p = 0.004），并且平均TCA无显著差异（标准化平均差，-0.07；95% CI，-0.22至0.08；p = 0.000）。根据我们的结果，在获得合适的胫骨截骨方面，所用机械导向装置的类型没有优势。
