Mannan Ashim, Akinyooye Deji, Hossain Fahad
Department of Trauma and Orthopaedics, Mid Yorkshire Hospitals NHS Trust, Wakefield, United Kingdom.
J Knee Surg. 2017 Sep;30(7):668-674. doi: 10.1055/s-0036-1593869. Epub 2016 Dec 1.
Alignment data in patient-specific instrumented (PSI) knee arthroplasty have been examined in several meta-analyses, with demonstration of comparative but not improved restitution of a neutral mechanical axis and favorable outcomes in femoral implant axial alignment. To date, no comprehensive synthesis of data has been conducted specifically for functional outcomes. Relevant databases were searched according to Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines during the period 2000 to 2015 of Levels 1 and 2 studies comparing functional outcomes of patient-specific instrumentation (PSI) versus conventional instrumentation. Outcomes of interest included postoperative Knee Society score (KSS) (function), KSS (knee), range of movement (ROM), Oxford knee scores (OKS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores. Five randomized controlled trials and three prospective-comparative studies were included reporting on a total of 828 knees. All eight studies reported postoperative KSS (function) and seven studies reported KSS (knee). Three studies reported postoperative OKS, four documented ROM, and two reported WOMAC scores. Meta-analysis demonstrated equivalent KSS (function) scores 3 months postsurgery ( = 1.71, = 0.09). In addition, no significant differences were found for KSS (function) at 6 months ( = 0.51, = 0.61) or 12 to 24 months postsurgery ( = 0.05, = 0.96). In addition, no significant differences were found between PSI and conventional instrumentation for postoperative KSS (knee), ROM, or OKS. In summary, this systematic review and meta-analysis demonstrates no conclusive evidence for or against PSI when considering short-term functional outcomes. Further high-quality studies are required to investigate both mid- and long-term outcomes as well as survivorship data.
在多项荟萃分析中已对患者特异性器械辅助（PSI）膝关节置换术中的对线数据进行了研究，结果表明在恢复中立机械轴方面具有可比性，但并未得到改善，且股骨假体轴向对线取得了良好结果。迄今为止，尚未专门针对功能结局进行全面的数据综合分析。根据系统评价和荟萃分析的首选报告项目指南，在2000年至2015年期间检索了相关数据库，纳入了比较患者特异性器械辅助（PSI）与传统器械辅助功能结局的1级和2级研究。感兴趣的结局包括术后膝关节协会评分（KSS）（功能）、KSS（膝关节）、活动范围（ROM）、牛津膝关节评分（OKS）以及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分。纳入了五项随机对照试验和三项前瞻性比较研究，共报告了828个膝关节。所有八项研究均报告了术后KSS（功能），七项研究报告了KSS（膝关节）。三项研究报告了术后OKS，四项记录了ROM，两项报告了WOMAC评分。荟萃分析表明，术后3个月时KSS（功能）评分相当（ = 1.71， = 0.09）。此外，术后6个月时KSS（功能）无显著差异（ = 0.51， = 0.61），术后12至24个月时也无显著差异（ = 0.05， = 0.96）。此外，在术后KSS（膝关节）、ROM或OKS方面，PSI与传统器械辅助之间未发现显著差异。总之，这项系统评价和荟萃分析表明，在考虑短期功能结局时，没有确凿证据支持或反对PSI。需要进一步开展高质量研究来调查中期和长期结局以及假体生存率数据。
