Tang Qian, Shang Ping, Zheng Gang, Xu Hua-Zi, Liu Hai-Xiao
Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109, Xueyuanxi road, 325027, Wenzhou, China.
Department of Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi road, Wenzhou, 325027, China.
J Orthop Surg Res. 2017 Jun 5;12(1):82. doi: 10.1186/s13018-017-0582-3.
There is no consensus whether the use of the extramedullary femoral cutting guide takes advantage over the intramedullary one in total knee arthroplasty. The aim of this study was to compare the extramedullary femoral alignment guide system with the conventional intramedullary alignment guide system for lower limb alignment, blood loss, and operative time during total knee arthroplasty.
The Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Chinese Periodical, Google, and reference lists of all the included studies were searched for randomized controlled trials. The following parameters were compared between the extramedullary technique and the intramedullary technique: (1) lower limb coronal alignment, (2) coronal alignment of femoral component, (3) sagittal alignment of femoral component, (4) blood loss, (5) and operation time.
Four randomized controlled trials consisting of 358 knees were included in our study. There was no significant difference between the extramedullary and intramedullary groups for the lower limb coronal alignment (RR = 1.20, 95%CI 0.285.21, n.s.), coronal alignment of femoral component (RR = 0.65, 95%CI 0.192.22, n.s.), and sagittal alignment of femoral component (RR = 0.73, 95%CI 0.381.41, n.s.). A reduced blood loss was associated with the use of the extramedullary guide (MD = -120.34, 95%CI -210.08-30.59, P = 0.009). No significant difference in operation time was noted between the two groups (MD = 1.41, 95%CI -1.82~4.64, n.s.).
Neither extramedullary nor intramedullary femoral alignment is more accurate than the other in facilitating the femoral cut in total knee arthroplasty. Use of the extramedullary guide results in less blood loss and exhibits a similar operation time as compared with the intramedullary guide.
在全膝关节置换术中，髓外股骨截骨导向器的使用是否优于髓内截骨导向器尚无定论。本研究旨在比较全膝关节置换术中髓外股骨对线导向系统与传统髓内对线导向系统在下肢对线、失血量和手术时间方面的差异。
检索Medline、Embase、Cochrane图书馆、中国知网（CNKI）、万方中文期刊、谷歌以及所有纳入研究的参考文献列表，查找随机对照试验。比较髓外技术和髓内技术在以下参数方面的差异：（1）下肢冠状面排列；（2）股骨假体的冠状面排列；（3）股骨假体的矢状面排列；（4）失血量；（5）手术时间。
本研究纳入了4项随机对照试验，共358例膝关节。髓外组和髓内组在下肢冠状面排列（RR = 1.20，95%CI 0.285.21，无统计学意义）、股骨假体冠状面排列（RR = 0.65，95%CI 0.192.22，无统计学意义）和股骨假体矢状面排列（RR = 0.73，95%CI 0.381.41，无统计学意义）方面无显著差异。使用髓外导向器可减少失血量（MD = -120.34，95%CI -210.08-30.59，P = 0.009）。两组手术时间无显著差异（MD = 1.41，95%CI -1.82~4.64，无统计学意义）。
在全膝关节置换术中，髓外和髓内股骨对线在引导股骨截骨方面的准确性并无差异。与髓内导向器相比，使用髓外导向器可减少失血量，且手术时间相近。
