Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands.
Zuyderland Academy, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2018 Sep;26(9):2659-2668. doi: 10.1007/s00167-017-4637-0. Epub 2017 Jul 11.
Patient-specific instruments (PSIs) are already in relatively common use, and their post-operative radiographic results are equal to those for total knee arthroplasty (TKA) with conventional instrumentation. PSI use requires a preoperative MRI scan, CT scan, or a combination of MRI and a long-leg standing radiograph. However, there is no consensus as to which of these modalities, MRI or CT, is the preferred imaging modality when performing TKA with PSIs.
This systematic literature review and meta-analysis studied the differences in alignment outliers between CT- and MRI-based PSI for TKA. A search of the Cochrane Database of Systematic Reviews, MEDLINE/PubMed and Embase was conducted, without restriction on date of publication. Only level I evidence studies written in English that included TKA with the use of MRI- and CT-based PSI were selected. A meta-analysis was then performed of the rate of outliers in the biomechanical axis and individual femoral and tibial component alignment. Where considerable heterogeneity among studies was present or the data did not provide sufficient information for performing the meta-analysis, a qualitative synthesis was undertaken.
Twelve randomized controlled trials, studying 841 knees, were eligible for data extraction and meta-analysis. MRI-based PSI resulted in a significantly lower proportion of coronal plane outliers with regard to the lateral femoral component (OR 0.52, 95% CI 0.30-0.89, P = 0.02), without significant heterogeneity (n.s.). There were no significant differences regarding the biomechanical axis or frontal femoral and individual tibial component alignment.
This systematic review and meta-analysis demonstrate that alignment with MRI-based PSI is at least as good as, if not better than, that with CT-based PSI. To prevent for malalignment, MRI should be the imaging modality of choice when performing TKA surgery with PSI.
I.
患者特异性器械（PSI）已经得到了相对广泛的应用，其术后放射学结果与传统器械全膝关节置换术（TKA）相当。PSI 使用需要术前 MRI 扫描、CT 扫描或 MRI 和长腿站立射线照相的组合。然而，当使用 PSI 进行 TKA 时，哪种成像方式，MRI 还是 CT，是首选成像方式，目前尚未达成共识。
本系统文献复习和荟萃分析研究了 CT 基 PSI 和 MRI 基 PSI 用于 TKA 时的对线偏差的差异。对 Cochrane 系统评价数据库、MEDLINE/PubMed 和 Embase 进行了检索，没有对发表日期的限制。仅选择了使用 MRI 和 CT 基 PSI 进行 TKA 的、证据水平为 I 级的、英文书写的研究。然后对生物力学轴和个体股骨和胫骨组件对线的偏差率进行了荟萃分析。如果研究之间存在很大的异质性，或者数据没有提供足够的信息进行荟萃分析，则进行定性综合。
12 项随机对照试验，共 841 个膝关节，符合数据提取和荟萃分析的条件。MRI 基 PSI 导致外侧股骨组件的冠状面偏差率显著降低（OR 0.52，95%CI 0.30-0.89，P=0.02），且没有显著的异质性（n.s.）。生物力学轴或正面股骨和个体胫骨组件的对线没有显著差异。
本系统评价和荟萃分析表明，MRI 基 PSI 的对线与 CT 基 PSI 一样好，如果不是更好的话。为了防止对线不良，在使用 PSI 进行 TKA 手术时，MRI 应作为首选的成像方式。
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