Wu Xiang-Dong, Xiang Bing-Yan, Schotanus Martijn G M, Liu Zun-Han, Chen Yu, Huang Wei
Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China; Evidence-Based Perioperative Medicine 07 Collaboration Group, China.
Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China; Department of Orthopaedic Surgery, The First People's Hospital of Zunyi City, Zunyi, 563000, Guizhou Province, China.
Surgeon. 2017 Dec;15(6):336-348. doi: 10.1016/j.surge.2017.06.002. Epub 2017 Jul 26.
To determine whether computed tomography (CT) or magnetic resonance imaging (MRI) is more suitable for the patient-specific instrumentation (PSI) systems for total knee arthroplasty (TKA).
PubMed, Embase, and the Cochrane Library were searched from inception to June 2016 for prospective comparative trials that compared CT- versus MRI-based PSI systems for TKA. Our predefined primary outcome was the outliers incidence of coronal overall limb alignment.
Six studies with a total of 336 knees meeting the eligibility criteria, and four trials were included in the meta-analysis. Compared with MRI-based PSI systems, CT-based PSI systems were associated with a higher outliers incidence of coronal overall limb alignment (risk ratio: 1.67; 95% confidence interval (CI): 1.03-2.72; P = 0.04), more angular errors of coronal overall limb alignment (mean difference (MD): 1.01°; 95% CI: 0.47-1.56; P = 0.0003), and longer operation time (MD: 5.02 min; 95% CI: 1.26-8.79; P = 0.009). While no significant differences in the coronal/sagittal alignment of the femoral/tibial component outliers, the angular errors of coronal overall limb alignment, the angular errors of the femoral/tibial component in coronal plane, or incidence of change of implant size of the femoral/tibial component were observed.
The current limited evidence suggests that MRI-based PSI systems exhibit higher accuracy for TKA regarding the coronal limb axis than CT-based PSI systems. However, well-designed studies comparing CT-versus MRI-based PSI systems for TKA are warrant to confirm these results before widespread use of this technique can be recommended.
确定计算机断层扫描（CT）或磁共振成像（MRI）是否更适用于全膝关节置换术（TKA）的患者特异性器械（PSI）系统。
检索PubMed、Embase和Cochrane图书馆，从建库至2016年6月，查找比较基于CT和基于MRI的TKA的PSI系统的前瞻性对照试验。我们预先定义的主要结局是冠状面整体肢体对线的异常值发生率。
六项研究共336例膝关节符合纳入标准，四项试验纳入荟萃分析。与基于MRI的PSI系统相比，基于CT的PSI系统冠状面整体肢体对线的异常值发生率更高（风险比：1.67；95%置信区间（CI）：1.03 - 2.72；P = 0.04），冠状面整体肢体对线的角度误差更大（平均差（MD）：1.01°；95% CI：0.47 - 1.56；P = 0.0003），手术时间更长（MD：5.02分钟；95% CI：1.26 - 8.79；P = 0.009）。而在股骨/胫骨组件异常值的冠状面/矢状面对线、冠状面整体肢体对线的角度误差、冠状面股骨/胫骨组件的角度误差或股骨/胫骨组件植入物尺寸变化发生率方面未观察到显著差异。
目前有限的证据表明，对于TKA，基于MRI的PSI系统在冠状肢体轴方面比基于CT的PSI系统具有更高的准确性。然而，在推荐广泛使用该技术之前，需要设计良好的比较基于CT和基于MRI的TKA的PSI系统的研究来证实这些结果。
