患者特异性器械可改善全膝关节置换术后股骨组件的轴向对线、手术时间和围手术期失血量。
Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty.
机构信息
Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Rehabilitation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2019 Apr;27(4):1083-1095. doi: 10.1007/s00167-018-5256-0. Epub 2018 Oct 30.
PURPOSE
The purpose of the present study was to compare patient-specific instrumentation (PSI) with standard instrumentation (SI) in patients undergoing total knee arthroplasty (TKA). PSI is hypothesized to have advantages with respect to component alignment; number of outliers (defined as alignment > 3° from the target alignment); operative time; perioperative blood loss; and length of hospital stay. This new surgical technique is expected to exhibit superior performance.
METHODS
A total of 23 randomized controlled trials (RCTs) involving 2058 knees that compared the clinical outcomes of TKA between PSI and SI were included in the present analysis; these RCTs were identified via a literature search of the PubMed, Embase, and Cochrane Library databases through March 1, 2018. The outcomes of interest included coronal, sagittal and axial component alignment (presented as the angle of deviation from the transcondylar line); number of outliers; operative time; perioperative blood loss; and length of hospital stay.
RESULTS
There was a significant difference in postoperative femoral axial alignment between PSI and SI patients (95% CI - 0.71 to - 0.21, p = 0.0004, I = 48%). PSI resulted in approximately 0.4° less deviation from the transcondylar line than SI. Based on our results, PSI reduced operative time by a mean of 7 min compared with SI (95% CI - 10.95 to - 3.75, p < 0.0001, I = 78%). According to the included literature, PSI reduced perioperative blood loss by approximately 90 ml compared with SI (95% CI - 146.65 to - 20.18, p = 0.01, I = 74%). We did not find any differences between PSI and SI with respect to any other parameters.
CONCLUSIONS
PSI has advantages in axial alignment of the femoral component, operative time, and perioperative blood loss relative to SI. No significant differences were found between PSI and SI with respect to alignment of the remaining components, number of outliers, or length of hospital stay.
LEVEL OF EVIDENCE
Therapeutic study (systematic review and meta-analysis), Level I.
目的
本研究旨在比较全膝关节置换术（TKA）中患者特异性仪器（PSI）与标准仪器（SI）的临床效果。假设 PSI 在器械部件对齐方面具有优势，包括器械部件的偏离角度（定义为与目标对齐的角度偏差>3°）、手术时间、围手术期失血量和住院时间。这种新的手术技术预计将表现出更好的性能。
方法
通过对 2018 年 3 月 1 日前在 PubMed、Embase 和 Cochrane Library 数据库中进行的文献检索，共纳入 23 项随机对照试验（RCT），共涉及 2058 例膝关节接受 PSI 和 SI 的 TKA 患者。这些 RCT 评估了 TKA 中 PSI 和 SI 之间的临床结果。研究结果包括冠状面、矢状面和轴向器械部件的对齐（以偏离髁间线的角度表示）、偏离角度超过 3°的数量、手术时间、围手术期失血量和住院时间。
结果
PSI 组与 SI 组患者的股骨轴向对齐存在显著差异（95%置信区间-0.71 至-0.21，p=0.0004，I=48%）。PSI 比 SI 更接近髁间线，偏差约为 0.4°。根据我们的结果，PSI 组的手术时间平均比 SI 组减少了 7 分钟（95%置信区间-10.95 至-3.75，p<0.0001，I=78%）。根据纳入的文献，PSI 组的围手术期失血量比 SI 组减少了约 90ml（95%置信区间-146.65 至-20.18，p=0.01，I=74%）。我们没有发现 PSI 和 SI 在其他参数方面存在差异。
结论
PSI 在股骨组件的轴向对齐、手术时间和围手术期失血量方面优于 SI。PSI 与 SI 在其余器械部件的对齐、偏离角度超过 3°的数量或住院时间方面没有显著差异。
证据水平
治疗性研究（系统评价和荟萃分析），I 级。
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