Guangzhou University of Traditional Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510403, Guangdong, People's Republic of China.
The Foshan Hospital of Traditional Chinese Medicine, No. 6, Qinren Road, Chancheng District, Foshan, 528000, Guangdong, People's Republic of China.
Knee Surg Sports Traumatol Arthrosc. 2020 Sep;28(9):2930-2941. doi: 10.1007/s00167-019-05678-x. Epub 2019 Aug 21.
Previous studies comparing the surgical accuracy between computed tomography (CT)- and magnetic resonance imaging (MRI)-based patient-specific instrumentation (PSI) methods have produced contradictory results. The aim of this study was to determine which is the more reliable imaging method (CT versus MRI) for patient-specific total knee arthroplasty (TKA). CT-based PSI is hypothesised to have an advantage regarding the number of outliers.
A total of 22 randomised controlled trials (RCTs), including 1749 TKA cases, were eligible for the meta-analysis. RCTs, systematic reviews and meta-analyses on this topic published in databases before September 2018 were identified by a literature search. The primary outcome was the number of lower extremities with greater than 3° of difference in alignment angles between the postoperative outcomes and target outcomes. The parameters calculated from the meta-analysis included risk ratios (RRs) and 95% confidence intervals (CIs). Additionally, the publication bias and heterogeneity of the studies were assessed.
The risk of femoral rotational outliers in the PSI group (RR = 0.48; 95% CI 0.24-0.98) was significantly reduced. Furthermore, subgroup analysis showed that the accuracy in the CT-based PSI group was significantly higher than that in the MRI-based CSI group (RR = 0.31; 95% CI 0.10-0.92).
This meta-analysis shows that when performing TKA with PSI, preoperative CT is beneficial for the production of the PSI, resulting in a significantly lower proportion of outliers in femoral rotational alignment. CT should be the preferred choice for imaging when performing TKA surgery with PSI to obtain better femoral rotational alignment.
Therapeutic study (systematic review and meta-analysis), Level I.
先前比较基于计算机断层扫描（CT）和磁共振成像（MRI）的患者特异性仪器（PSI）方法的手术准确性的研究结果相互矛盾。本研究旨在确定哪种成像方法（CT 与 MRI）更适合用于患者特异性全膝关节置换术（TKA）。我们假设 CT 基于 PSI 在离群值数量方面具有优势。
共有 22 项随机对照试验（RCT），包括 1749 例 TKA 病例，符合荟萃分析的条件。通过文献检索，确定了该主题的 RCT、系统评价和荟萃分析，这些研究均发表在 2018 年 9 月之前的数据库中。主要结局是术后结果与目标结果之间的对线角度差异大于 3°的下肢数量。荟萃分析中计算的参数包括风险比（RR）和 95％置信区间（CI）。此外，还评估了研究的发表偏倚和异质性。
PSI 组股骨旋转离群值的风险（RR=0.48；95％CI 0.24-0.98）显著降低。此外，亚组分析显示，基于 CT 的 PSI 组的准确性明显高于基于 MRI 的 CSI 组（RR=0.31；95％CI 0.10-0.92）。
这项荟萃分析表明，在使用 PSI 进行 TKA 时，术前 CT 有利于 PSI 的制作，从而使股骨旋转对线的离群值比例显著降低。在使用 PSI 进行 TKA 手术时，CT 应作为首选成像方法，以获得更好的股骨旋转对线。
治疗研究（系统评价和荟萃分析），I 级。
