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计算机导航与传统全膝关节置换术:中国一项随机对照试验方案

Computer-navigated versus conventional total knee arthroplasty: A randomized controlled trial protocol in China.

作者信息

Yu Yefeng, Sheng Jianming, Zhou Xiao

机构信息

Department of orthopedics, Jiaxing Second Hospital, Zhejiang Province, China.

出版信息

Medicine (Baltimore). 2020 Aug 7;99(32):e21508. doi: 10.1097/MD.0000000000021508.

DOI:10.1097/MD.0000000000021508
PMID:32769888
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7593008/
Abstract

BACKGROUND

The literature lacks studies that confirm whether the improved radiographic alignment that can be achieved with computer-navigated total knee arthroplasty (TKA) improves patients' activities of daily living or the durability of total knee prostheses. Thus, in this protocol, we designed a randomized controlled trial to compare implant alignment, functional scores, and survival of the implant using computer-assisted surgery versus a conventional surgical technique.

METHODS

This prospective, blinded randomized controlled trial was conducted at our single hospital. This study was approved by the ethics committee of Jiaxing Second Hospital. The patient inclusion criteria were age 20 to 80 years' old, a body mass index of ≤35 kg/m, and consented for primary knee arthroplasty performed through a medial parapatellar approach by the senior author. We randomized consented study participants on a 1:1 ratio to 1 of 2 study groups using a computer-generated list of random numbers in varying block sizes. The primary outcome in this study was the Knee Injury and Osteoarthritis Outcome Score. Secondary outcomes were the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, complications, and range of motion together with alignment and rotational positioning of the implant. Statistical significance was defined as a P value of ≤0.05.

CONCLUSIONS

Authors hypothesized that computer-assisted surgery in primary TKA improves implant alignment, functional scores, and survival of the implant compared to the conventional technique.

摘要

背景

目前的文献中缺乏相关研究来证实,计算机导航全膝关节置换术(TKA)所实现的更好的影像学对线是否能改善患者的日常生活活动能力或全膝关节假体的耐用性。因此,在本方案中,我们设计了一项随机对照试验,以比较使用计算机辅助手术与传统手术技术时的植入物对线、功能评分以及植入物的生存率。

方法

这项前瞻性、双盲随机对照试验在我们单家医院进行。本研究获得了嘉兴市第二医院伦理委员会的批准。患者纳入标准为年龄在20至80岁之间,体重指数≤35kg/m²,并同意由资深作者通过髌旁内侧入路进行初次膝关节置换术。我们使用计算机生成的不同块大小的随机数字列表,将同意参与研究的参与者按1:1的比例随机分配到2个研究组中的1组。本研究的主要结局指标是膝关节损伤和骨关节炎疗效评分。次要结局指标包括膝关节协会评分、西安大略和麦克马斯特大学骨关节炎指数、并发症、活动范围以及植入物的对线和旋转定位。统计学显著性定义为P值≤0.05。

结论

作者假设,与传统技术相比,初次全膝关节置换术中的计算机辅助手术可改善植入物对线、功能评分以及植入物的生存率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4077/7593008/21e3776da619/medi-99-e21508-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4077/7593008/21e3776da619/medi-99-e21508-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4077/7593008/21e3776da619/medi-99-e21508-g001.jpg

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本文引用的文献

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Computer-Navigated versus Conventional Total Knee Arthroplasty: A Meta-Analysis of Functional Outcomes from Level I and II Randomized Controlled Trials.计算机导航与常规全膝关节置换术:Ⅰ级和Ⅱ级随机对照试验功能结果的荟萃分析。
J Knee Surg. 2021 May;34(6):648-658. doi: 10.1055/s-0039-1700494. Epub 2019 Nov 4.
2
A Comparison of Long-Term Outcomes of Computer-Navigated and Conventional Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials.计算机导航与常规全膝关节置换术长期疗效的比较:随机对照试验的荟萃分析。
J Bone Joint Surg Am. 2019 Oct 16;101(20):1875-1885. doi: 10.2106/JBJS.19.00257.
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Comparative outcomes of epidural steroids versus placebo after lumbar discectomy in lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials.
腰椎间盘突出症患者行腰椎间盘切除术后硬膜外注射类固醇与安慰剂的比较结果:一项随机对照试验的系统评价和荟萃分析
Eur J Orthop Surg Traumatol. 2018 Dec;28(8):1589-1599. doi: 10.1007/s00590-018-2229-4. Epub 2018 May 29.
4
Clinical Outcomes of Gap Balancing vs Measured Resection in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis Involving 2259 Subjects.全膝关节置换术中间隙平衡与测量截骨的临床疗效比较:一项包含 2259 例患者的系统评价和荟萃分析。
J Arthroplasty. 2018 Aug;33(8):2684-2693. doi: 10.1016/j.arth.2018.03.015. Epub 2018 Mar 17.
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Twelve-Year Follow-Up of Navigated Computer-Assisted Versus Conventional Total Knee Arthroplasty: A Prospective Randomized Comparative Trial.导航计算机辅助与常规全膝关节置换术的 12 年随访:一项前瞻性随机对照试验。
J Arthroplasty. 2018 May;33(5):1404-1411. doi: 10.1016/j.arth.2017.12.012. Epub 2017 Dec 21.
6
Perioperative steroids for lumbar disc surgery: A meta-analysis of randomized controlled trials.腰椎间盘手术围手术期使用类固醇:随机对照试验的荟萃分析。
Surg Neurol Int. 2017 Apr 5;8:42. doi: 10.4103/sni.sni_478_16. eCollection 2017.
7
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Acta Orthop. 2016 Dec;87(6):592-599. doi: 10.1080/17453674.2016.1244884. Epub 2016 Oct 24.
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