机器人辅助与手动单髁膝关节置换术的比较：MAKO 机器人系统的系统评价和荟萃分析。

Robotic arm-assisted versus manual unicompartmental knee arthroplasty : a systematic review and meta-analysis of the MAKO robotic system.

机构信息

Tan Tock Seng Hospital, Singapore, Singapore.

Edinburgh Orthopedics, Royal Infirmary of Edinburgh, Edinburgh, UK.

出版信息

Bone Joint J. 2022 May;104-B(5):541-548. doi: 10.1302/0301-620X.104B5.BJJ-2021-1506.R1.

DOI:10.1302/0301-620X.104B5.BJJ-2021-1506.R1

PMID:35491572

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9948441/

Abstract

AIMS

This systematic review aims to compare the precision of component positioning, patient-reported outcome measures (PROMs), complications, survivorship, cost-effectiveness, and learning curves of MAKO robotic arm-assisted unicompartmental knee arthroplasty (RAUKA) with manual medial unicompartmental knee arthroplasty (mUKA).

METHODS

Searches of PubMed, MEDLINE, and Google Scholar were performed in November 2021 according to the Preferred Reporting Items for Systematic Review and Meta--Analysis statement. Search terms included "robotic", "unicompartmental", "knee", and "arthroplasty". Published clinical research articles reporting the learning curves and cost-effectiveness of MAKO RAUKA, and those comparing the component precision, functional outcomes, survivorship, or complications with mUKA, were included for analysis.

RESULTS

A total of 179 articles were identified from initial screening, of which 14 articles satisfied the inclusion criteria and were included for analysis. The papers analyzed include one on learning curve, five on implant positioning, six on functional outcomes, five on complications, six on survivorship, and three on cost. The learning curve was six cases for operating time and zero for precision. There was consistent evidence of more precise implant positioning with MAKO RAUKA. Meta-analysis demonstrated lower overall complication rates associated with MAKO RAUKA (OR 2.18 (95% confidence interval (CI) 1.06 to 4.49); p = 0.040) but no difference in re-intervention, infection, Knee Society Score (KSS; mean difference 1.64 (95% CI -3.00 to 6.27); p = 0.490), or Western Ontario and McMaster Universities Arthritis Index (WOMAC) score (mean difference -0.58 (95% CI -3.55 to 2.38); p = 0.700). MAKO RAUKA was shown to be a cost-effective procedure, but this was directly related to volume.

CONCLUSION

MAKO RAUKA was associated with improved precision of component positioning but was not associated with improved PROMs using the KSS and WOMAC scores. Future longer-term studies should report functional outcomes, potentially using scores with minimal ceiling effects and survival to assess whether the improved precision of MAKO RAUKA results in better outcomes. Cite this article: 2022;104-B(5):541-548.

摘要

目的

本系统评价旨在比较 Mako 机械臂辅助单髁膝关节置换术（RAUKA）与手动内侧单髁膝关节置换术（mUKA）在组件定位精度、患者报告的结局测量（PROMs）、并发症、存活率、成本效益和学习曲线方面的差异。

方法

根据系统评价和荟萃分析的首选报告项目声明，于 2021 年 11 月对 PubMed、MEDLINE 和 Google Scholar 进行了检索。检索词包括“机器人”、“单髁”、“膝关节”和“关节置换”。纳入分析的研究包括报告 Mako RAUKA 学习曲线和成本效益的临床研究文章，以及比较组件精度、功能结局、存活率或并发症的 mUKA 文章。

结果

从初步筛选中总共确定了 179 篇文章，其中 14 篇文章符合纳入标准并进行了分析。分析的论文包括一篇关于学习曲线的论文、五篇关于植入物定位的论文、六篇关于功能结果的论文、五篇关于并发症的论文、六篇关于存活率的论文和三篇关于成本的论文。学习曲线为 6 例手术时间和 0 例精度。有一致的证据表明 Mako RAUKA 具有更精确的植入物定位。荟萃分析表明，MAKO RAUKA 相关的总体并发症发生率较低（OR 2.18（95%置信区间（CI）1.06 至 4.49）；p = 0.040），但再干预、感染、膝关节学会评分（KSS；平均差异 1.64（95%CI-3.00 至 6.27）；p = 0.490）或西部安大略省和麦克马斯特大学关节炎指数（WOMAC）评分（平均差异-0.58（95%CI-3.55 至 2.38）；p = 0.700）无差异。MAKO RAUKA 被证明是一种具有成本效益的手术方法，但这与手术量直接相关。