Luan Yichao, Wang Huizhi, Zhang Min, Li Junwei, Zhang Ningze, Liu Bolun, Su Jian, Fang Chaohua, Cheng Cheng-Kung
Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
Engineering Research Center of Digital Medicine, Ministry of Education; School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
Front Surg. 2023 Jan 17;10:1112147. doi: 10.3389/fsurg.2023.1112147. eCollection 2023.
Component alignment is a crucial factor affecting the clinical outcome of total knee arthroplasty (TKA). Accelerometer-based navigation (ABN) systems were developed to improve the accuracy of alignment during surgery. This study aimed to compare differences in component alignment, clinical outcomes, and surgical duration when using conventional instrumentation (CONI), ABN, and computer navigation (CN) systems.
A comprehensive literature search was carried out using the Web of Science, Embase, PubMed, and Cochrane databases. Articles that met the eligibility criteria were included in the study. Meta-analyses were performed using the Cochrane Collaboration Review Manager based on Cochrane Review Method. The variables used for the analyses were postoperative clinical outcome (PCO), surgical duration, and component alignment, including the hip-knee-ankle (HKA) angle, coronal femoral angle (CFA), coronal tibial angle (CTA), sagittal femoral angle (SFA), sagittal tibial angle (STA), and the outliers for the mentioned angles. The mean difference (MD) was calculated to determine the difference between the surgical techniques for continuous variables and the odds ratio (OR) was used for the dichotomous outcomes.
The meta-analysis of the CONI and ABN system included 18 studies involving 2,070 TKA procedures, while the comparison of the ABN and CN systems included 5 studies involving 478 TKA procedures. The results showed that the ABN system provided more accurate component alignment for HKA, CFA, CTA, and SFA and produced fewer outliers for HKA, CFA, CTA, and STA. However, while the ABN system also required a significantly longer surgical time than the CONI approach, there was no statistical difference in PCO for the two systems. For the ABN and CN systems, there was no statistical difference in all variables except for the ABN system having a significantly shorter surgical duration.
There was no significant difference in the accuracy of component alignment between the ABN and CN systems, but the ABN approach had a shorter surgical duration and at lower cost. The ABN system also significantly improved the accuracy of component alignment when compared to the CONI approach, although the surgery was longer. However, there was no significant difference in PCO between the CONI, ABN, and CN systems.
组件对线是影响全膝关节置换术（TKA）临床结果的关键因素。基于加速度计的导航（ABN）系统旨在提高手术过程中对线的准确性。本研究旨在比较使用传统器械（CONI）、ABN和计算机导航（CN）系统时组件对线、临床结果和手术时间的差异。
使用科学网、Embase、PubMed和Cochrane数据库进行全面的文献检索。符合纳入标准的文章纳入本研究。基于Cochrane综述方法，使用Cochrane协作网综述管理器进行荟萃分析。分析所用变量包括术后临床结果（PCO）、手术时间和组件对线，其中组件对线包括髋-膝-踝（HKA）角、股骨冠状角（CFA）、胫骨冠状角（CTA）、股骨矢状角（SFA）、胫骨矢状角（STA）以及上述角度的离群值。计算平均差（MD）以确定连续变量手术技术之间的差异，并使用优势比（OR）来分析二分变量结果。
CONI和ABN系统的荟萃分析纳入了18项研究，涉及2070例TKA手术，而ABN和CN系统的比较纳入了5项研究，涉及478例TKA手术。结果表明，ABN系统在HKA、CFA、CTA和SFA方面提供了更准确的组件对线，并且在HKA、CFA、CTA和STA方面产生的离群值更少。然而，虽然ABN系统所需的手术时间也比CONI方法显著更长，但两种系统在PCO方面没有统计学差异。对于ABN和CN系统，除了ABN系统的手术时间显著更短外，所有变量均无统计学差异。
ABN和CN系统在组件对线准确性方面无显著差异，但ABN方法手术时间更短且成本更低。与CONI方法相比，ABN系统也显著提高了组件对线的准确性，尽管手术时间更长。然而，CONI、ABN和CN系统在PCO方面无显著差异。
