计算机导航辅助与传统开放胫骨高位截骨后临床效果比较的Meta分析  

Meta-analysis of clinical outcomes of computer-navigated versus conventional opening wedge high tibial osteotomy

作　　者：史俊恒[1] 钟的桂 洪伟武 黄永铨 Shi Jun-heng;Zhong De-gui;Hong Wei-wu;Huang Yong-quan(Guangzhou University of Chinese Medicine,Guangzhou 510006,Guangdong Province,China;Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510120,Guangdong Province,China)

机构地区：[1]广州中医药大学,广东省广州市510006 [2]广东省中医院,广东省广州市510120

出　　处：《中国组织工程研究》2018年第31期5077-5085,共9页Chinese Journal of Tissue Engineering Research

基　　金：广东省中医药局科研项目(20182043)~~

摘　　要：背景:传统胫骨高位截骨依赖术前计划及术中透视情况来调整矫正的角度,但这受到体位、透视角度、测量误差的影响,存在不稳定性。有研究报道计算机导航辅助胫骨高位截骨术可提高矫正角度、的精准性,但既往研究的病例数较少,存在争议,需要对计算机辅助胫骨高位截骨和传统手术临床和影像学结果进行系统分析与评价。目的:探讨计算机导航辅助对比传统内侧开放胫骨高位截骨临床效果与影像学结果的差异。方法:计算机全面搜集从建库到2018年4月Pub Med,EMbase,Cochrane Library,Web of Science数据库和中国期刊全文数据库、中国生物医学文献数据库、万方、维普数据库中关于计算机导航辅助对比传统内侧开放胫骨高位截骨术的临床研究,再由2名研究者对文献进行方法学质量评价,运用Rev Man5.3软件进行异质性检验,再进行Meta分析合并效应量。结果与结论:(1)纳入13个临床研究,共计1 030例内翻膝的患者,其中计算机导航辅助下行内侧开放胫骨高位截骨手术的患者471例(导航组),传统内侧开放胫骨高位截骨手术的患者559例(传统组);(2)Meta分析结果显示:与传统组比较,导航组术后下肢负重线比率更大、更接近于Fujisawa点[MD=2.14,95%CI(0.23,4.05)],术后胫骨后倾角增加程度明显更小[MD=-1.27,95%CI(-1.95,-0.60)],术后机械胫股角更准确[MD=0.81,95%CI(0.37,1.25)],术后出现胫股角异常的患者更少、比率更低[OR=0.39,95%CI(0.27,0.59)],相应的手术时间更长[MD=14.90,95%CI(9.93,19.88)],但在术后Lysholm评分[MD=1.30,95%CI(-0.31,2.90)]、术后膝关节活动度[MD=3.19,95%CI(-1.60,7.98)]、术后胫骨截骨处延迟愈合比率[OR=1.58,95%CI(0.44,5.65)]和手术部位感染比率[OR=1.75,95%CI(0.37,8.30)]方面,两者的差异均无统计学意义;(3)相较于传统内侧开放胫骨高位截骨术,计算机导航辅助下行内侧开放胫骨高位截骨术后影像学结果更精准,手术时间�BACKGROUND:Traditional high tibia osteotomy relies on preoperative planning and intraoperative fluoroscopy to adjust the angle of correction,but it is affected by position,perspective and measurement error,so it is instability.Some studies have reported that computer navigated high tibia osteotomy can improve the accuracy of the correction angle.As the number of cases in previous studies is small and controversial,it is necessary to systematically analyze and evaluate the clinical and imaging results of computer navigated high tibia osteotomy and traditional surgery.OBJECTIVE:To systematically evaluate the clinical and imaging results of computer navigated versus conventional opening wedge high tibial osteotomy.METHODS:Databases of PubMed,EMbase,Cochrane Library,Web of Science,CNKI,CBM,WanFang,and VIP were retrieved for the clinical studies about computer navigated versus conventional opening wedge high tibial osteotomy before April 2018.The quality of the studies was evaluated by two researchers,and heterogeneity test and meta-analysis were conducted on RevMan 5.3 software.RESULTS AND CONCLUSION:(1)Thirteen clinical studies involving 1 030 patients with genu varum were enrolled,471 patients underwent computer navigated high tibial osteotomy(navigation group),and 559 patients underwent opening wedge high tibial osteotomy(traditional group).(2)Results of meta-analysis showed that compared with the traditional group,patients in the navigation group had better weight bearing line ratio,closest to Fujisawa point(MD=2.14,95%CI(0.23,4.05)),less increase in tibial posterior slope(MD=-1.27,95%CI(-1.95,-0.60)),more exact mechanical axis(MD=0.81,95%CI(0.37,1.25)),lower in outliers of alignment(OR=0.39,95%CI(0.27,0.59))and longer operation time(MD=14.90,95%CI(9.93,19.88)).There were no significant differences in Lysholm score(MD=1.30,95%CI(-0.31,2.90)),range of motion of knee(MD=3.19,95%CI(-1.60,7.98)),delayed union rate at tibia osteotomy(OR=1.58,95%CI(0.44,5.65)),and infection rate(OR=1.75,95%CI(0.37,8.30))between two gro

关 键 词：计算机导航 胫骨高位截骨术 开放楔 META分析 膝内翻 胫骨 外科手术 计算机辅助 截骨术 META分析 

分 类 号：R318[医药卫生—生物医学工程]