机器人辅助人工全膝关节置换与传统手术临床效果比较的Meta分析  

Clinical effects of robot assisted total knee arthroplasty compared with traditional surgery:a Meta analysis

作　　者：张国华[1] 李凯[1] 赵斌[1] 张勇伟 王岩[1] 张芝良 ZHANG Guo-hua;LI Kai;ZHAO Bin;ZHANG Yong-wei;WANG Yan;ZHANG Zhi-liang(Department of Orthopaedics,The Second Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi,China)

机构地区：[1]山西医科大学第二医院骨科

出　　处：《中国骨伤》2019年第9期846-852,共7页China Journal of Orthopaedics and Traumatology

摘　　要：目的:通过Meta分析比较机器人辅助全膝关节置换术和传统全膝关节置换术效果的差异,以明确机器人辅助全膝关节置换术是否可提供更好的假体下肢力线及临床预后。方法:计算机检索建库至2018年11月Embase、Pubmed、Web of Science数据库和中国期刊全文数据库(CNKI)、万方数据库、维普中文科技期刊数据库(VIP),查找比较机器人辅助和传统全膝关节置换术效果差异的临床对照研究。根据纳入与排除标准进行文献筛选、质量评价及数据提取后,应用Revman 5.3软件对文献数据进行Meta分析。结果:共纳入6篇临床对照研究,机器人辅助全膝关节置换术组253例,传统全膝关节置换术组231例。Meta分析结果:机器人辅助TKA组在下肢冠状位力线角度[WMD=-1.00,95%CI (-1.66,-0.35),P=0.003],下肢冠状位力线内翻或外翻>3°发生率[RR=0.04,95%CI (0.01,0.13),P=0.000 01]方面优于传统全膝关节置换术组;但两组膝关节活动范围[WMD=0.06,95%CI(-5.43,5.55),P=0.98],正位片胫骨角[WMD=-0.19,95%CI(-0.81,0.43),P=0.55]与侧位片胫骨角[WMD=-1.37,95%CI(-3.73,0.99),P=0.25],正位片股骨角[WMD=0.30,95%CI(-1.37,1.96),P=0.72]与侧位片股骨角[WMD=-0.93,95%CI(-1.98,0.12),P=0.08],并发症发生率[RR=0.84,95%CI(0.45,1.58),P=0.60]比较,差异无统计学意义。机器人辅助TKA组手术时间长于传统TKA组[WMD=14.28,95%CI(0.79,27.77),P=0.04]。结论:在全膝关节置换术中使用机器人辅助系统可明显提高假体固定精度,更好地重建下肢力线,并有减轻患者术后疼痛、促进膝关节功能恢复的潜在优势。受纳入文献数量与质量的限制,未来仍需长期随访的高质量随机对照研究对本文结论加以佐证。Objective:To compare the difference between robotic-assisted TKA and traditional TKA by Meta-annlysis in order to determine whether robotic-assisted TKA can provide better lower limb force line and clinical prognosis. Methods:Computerized searches of Embase,Pubmed,Web of Science and CNKI,Wanfang and VIP databases were conducted until November 2018 to find out the difference between robotic assisted TKA and traditional TKA. After screening,quality evaluation and data extraction according to inclusion and exclusion criteria,Revman 5.3 software was used for meta-analysis of literature data. Results:Six clinical controlled studies were included,253 in robot-assisted TKA group and 231 in traditional TKA group. Meta-analysis showed that the incidence of coronal force line angle[WMD=-1.00,95%CI(-1.66,-0.35),P=0.003],coronal force line inversion or valgus>3°[RR=0.04,95% CI(0.01,0.13),P=0.000 01] in robot-assisted TKA group was significantly better than that in traditional TKA group,but there were no statistical differences between two groups in range of knee joint motion[WMD=0.06,95%CI(-5.43,5.55)],P=0.98],anterior position tibial angle[WMD=-0.19,95% CI(-0.81,0.43),95%,P=0.55] and lateral tibial angle[WMD=-1.37,95%CI(-3.73,0.99),P=0.25],anterior position femoral angle[WMD=0.30,95%CI(-1.37,1.96),P=0.72] and lateral femoral angle[WMD=-0.93,95%CI(-1.98,0.013),P=0.08],the incidence of complications[RR=0.84,95%CI(0.45,1.58),P=0.60]. The operation time of robot-cassisted TKA group was longer than that of traditional TKA group[WMD=14.28,95%CI(0.79,27.77),P=0.04]. Conclusion:The application of robotic assistant system in TKA surgery can significantly improve the accuracy of prosthesis fixation,better reconstruct the lower limb line of force,and has the potential advantages of reducing postoperative pain and promoting the recovery of knee joint function. Due to the limitation of the quantity and quality of the included literature,a high-quality randomized controlled study with long-term follow-up is still needed in the future to

关 键 词：关节成形术 置换 膝 外科手术 机器人手术 META分析 

分 类 号：R687.4[医药卫生—骨科学]