机器人辅助单髁置换与传统置换效果比较的Meta分析  

Meta-analysis of the postoperative effects of robot-assisted unicompartmental knee arthroplasty versus conventional surgery

作　　者：任兴宇 张一 徐浩然 范宾 戴士峰[2] 梁春雨 Ren Xingyu;Zhang Yi;Xu Haoran;Fan Bin;Dai Shifeng;Liang Chunyu(North China University of Science and Technology Affiliated Hospital,Tangshan 063000,Hebei Province,China;Second Hospital of Tangshan,Tangshan 063000,Hebei Province,China)

机构地区：[1]华北理工大学附属医院,河北省唐山市063000 [2]唐山市第二医院,河北省唐山市063000

出　　处：《中国组织工程研究》2021年第21期3416-3422,共7页Chinese Journal of Tissue Engineering Research

摘　　要：目的:全膝关节置换在一段时间里是单间室骨性关节炎的常用治疗方法,损伤更小的单髁置换由于生存率低,始终无法普及,但随着机器人辅助单髁置换的发展,使这一目标变得更有希望。文章通过Meta分析的方法观察机器人辅助单髁置换与传统单髁置换治疗骨关节炎的术后效果差异。方法:使用计算机检索万方、维普、中国知网、EMBASE、PubMed、Cochrane Library和Web of Science数据库,检索语言类型为英文和中文,时间为建库时间至2020年6月。对检索的文献进行质量评估,结局指标包括:手术时间、术后并发症、假体植入准确度、胫骨后倾角及翻修率。使用Cochrane协作网提供的RevMan 5.3软件对采集的数据进行Meta分析。结果:①共纳入11篇文献;包括3篇随机对照试验,其中低、中、高风险偏倚文献各1篇,还包括4篇队列研究和4篇病例对照研究,NOS评分均6分以上,质量较高;②Meta分析结果显示,机器人辅助单髁置换在胫骨组件置入准确度(MD=-1.32,95%CI:-1.74至-0.91,P <0.000 01)、股骨组件置入准确度(MD=-1.71,95%CI:-2.82至-0.61,P=0.002)、术后胫骨后倾角(MD=-2.40,95%CI:-2.80至-2.22,P <0.000 01)、翻修率(RR=0.34,95%CI:0.16-0.72,P=0.005)等方面均优于传统置换方法;③虽然机器人辅助单髁置换需时更长(MD=11.53,95%CI:5.12-17.94,P=0.000 4),但是并不增加手术并发症(RR=0.86,95%CI:0.45-1.64,P=0.65)。结论:在行膝关节单髁置换时,机器人辅助单髁置换的假体定位准确率更高,拥有更好的术后胫骨后倾角和更低的翻修率且未增加并发症的发生率,是一种较传统手术方法更为理想的手术方式,在临床实践中值得进一步探讨,但以上结论尚需更大样本、更高质量的随机对照研究加以验证。OBJECTIVE:Total knee arthroplasty has been a common treatment for single-compartment osteoarthritis for some time.Less invasive unicompartmental knee arthroplasty has not been widely available due to low survival rates,but with the development of robot-assisted unicompartmental knee arthroplasty,this goal has become more promising.This study observed the postope rative effects and differences between robot-assisted unicompartmental knee arthroplasty and traditional unicompartmental knee arthro plasty in the treatment of osteoarthritis by means of meta-analysis.METHODS:Relevant databases including Wanfang,VIP,CNKI,EM BASE,PubMed,Cochrane Library,and Web of Science were sea rched by computer in English and Chinese,and the time was from database inception to June 2020.Quality of retrieved articles was assessed.The outcome indicators included operation time,postoperative complications,implant accuracy,posterior slope and revision rate.Meta-analysis of the collected data was carried out using the RevMan 5.3 software provided by the Cochrane Collaboration.RESULTS:(1)A total of 11 articles were included.There were three randomized controlled trials,one low risk bias,one medium risk bias,and one high risk bias.There were four cohort studies and four case-control studies with NOS score above 6,which were of high quality.(2)Meta-analysis results showed that robotassisted unicompartmental knee arthroplasty was superior to traditional surgery in the accuracy of the tibial component placement(MD=-1.32,95%CI:-1.74 to-0.91,P<0.00001),the accuracy of the femoral component placement(MD=-1.71,95%CI:-2.82 to-0.61,P=0.002),the postope rative tibial posterior slope(MD=-2.40,95%CI:-2.80 to-2.22,P<0.00001),and the revision rate(RR=0.34,95%Ci:0.16-0.72,P=0.005).(3)Although robot-assisted unicompartmental knee arthroplasty took longer time(MD=11.53,95%Ci:5.12-17.94,P=0.0004),it did not increase the incidence of surgical complications(RR=0.86,95%CI:0.45-1,64,P=0.65).CONCLUSION:When performing unicompartmental knee arthroplasty,robot-assis

关 键 词：膝 关节 机器人 关节置换 单髁置换 关节炎 并发症 假体 META分析 

分 类 号：R459.9[医药卫生—治疗学] R605[医药卫生—临床医学]