个性化冠状位对线全膝关节置换术临床疗效的Meta分析  

Clinical efficacy of personalized coronal alignment in total knee arthroplasty:a Meta-analysis

作　　者：李铭 丁冉[2] 钟子康 张琛 岳峥嵘 汤建成 王卫国[2] LI Ming;DING Ran;ZHONG Zikang;ZHANG Chen;YUE Zhengrong;TANG Jiancheng;WANG Weiguo(Peking University China-Japan Friendship School of Clinical Medicine,Beijing 100029,China;Department of Orthopedics,China-Japan Friendship Hospital,Beijing 100029,China;Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Graduate School of Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京大学中日友好临床医学院,北京100029 [2]中日友好医院骨科,北京100029 [3]中国医学科学院北京协和医学院,北京100730 [4]北京中医药大学研究生院,北京100029

出　　处：《机器人外科学杂志(中英文)》2025年第2期187-198,共12页Chinese Journal of Robotic Surgery

摘　　要：目的:评价个性化冠状位对线在全膝关节置换术(TKA)治疗膝骨关节炎中的临床效果。方法:检索万方、维普、中国知网、中国生物医学文献数据库、PubMed、The Cochrane Library、Web of Science、Embase,对比个性化对线与经典机械对线(MA)全膝关节置换术治疗膝骨关节炎的随机对照试验(RCT),个性化对线技术包括运动学对线(KA)、限制性运动学对线(r KA)、改良机械对线(aMA)和功能对线(FA),时间范围为从建库开始至2024年2月。运用Microsoft Excel 2021和RevMan 5.3软件进行Meta分析。结果:共纳入11项符合条件的RCT研究。KA组术后3个月牛津大学膝关节评分、术后6个月美国膝关节协会评分(American Knee Society Score,KSS)膝评分、术后2年KSS功能评分显著优于MA组,与MA组相比,术后5年及以上假体翻修率差异无统计学意义。rKA组术后1年KSS总分显著优于MA组。FA的发展与机器人辅助技术密切相关,FA组术后72 h内视觉模拟评分法(VAS)疼痛评分显著低于MA组。未检索到aMA与MA的RCT研究。结论:相较于经典的机械对线技术,个性化对线技术在术后早期随访中展现出更好的功能结局,长期随访中并未出现更高的假体翻修率。机器人辅助技术促进了个性化对线技术在全膝关节置换术中的应用,其临床效果有待进一步验证。Objective:To evaluate the clinical outcomes of personalized coronal alignment in total knee arthroplasty(TKA)for the treatment of knee osteoarthritis.Methods:Wanfang Database,VIP Database,CNKI,China Biology Medicine disc,PubMed,The Cochrane Library,Web of Science,and Embase were searched for comparing the randomized controlled trials(RCT)between personalized alignment and classical mechanical alignment(MA)in total knee arthroplasty for the treatment of knee osteoarthritis.The personalized alignment techniques included kinematic alignment(KA),restricted kinematic alignment(rKA),adjusted mechanical alignment(aMA),and functional alignment(FA),with a timeframe from the creation of databases to February 2024.Meta-analysis was performed using Microsoft Excel 2021 and RevMan 5.3 software.Results:A total of 11 eligible RCTs were included.The Oxford knee scores at 3 months after surgery,the American Knee Society Score(KSS)knee scores at 6 months after surgery,and the KSS functional scores at 2 years after surgery were significantly better in the KA group than those in the MA group,and the difference in the rate of prosthesis revision at 5 years or more after surgery was not statistically significant between the two groups.The total KSS scores at 1 year after surgery was significantly better in the rKA group than those in the MA group.The development of FA was closely related to robot-assisted technology,and the visual analog scale(VAS)scores at 3 d after surgery was significantly lower in the FA group than those in the MA group.No RCT studies comparing aMA with MA was retrieved.Conclusion:Compared with the classical mechanical alignment technique,the personalized alignment technique demonstrated better functional outcomes in early postoperative follow-up and showed no higher rate of prosthesis revision in long-term follow-up.Robot-assisted technology facilitates the use of personalized alignment in TKA,but its clinical effectiveness needs to be further verified.

关 键 词：全膝关节置换术 下肢力线 个性化对线 随机对照试验 机器人辅助手术 

分 类 号：R687.4[医药卫生—骨科学]