计算机导航与传统全膝关节置换疗效比较的Meta分析

背景：计算机辅助导航能否提高全膝关节置换假体的精确性及临床效果，一直存在很大争议。 目的：对国内外有关计算机辅助导航全膝关节置换的研究文献进行Meta分析，评价计算机辅助导航全膝关节置换与传统技术临床疗效的差异。 方法：计算机检索PubMed，Ovid，Elsevier，CNKI、数字图书馆等数据库，检索2005-01-01/2013-12-31有关计算机辅助导航与传统全膝关节置换临床效果随机对照试验的文献资料。采用 Cochrane 协作网提供的RevMan 5.0软件进行Meta分析，比较计算机辅助导航全膝关节置换与传统技术的临床疗效，并对数据进行异质性检验。 结果与结论：共纳入符合设计标准的16篇随机对照试验文献，导航组1322膝，传统组1299膝，导航组下肢力线内翻或外翻大于2°和3°的发生率、股骨胫骨假体冠状位对线内翻或外翻角大于3°的发生率、股骨假体矢状位对位线大于3°的发生率、胫骨后倾角大于3°的发生率均低于传统组。在胫骨假体矢状位对位线、股骨、胫骨假体内外旋转角度和并发症发生率两组差异无显著性意义。提示导航组能带来更佳的下肢力线和假体位置，但还需更多研究来提高远期效果。

Meta-analysis of therapeutic effects of computer-assisted navigation versus conventional total knee arthroplasty

BACKGROUND：It is stil controversial whether computer-assisted navigation elevated the accuracy and clinical outcomes of total knee arthroplasty.
OBJECTIVE：To analyze the literatures in English and Chinese on computer-assisted navigation total knee arthroplasty, and to evaluate the clinical outcomes between computer-assisted navigation and conventional total knee arthroplasty.
METHODWe retrieved PubMed, Ovid, Elsevier, China National Knowledge Infrastructure and Digital Library for literatures concerning randomized control ed trial of clinical outcomes of computer-assisted navigation and total knee arthroplasty published from January 1st 2005 to December 31st 2013. Meta analysis was performed with RevMan 5.0 software from the Cochrane col aboration. Clinical outcomes of computer-assisted navigation total knee arthroplasty and conventional technique were compared. The heterogeneity of data was checked.
RESULTS AND CONCLUSION：A total of 16 randomized control ed papers were included in this analysis. Computer-assisted navigation group consisted of 1 322 knees, and the conventional group consisted of 1 299 knees. Compared with the conventional group, patients in the computer-assisted navigation group had a significantly lower risk of implant malalignment at more than 3° as wel as more than 2°, malalignment for both coronal femoral component and coronal tibial component of〉3°, and both sagittal femoral component alignment and tibial slope at〉3° malalignment. The meta-analysis did not find a significant difference in the sagittal tibial component alignment, the rates of complications, axial （rotational） alignment of the femoral component and the tibial component between both groups. These data indicated that computer-assisted navigation group had significant improvement in alignment of the limb and the component position, but long-term clinical outcomes using computer-assisted surgery in total knee arthroplasty require further investigation.