计算机导航技术辅助全髋关节置换的系统分析

背景：传统手术方法依赖术者的经验和目测解剖标志来安置髋臼假体往往会产生偏差，而在术中应用计算机导航技术可以很好地提高髋臼假体位置的精确度。 目的：研究全髋关节置换应用计算机导航系统对髋臼假体植入位置精度的影响及临床意义。 方法：计算机检索Cochrane Library、MEDLINE、EMBASE、中国生物医学文献数据库、中国期刊全文数据库，手工检索相关的中文杂志，纳入符合要求的临床试验，用RevMan5.0.18软件进行统计分析。 结果与结论：共纳入9篇临床试验合计695例。Meta分析结果显示：与传统手术相比，计算机导航技术在全髋关节置换后髋臼假体位置放置更精准超RR=0.22，95%CI(0.14~0.34)，P < 0.000 01]、双下肢不等长较传统手术轻RR=-4.61，95%CI(-7.74~-1.48)，P=0.004]；而外展角度RR=-1.76，95%CI(-5.02~1.50)，P=0.29]、前倾角度RR=-1.28，95%CI(-5.68~3.12)，P=0.57]、术后脱位率RR=1.25，95%CI(0.05~31.66)，P=0.89]差异均无显著性意义。提示导航技术与传统手术在髋臼位置的精确度方面差异并无显著性意义。

Meta analysis of computer navigation in total hip arthroplasty

BACKGROUND: Traditional operation frequently depends on experience of doctors and anatomic landmark visual observation, which often leads to deviation in acetabular prosthesis implantation. Computer navigation technique greatly improves accuracy of prosthesis implantation. OBJECTIVE: To assess the accuracy and clinical significance of computer navigation for acetabular implantation in total hip arthroplasty. METHODS: A computer-based online search of Cochrane Library, Medline, Embase, CBM, and CNKI was performed, and related Chinese journals were manually searched. Clinical trials were selected and analyzed using RevMan5.0.18 software. RESULTS AND CONCLUSION: A total of 9 clinical trials were included, involving 695 cases. Meta analysis showed that compared with traditional surgery, acetabular component of computer navigation technology in total hip arthroplasty was more accurate in prosthesis position RR=0.22, 95%CI(0.14-0.34), P < 0.000 01], the degree of inclination angles RR=-1.76, 95%CI (-5.02 to 1.50), P=0.29], but no differences in the degree of anteversion angles RR=-1.28, 95%CI (-5.68 to 3.12), P=0.57], and postoperative dislocation rate RR = 1.25, 95%CI (0.05-31.66), P = 0.89]. There was no statistical difference between navigation applications and traditional surgery in the accuracy of acetabular position.