中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (21): 3416-3422.doi: 10.3969/j.issn.2095-4344.3874

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

机器人辅助单髁置换与传统置换效果比较的Meta分析

任兴宇1，张  一1，徐浩然1，范  宾1，戴士峰2，梁春雨1   

  1. 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
  • 收稿日期:2020-09-02 修回日期:2020-09-04 接受日期:2020-10-24 出版日期:2021-07-28 发布日期:2021-01-25
  • 通讯作者: 梁春雨，硕士，主任医师，华北理工大学附属医院，河北省唐山市 063000
  • 作者简介:任兴宇，男，1992年生，天津市人，汉族，华北理工大学在读硕士，医师。

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

Ren Xingyu1, Zhang Yi1, Xu Haoran1, Fan Bin1, Dai Shifeng2, Liang Chunyu1   

  1. 1North China University of Science and Technology Affiliated Hospital, Tangshan 063000, Hebei Province, China; 2Second Hospital of Tangshan, Tangshan 063000, Hebei Province, China 
  • Received:2020-09-02 Revised:2020-09-04 Accepted:2020-10-24 Online:2021-07-28 Published:2021-01-25
  • Contact: Liang Chunyu, Master, Chief physician, North China University of Science and Technology Affiliated Hospital, Tangshan 063000, Hebei Province, China
  • About author:Ren Xingyu, Master candidate, Physician, North China University of Science and Technology Affiliated Hospital, Tangshan 063000, Hebei Province, China

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摘要：

文题释义：
机器人辅助：机器人辅助技术是于1992年在骨科手术中被首次使用，据统计目前15%-20%的膝关节单髁置换是在机器人辅助下进行的。骨科机器人依据其运行方式可分主动型、半主动型和被动型3种，目前其在关节科的应用较为成熟，且使用广泛的是半主动型半主动式骨科机器人，这种机器人是在计算机模拟和规划后，由术者通过触觉反馈系统操控机械臂，在机器人规划的范围内实现假体精确安置。
Meta分析：Meta希腊词，意思是“after，more comprehensive，secondary”，中国曾翻译为后分析、荟萃分析、元分析、综合分析，是以综合研究结果为目的而对不同的研究结果进行收集、合并及统计分析的一种方法，可以将针对同一问题的多个独立的研究结果汇总进行定量分析。目前，国外文献常将系统评价与Meta分析交叉使用。

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。

https://orcid.org/0000-0001-6768-9795 (任兴宇) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

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

Abstract: 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 postoperative effects and differences between robot-assisted unicompartmental knee arthroplasty and traditional unicompartmental knee arthroplasty in the treatment of osteoarthritis by means of meta-analysis.
METHODS: Relevant databases including Wanfang, VIP, CNKI, EMBASE, PubMed, Cochrane Library, and Web of Science were searched 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 robot-assisted 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 < 0.000 01), the accuracy of the femoral component placement (MD=-1.71, 95%CI: -2.82 to -0.61, P=0.002), the postoperative tibial posterior slope (MD=-2.40, 95%CI: -2.80 to -2.22, P < 0.000 01), 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=0.000 4), 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-assisted unicompartmental knee arthroplasty has higher prosthesis positioning accuracy, better postoperative tibial inclination and lower revision rate without increasing the incidence of complications. It is a surgical method that is more ideal than traditional surgical methods, and is worthy of further discussion in clinical practice, but the above conclusions still need to be verified by large-sample and high-quality randomized controlled studies.

Key words: knee, joint, robot, joint arthroplasty, unicompartmental arthroplasty, arthritis, complications, prosthesis, meta-analysis

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