目标:目前,髓芯减压(CD)已成为治疗股骨头坏死(ONFH)的主要手术方法;CD手术需要较高的手术经验,重复透视会增加患者的辐射损伤,和医务人员。本文通过荟萃分析比较了机器人辅助CD和徒手CD治疗ONFH的临床疗效。
方法:PubMed的计算机搜索,WebofScience,Embase,科克伦图书馆,中国国家知识基础设施,中国科技期刊数据库,万方,和中国生物医学文献数据库从数据库建立到2023年11月15日进行。收集有关机器人辅助和徒手CD治疗ONFH的临床疗效的文献。两名研究者根据纳入和排除标准独立筛选文献,提取的数据,并严格评估纳入文献的质量。结果措施包括手术持续时间,术中失血量,术中荧光镜检查的频率,视觉模拟量表(VAS)评分,哈里斯髋关节评分(HHS),并发症,和放射学进展。使用ReviewManager5.4.1软件进行数据合成。根据建议评估开发和评估等级(GRADE)标准对证据质量进行评估。
结果:七项回顾性队列研究纳入了355例患者。荟萃分析结果显示,在机器人辅助组中,手术时间(MD=-17.60,95%CI:-23.41至-11.78,P<0.001),术中失血量(MD=-19.98,95%CI:-28.84~-11.11,P<0.001),术中荧光镜检查频率(MD=-6.60,95%CI:-9.01至-4.20,P<0.001),和ΔVAS评分(MD=-0.45,95%CI:-0.67至-0.22,P<0.001)明显优于徒手组。等级证据评估显示ΔVAS评分为低质量,其他指标为极低质量。ΔHHS无显著性差异(MD=0.51,95%CI:-1.34~2.35,P=0.59),并发症(RR=0.30,95%CI:0.03至2.74,P=0.29),两组之间的影像学进展(RR=0.50,95%CI:0.25至1.02,P=0.06)。
结论:有有限的证据表明机器人辅助治疗对ONFH患者的治疗有益,而且大部分质量都很低。因此,在解释这些结果时应谨慎行事。建议进行更多高质量的研究,以在未来的研究中验证这些发现。
背景:https://www.crd.约克。AC.uk/prospro/#recordDetails,CRD42023420593。
OBJECTIVE: At present, the core decompression (CD) has become the main surgical procedure for the treatment of osteonecrosis of the femoral head (ONFH); however, the CD surgery requires high operator experience and repeated fluoroscopy increases the radiation damage to patients, and medical staff. This article compares the clinical efficacy of robot-assisted and freehand CD for ONFH by meta-analysis.
METHODS: Computer searches of PubMed, Web of Science, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang, and Chinese BioMedical Literature Database were conducted from the time of database inception to November 15, 2023. The literature on the clinical efficacy of robot-assisted and freehand CD in the treatment of ONFH was collected. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and strictly evaluated the quality of the included literature. Outcome measures encompassed operative duration, intraoperative blood loss volume, frequency of intraoperative fluoroscopies, visual analog scale (VAS) score, Harris hip score (HHS), complications, and radiographic progression. Data synthesis was carried out using
Review Manager 5.4.1 software. The quality of evidence was evaluated according to Grades of Recommendation Assessment Development and Evaluation (GRADE) standards.
RESULTS: Seven retrospective cohort studies involving 355 patients were included in the study. The results of meta-analysis showed that in the robot-assisted group, the operative duration (MD = -17.60, 95% CI: -23.41 to -11.78, P < 0.001), intraoperative blood loss volume (MD = -19.98, 95% CI: -28.84 to -11.11, P < 0.001), frequency of intraoperative fluoroscopies (MD = -6.60, 95% CI: -9.01 to -4.20, P < 0.001), and ΔVAS score (MD = -0.45, 95% CI: -0.67 to -0.22, P < 0.001) were significantly better than those in the freehand group. The GRADE evidence evaluation showed ΔVAS score as low quality and other indicators as very low quality. There was no significant difference in the terms of ΔHHS (MD = 0.51, 95% CI: -1.34 to 2.35, P = 0.59), complications (RR = 0.30, 95% CI: 0.03 to 2.74, P = 0.29), and radiographic progression (RR = 0.50, 95% CI: 0.25 to 1.02, P = 0.06) between the two groups.
CONCLUSIONS: There is limited evidence showing the benefit of robot-assisted therapy for treatment of ONFH patients, and much of it is of low quality. Therefore, caution should be exercised in interpreting these results. It is recommended that more high-quality studies be conducted to validate these findings in future studies.
BACKGROUND: https://www.crd.york.ac.uk/prospero/ #recordDetails, CRD42023420593.