计算机辅助下相关数字影像资料对人工全膝关节置换术的优化作用

Role of computer-assisted relative digital image data in optimizing artificial total knee arthroplasty

目的:基于Ceravision系统辅助人工全膝关节置换的手术结果,讨论相关数字影像资料对优化人工全膝关节置换术的作用。方法:选择2002-11/2003-06法国亨利蒙多医院(HOPITALHENRIMONDOR)矫形与创伤外科用三维骨建模Ceravision导航系统辅助完成的21例人工全膝关节置换术患者的影像资料进行对比分析,根据术前的常规膝关节X射线片,下肢全长片、全麻下膝关节内外翻应力X射线片和髋、膝、踝扭转的CT片,以及术中Ceravision系统检测和术后X射线片,效果评估以重建的下肢力线膝关节内外翻≤3°为满意。①术前和术中膝关节内、外翻角度。②应力下术前和术中膝关节内、外翻角度。③术毕膝关节内、外翻角度。④并发症。结果:按意向处理分析,21例患者均进入结果分析。①下肢力线测量结果:术前X射线下肢全长片与术中电脑导航系统的测量平均外翻2.36°(内翻13°～外翻13°),3.33°(内翻12°～外翻10°),二者比较有显著差异(P=0.0025)。②应力下膝内翻、外翻测量结果:术前X射线正位片测量与术中导航系统的测量平均8.47°(内翻2°～内翻20°),3.63°(内翻7°～外翻12°),6.47°(内翻0°～内翻24°),4.32°(内翻8°～外翻15°),二者比较有显著差异(P<0.0001)。③术毕时膝内外翻测量结果:导航系统测得的膝内外翻平均为0.175°(内翻2°～外翻3°),术后X射线下肢全长片测量平均0.3°(内翻3.5°～外翻1.5°),二者比较,无明显差别(P>0.05)。④不良事件和副反应:所有的膝关节胫、股骨部件都得到满意的摆位置入。无髌骨失稳和脱位等并发症,且无异常的关节松弛度。结论:Ceravision系统辅助全膝人工关节置换术,有利于术中人机互动,取得精确的假体定位及韧带平衡和准确置换,达到下肢力线在内外翻3°以内范围的满意效果。

AIM: To discuss the role of relative digital image data in optimizing artificial total knee arthroplasty based on the operative outcomes of computer-assisted Ceravision system. METHODS: The image data of 21 postoperative patients, who undertook the artificial total knee arthroplasty assisted by the Ceravision navigation system established with the three-dimensional bone in the Departmennt of Orthopaedics and Traumatology, Hospital Henri Mondor between November 2002 and June 2003, were compared and analyzed. According to the pre-operative routine knee joint radiograph, full-length radiograph of lower limb, varus-valgus stress radiographs under general anaethesia, CT scan of femoral, genual and malleolar torsion, Ceravision system detection during operation and post-operative radiograph, the evaluation of effect took the reconstructive lower limb alignment knee joint varus-valgus ≤3°as satisfactory. ①Varus-valgus angles of knee joint before and during operation; ②Varus-valgus angles of knee joint under stress before and during operation; ③Varus-valgus angles of knee joint after operation; ④Complication. RESULTS: According to intention-to-treat analysis, all the 21 cases were involved in the analysis. ①Detection of the lower limb alignment: The average valgus detected with pre-operative full-length radiograph of lower limb and Ceravision navigation system during operation were significantly different [2.36 °(varus 13°to valgus 13°), 3.33 °(varus 12°to valgus 10°); P=0.002 5]. ②Measuring results of knee varus-valgus under stress: There were significant differences between the results detected by pre-operative radiograph (laying position) and Ceravision navigation system during operation [8.47°(varus 2°to varus 20°), 3.63°(varus 7°to valgus 12°), 6.47°(varus 0°to varus 24°), 4.32°(varus 8°to valgus 15°;P< 0.000 1). ③Results of knee varus-valgus after operation: There were insignificant differences between the results detected by the navigation system and the post-operative full-length radiograph of lower limb [0.175°(varus 2°to valgus 3°), 0.3°(varus 3.5°to valgus 1.5°); P >0.05]. ④Adverse events and side effects: All the femoral and tibial components were planted in the satisfactory position. There were not any complications of patellar instability and dearticulation. No abnormal joint laxity was observed. CONCLUSION: The utilization of Ceravision system-assisted artificial total knee arthroplasty is good for the human-machine interaction, it is also very helpful to assess satisfactory accuracy of components alignment and ligaments balance, and precise replacement to optimize the results that lower limb alignment is ranged within varus 3°.