计算机导航辅助全膝关节置换术的初步临床研究

Computer assisted imaging guided total knee arthroplasty:preliminary cfinicai study of 46 cases

目的探讨在计算机导航下进行全膝关节置换术的方法和疗效。方法采用计算机导航对46例(54膝)进行全膝关节置换术。根据术中数字化三维骨模显示的下肢力线、关节间隙和韧带均衡情况进行截骨、调整软组织平衡和假体旋转摆位。术后观察手术时间、出血量和48h 引流量、并发症。观察手术前后的 HISS 评分膝关节的功能、膝关节的活动度;摄下肢全长 X 线片测量,观察手术前后 KNA 角(髋膝踝角)、应力下关节间隙角度变量和拉力下关节间隙的分离变量。术后 CT测量胫、股骨假体的旋转摆位角,摄髌骨 X 线片切线位,了解髌股关节的对合情况。观察术后3个月近期疗效。结果在计算机导航下成功完成54个全膝关节置换,无神经、血管损伤、骨折、脂肪栓塞等并发症。手术时间为(80±15)min/膝,48h 出血引流量为(550±60)ml/膝。术后2周 HISS 评分为(92±4)分,与术前的(46±6)分有高度差异有统计学意义(P<0.01)。术后2周膝关节活动度有高度、手术前后示 KNA 角、手术前后内侧应力下关节间隙角度变量、外侧应力下关节间隙角度变量和拉力下关节间隙的分离变量有高度差异有统计学意义(P<0.01)。术后 CT 测量胫、股骨假体的旋转摆位角(4.2±0.4)°。术后髌骨 X 线片切线位显示髌骨关节的对合良好,无脱位和不稳。术后3个月的关节活动度屈曲为(120±9)°,无异常的膝关节松弛度。结论术中计算机导航可实时、动态地观察下肢力线变化、膝关节假体旋转对位和软组织韧带平衡情况,并提供几何学和形态学资料,对膝关节进行生物力学和解剖学的重建,提高了全膝人工关节置换术的可重复性,并保证系统的安全性。

Objective To discuss the approach and curative effect of total knee arthroplasty by intraoperative digital 3D bone mode. Methods 28 patients with bone arthritis,7 with rheumatoid arthritis,7 with ankylosing spondylitis, totally 46 patients with 54 knees affected, 29 males and 17 females, aged 48 （31 -76）, underwent total knee arthroplasty by digital 3D bone mode, including osteotomy, adjustment of soft tissue, and rotational positioning of prostheses. The operative time, hemorrhage and drainage 48 h after operation, and complication were observed. The pre-postoperative knee function was evaluated by HISS scoring system. The pre-postoperative range of motion of knee joint, and angle of KNA, variance of angle in exterior and interior stress and separation of joint space in tensile force, and postoperative rotational angle of tibia-femur prostheses were measured. X-ray tangential projection photography of patella was used to evaluate the apposition of patellofemoral joint. The postoperative curative effect was observed for 3 months. Results No complication as injury of nerves and blood vessel, bone fracture, fat embolism and so on was observed. The operative time was 80 ± 15 min per knee. The hemorrhage and drainage in 48 h was 550 ± 60 ml per knee. The Hand Injury Severity Score （HISS） 2 weeks after the operation was （92±4） , significantly higher than that before operation[ （46 ±6）, P 〈0.01 ]. There were statistically significant differences in the KNA angle, variance of angle under exterior stress, interior stress, and separation of joint space in tensile force preand postoperatively （ all P 〈 0.01 ） The postoperative rotational angle of tibia-femur prostheses was （4.2 ±0. 4 ）% The X-ray tangential projection photograph of patella showed excellent apposition of patellofemoral joint, and no dislocation and unsteadiness. The postoperative range of motion of knee joint was 120°± 9°3 months after operation. No joint laxity was found. Conclusion Computer assisted imaging guidance actually and dynamically observe the changes of line of force of the lower limbs, knee joint rotational apposition and ligament balance, provides geometrical and morphological data and rebuild the knee joint bio-mechanically and anatomically, thus elevating the reproducibility of total knee arthroplasty and ensuring the safety of the system.