计算机导航辅助下微创膝关节单髁置换术

Virtual image-guided minimal incision sugary unicondylar knee arthroplasty

目的探讨虚拟影像导航辅助下微创膝关节单髁置换的方法和疗效。方法在导航系统下进行小切口微创膝关节单髁置换术26例。统计切口大小、手术时间、出血量和48 h 引流量,进行 HISS 评分分析,测量下肢力线和关节活动度。结果在导航系统下顺利完成26例小切口微创膝关节单髁置换,手术切口大小为(7.4±0.6)cm,手术时间为(78±12)min,出血量为(122±13)ml和48 h,引流量(114±18)ml。术前 HISS 评分(72±6)分,术后2周为(98±2)分。术前髋膝踝角为(7.6±1.8)°,术后2周为(0.8±0.6)°。术前屈曲挛缩(6.8±1.6)°,膝关节活动范围为(107.5±6.2)°,术后屈曲挛缩(1.8±1.1)°,膝关节活动度为(132.6±3.5)°。26例均获随访,随访(8.2±2.4)个月,无感染、假体位置不良及髌股关节疼痛等并发症。结论计算机导航系统的应用解决了MIS-UKA 操作中视野的局限,同时可以实时、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,提高了假体置换的精确性。

Objective To investigate the curative effect of virtual image-guided minimal incision sugary unicondylar knee arthroplasty （MIS-UKA）. Methods Twenty-six patients of knee osteoarthritis （with 26 knees） received virtual image-guided MIS-UKA and followed up for （8. 2 ± 2.4 ） months. The incision length, operative time, hemorrhage, and 48 h drainage were calculated. The patients were evaluated by hand injury severity score （HISS） system knee score. X-ray film of the whole lower limb was taken to observe the line of force and range of motion of knee. Results MIS-UKA was successfully performed on the 26 knees with the average incision length of 7.4 ±0. 6 cm, the average operative time of 78 ± 12 min, the average hemorrhage of 114 ± 18 ml, and the 48 h drainage of 122± 13 ml. Two weeks after the operation, the average HISS hip score was 98, higher than that before the operation （72）, the hip-knee-ankle angle was 0. 8°±0. 6°, larger than that before the operation （7. 6° ± 1.8°）, the flexion contraction angle was 1.8°±1.1°, smaller than that before the operation （6. 8° ±1.6°） , and the joint range of motion of knee was 132.6°± 3.5°, larger than that before the operation （107.5° ± 6.2°）. No infection, prosthesis cacothesis, and patellofemoral joint pain were found. Condusion The surgical navigation system surmounts the disadvantage of small visual field, observes the line of force of the lower limbs, knee joint rotational apposition, and ligament balance dynamically with digital 3D bone mode ,provide geometry and morphology data, and rebuilds knee joint vitodynamically and anatomically , and hight3ens the accuracy of prostheses replacement, thus having important clinic value in MIS-UKA.