计算机导航辅助下微创膝关节单髁置换术的初步临床研究

The primitive clinical study of navigation guided minimal invasive surgery of 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48h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7～8cm,手术时间为70～90min,出血量为100～150mL和48h引流量80～150mL。术前HISS评分72分,术后2周为98分。术前髋膝踝角为5°～10°,术后2周为0°～2°。术前屈曲挛缩0°～10°,膝关节活动度为100°～120°,术后2周屈曲挛缩0°～4°,膝关节活动度为125°～135°。26例均获随访,平均随访时间8.2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,提高了假体放置的精确性,使骨质和假体之间有了最大的贴合度,具有重要的临床价值。

Objective To study the method and curative effect of navigation guided minimal invasive sugery of unicondylar knee arthroplasty. Methods 26 knees were adopted navigation guided minimal minimal invasive sugery of unicondylar knee arthroplasty. The incision length, operative time, hemorrhage and 48h drainage were calculated. Patients were evaluated by HISS knee score, biomechanic line the lower limbs and range of motion of knee. Results Minimal invasive sugery of unicondylar knee arthroplasty were succeeded in 26 hips by navigation system. The average incision length was 7 - 8 cm. The average operative time was 70 -90 min. The average hemorrhage were 250 mL （200 - 350 mL） and 48h drainage were 80 - 150 mL. The average HISS hip score was 98 2 weeks after operation and that of preoperation was 72. The hip-knee-ankle angle was 0° -2° 2 weeks after operation and that of preoperation was 5° - 10°. The flexion contraction angle was 0° - 4° 2 weeks after operation and that of preoperation was 0°- 10°. The joint range of motion of knee was 125°-135° 2 weeks after operation and that of preoperation was 100° -120°. 26 knees were all followed up. The average follow-up period was 8.2 months. No prothesis infection, cacothesis and patellofemoral joint pain were found. Conclusions The navigation system can make up the disad- vantage of small visual field, observe the biomechanic line the lower limbs, knee joint rotational apposition and ligament balance in an actual and dynamic condition with digital 3D bone mode, provide geometry and morphology data, rebuild knee joint in a vitodynamic and anatomy station and make prostheses implanted accurately which has important clinic value in MIS-UKA.