三维骨建模系统在人工全膝关节置换中的优化作用:导航与常规手术早期 疗效比较(英文)

Bone morphing system optimizes total knee arthroplasty Comparison of early curative effects with conventional procedure

背景:人工全膝关节置换手术的重点是准确的假体三维定位,重建良好的下肢力线,维持膝关节韧带的平衡,避免髌股关节并发症,从而取得一个无痛稳定、功能良好和持久耐用的关节。目的:通过对比导航和常规全膝关节置换的近期效果,讨论三维骨建模系统对人工全膝关节置换手术中精确重建下肢力线、旋转对位和韧带平衡的优化作用。设计:分组对比观察单位:法国亨利蒙多医院矫形与创伤外科。对象:选2002-11/2003-06 在法国亨利蒙多医院矫形与创伤外科进行的计算机辅助人工膝关节置换21例为导航手术组,年龄64～79 岁,14 例膝内翻,7例膝外翻;常规手术人工膝关节置换20例传统手术组,年龄 65～83 岁,15例膝内翻,5例膝外翻;纳入标准均为的骨性关节炎患者,排除复治的人工全膝关节翻修术患者,患者均知情同意。方法:均采用后稳定型人工表面全膝关节(Hermes?法国 Ceraver),两组的手术基本操作相同,导航手术组在 Ceravision ?无需影像资料的三维骨建模(Bone-Morphing)计算机辅助系统监控下进行。主要观察指标:对比术前、术中和术后的相关影像资料,分析下肢力线重建和韧带平衡的结果;检查术后 3 个月手术膝关节的活动度、额面松弛度和髌骨稳定性。结果:41例患者均进入结果分析。①所有患者都获得人工膝关节胫、股骨假体的满意对位植入和韧带平衡。②Ceravision系统对下肢力线的测量及在膝内外翻应力下的测量均比X射线片更精确;两组病例的下肢力线都在内外翻3°的范围内(P> 0.05)。③两组术后3个月的关节活动度比较差异不显著(P=0.06);导航手术组膝关节额面松弛度优于常规手术组(P=0.03)。④两组均无髌骨失稳和脱位等并发症。结论:应用以三维骨建模为基础的计算机辅助手术系统,优化了人工全膝关节置换,精确实现了截骨和三维对位,获得良好的膝关节屈伸位下关节等距间隙,保证良好的膝关节韧带张力与平衡稳定,取得比常规手术更合理的额面松弛度,术后的韧带平衡稳定更好,早期疗效满意。

BACKGROUND： The aims of the total knee arthroplasty （TKA） are to restore accurately the position of components in three dimensions and the alignment of lower limb, to maintain the ligament balance of knee and to avoid the femoropatellar complications, to achieve a pain free, stable, good functional and long durable prosthesis. OBJECTIVE： To investigate the optimization of Bone Morphine system for proper restoration of lower limb mechanical axis alignment, rotational position of components and ligament balance in TKA by comparison of the initial outcomes between the computer-navigated and conventional procedures. DESIGN： A prospective clinical comparative study. SETTING： Department of Orthopaedic and Traumatic Surgery, Henri Mondor Hospital, France. PARTICIPANTS： Between November 2002 and June 2003 in Henri Mondor Hospital of France, 21 patients including 14 varus knees and 7 valgus knees, aged from 64 to 79 years, were operated by an experienced senior surgeon with TKA using a Bone Morphing based image-free Ceravision navigation system （navigated group）. Twenty patients, including 15 varus knees and 5 valgns knees, aged from 65 to 83 years, were operated by the same surgeon with the same type of prosthesis using conventional technique （conventional group）. All patients suffered from gonarthrosis received the primary arthroplasty were enrolled in the study. The reversion cases were excluded. All patients were informed with the intervention and agreed to be operated. METHODS： All patients underwent TKA using posterior stabilized total knee prosthesis （Hermes Ceraver, France） by the basically same procedure. In the navigated group, TKA was performed under the monitoring of Bone Morphing based image-free computer-assisted Ceravision system. MAIN OUTCOME MEASURES： To compare the preoperative, intra-operative and postoperative relative image data in navigation group, and to analyze the postoperative alignment and ligament balance, and to assess the range of motion （ROM）, frontal laxity, stability and patella complication of the operated knees. RESULTS： All the patients of the two groups were included in this clinical study and analysis. All femoral, tibial and patella components were implanted in satisfactory position in all patients. The Bone Morphing system showed the accuracy of components alignment and ligaments balance. Lower limb alignments deviated within 3° varus and 3° valgus in frontal view. There was no significant difference between the two groups （P 〉 0.05）. Three months postoperative clinical check-up showed the average ROM was 115° in the navigated group, 109.4° in the conventional group, There was no significant difference between the two groups （P =0.06）, Frontal laxity in the navigated group was found with internal laxity, 0.27（0.2-0.5） mm/ external laxity 1.7（1.0-2.5） mm, in the conventional group was internal laxity 0.27（0.1-0.5） mm/ external laxity 2.23（1.0-3.0） mm. There was a significant difference between the two groups （P =0.03）, There were no knee instability and patella complications. CONCLUSION： Bone Morphing navigated system allows for optimization of lower axis alignment and prosthesis rotational position as well as ligament balance in TKA, more ideal frontal laxity and ligament balance impacted on initial clinical outcome.