非影像依赖型计算机辅助全膝关节置换术的初步临床观察

Investigation of preliminary clinical outcome following total knee arthroplasty using image-free computer-assisted navigation system

目的 探讨非影像依赖型计算机辅助全膝关节置换术的技术特点、学习曲线及早期临床疗效。方法 2007年8月至2008年5月应用非影像依赖型无线导航技术（导航组）辅助人工全膝关节置换术治疗KSS—A类患者19例22膝，男5例5膝，女14例17膝，平均年龄64．53岁；同期应用器械定位技术（非导航组）41例45膝，男11例12膝，女30例33膝，平均年龄66．34岁。两组患者术前一般资料、下肢力线和关节活动度无差异。比较两组手术时间、出血量、术后力线内或外翻偏差、早期关节最大屈曲角度及股四头肌功能恢复情况。结果 导航组手术时间比非导航组长，但随手术例数增加及经验积累呈逐渐下降趋势，实施5例手术后因导航技术增加的手术时间平均小于17min。导航组出血量（555．26±152．66）ml，非导航组（647．56±146．61）ml，差异有统计学意义。导航组术后下肢力线内或外翻偏差角度平均1．159°±1．322°，非导航组2．489°±1．532°，差异有统计学意义。术后3天两组股四头肌功能不良发生率的差异有统计学意义。术后5天导航组患者伸膝迟滞均小于25°。结论 导航技术的应用可提高全膝关节置换术假体安放的准确性，学习曲线短，术后早期股四头肌功能恢复比传统定位技术快。

Objective To investigate the technique, learning curve, and early clinical effects of computer-assisted total knee arthroplasty （TKA） or standard instrumentation TKA. Methods From August 2007 to May 2008, 60 KSS-A type patients （67 knees） underwent primary TKA operations by the same surgical team. Among them, 22 knees underwent THA with the aid of the image-free navigation system （including 5 knees and 17 knees, with the average age of 64.53 years）; the other 45 underwent conventional TKA （12 knees and 33 knees, with the average age of 66.34 years）. The preoperative demographic data and functional data have no statistical differences. The operation time, blood loss, duration of early postoperative quadriceps dysfunctions and complications were compared between the two groups. Results The operating time was significantly longer in computer-assisted group compared with conventional TKA group （P〈 0.05）. The technique had a short learning curve, and the additional operation time was less than 17 minutes after 5 operations. The alignment deviations in computer-assisted group were better than that in conventional manual method group （P〈 0.05）. The average blood loss was 555.26 ml in computer-assisted group and 647.56 ml in conventional manual method group （P〈 0.05）. The incidence and duration of early postoperative quadriceps dysfunction was no significant （P 〉0.05）. No patient who received computer-assisted TKA had an extent lag of more than 25 degrees 5 clays postoperatively. Conclusion Use of image-free navigation system in TKA has improved the accuracy of total knee prosthesis alignment, and provided faster quadriceps functional recovery than conventional manual methods. The technique of using of Image-free navigation system in TKA is easy to use, and has a short learning curve.