计算机导航下与传统人工全膝关节置换术的疗效比较

COMPARISON OF TOTAL KNEE ARTHROPLASTY WITH COMPUTER NAVIGATION SYSTEMS AND CONVENTIONAL TECHNIQUES

目的通过与传统人工全膝关节置换术（totalkneearthroplasty，TKA）比较，探讨计算机导航技术在TKA中的应用价值。方法回顾分析2010年5月-2011年12月符合选择标准的45例单膝初次TKA患者临床资料，其中22例术中采用计算机导航技术（A组），23例采用传统术式（B组）。两组患者性别构成、年龄、体重指数、侧别、病因、病程及术前膝关节活动度、美国特种外科医院（Hss）评分比较，差异均无统计学意义（P〉0．05）。比较两组手术时间、术中出血量、术中髌股外侧支持带松解情况、术后引流量、并发症发生情况以及随访期间假体松动、膝关节活动度及HSS评分。结果术中A组3例（13．6％）、B组1例（4．3％）行髌股外侧支持带松解，比较差异无统计学意义（χ2=1．198，P=0．346）。与B组比较，A组手术时间延长（t=7．557，P=-0．000），术中出血量无显著差异（t=-0．295，P=-0．769），术后引流量明显减少（t=-2．419，P=-0．020）。A组发生术中骨裂1例，术后急性感染1例；B组无并发症发生；并发症发生率比较差异有统计学意义（z=-0．509，P=-0．000）。两组患者均获随访，随访时间27～46个月。两组膝关节内、外翻及股骨、胫骨假体内、外翻偏移比较，差异均无统计学意义（P〉0．05）；末次随访时HSS评分及膝关节活动度比较，差异亦无统计学意义（P〉0．05）。均无假体松动发生。结论与传统TKA相比，计算机导航下行TKA在下肢力线准确度方面无明显差异，但手术时间延长，且存在感染和定位针部位骨裂的风险。

Objective To evaluate the value of total knee arthroplasty （TKA） with computer navigation by comparing with conventional TKA. Methods Between May 2010 and December 2011, 45 patients underwent primary unilateral TKA, and the clinical data were retrospectively analyzed. Of 45 patients, 22 cases were treated with TKA with computer navigation （group A）, 23 cases with the conventional TKA （group B）. There was no significant difference in gender, age, body mass index, side, cause of disease, disease duration, preoperative range of motion （ROM） of the knee, and preoperative Hospital for Special Surgery （HSS） score between 2 groups （P 〉 0.05）. The operation time, intraoperative blood loss, incidence of patellar retinacular release, complication, and drainage volume were compared. The prosthesis loosening, postoperative HSS score, and ROM of the knee were also compared. Results No difference was found in the incidence ofpatellar retinacular release during TKA, and it was 13.6% （3/22） in group A and was 4.3% （1/23） in group B, showing no significant difference （χ2=1.198, P=0.346）. The operation time of group A was significantly longer than that of group B （t=7.557, P=O.O00）. There was no significant difference in intraoperative blood loss during TKA between 2 groups （t=- -0.295, P=0.769）, while the drainage volume of group A was significantly less than that of group B （t= -2.419, P=0.020）. Incomplete fracture during TKA and acute infection occurred at 8 days after TKA in 1 case of group A respectively, while no fracture or infection was found in group B, showing significant difference （Z= -0.509, P=0.000）. The patients of 2 groups were followed up 27-46 months. No significant difference in valgus and varus of knee, and malalignment of the femoral and tibial prosthesis was found （P 〉 0.05）. There was no significant difference in HSS score and ROM of the knee at last follow-up between 2 groups （P 〉 0.05）. No prosthesis loosening was found in 2 groups. Conclusion TKA with computer navigation has similar results to conventional TKA in the mechanical alignment, but it obviously prolongs operation time. It may also increase the incidence of infection and tractor pin related fracture.