个性化截骨技术在全膝关节置换术中临床应用和疗效分析

The value of patient-specific instrumentation in total knee arthroplasty

[目的]探讨个性化截骨技术（patient-specific instrumentation）在全膝关节置换术中应用价值和疗效分析。[方法]选择2011年12月∽2014年6月行全膝关节置换术25例31膝重度骨性关节炎患者采用个性化截骨技术（SignatureTM,Biomet公司）行全膝关节置换术,同期选择27例33膝采用传统手术技术行全膝关节置换术。术前两组患者的年龄、性别、体重指数、下肢机械轴线（站立位髋-膝-踝角）及功能评分等指标的差异均无统计学意义。前瞻性记录两组患者手术时间、术中失血量、刀口长度、术后下肢机械轴线（站立位髋-膝-踝角）和术后3个月时KSS功能评分。[结果]术后个性化截骨组髋-膝-踝角为（1.44±0.25）°,传统手术组为（2.28±0.30）°,两组比较差异具有统计学意义;术中出血量个性化截骨组为（177.1±13.34）ml,传统手术组为（219.7±9.72）ml,两组比较差异具有统计学意义。术后刀口均一期愈合,无下肢深静脉血栓形成、无血管神经损伤及心肺等重要脏器并发症发生。随访过程未见感染、假体松动、断裂等情况。[结论]个性化截骨技术操作简便,具有提高下肢机械轴线的精确性、减少出血量等优势。

[ Objective] To compare the therapeutic effect of patient - specific instrumentation with conventional instrumen- tation in total knee arthroplasty and assess the value of the patient -specific instrumentation. [ Methods] From December 2011 to June 2014, 25 patients with 31 knees underwent total knee replacement with patient - specific instrumentation （PSI） and 27 patients with 33 knees with conventional instrumentation. The preoperative parameters such as age, gender, body mass index, hip -knee -ankle angle and KSS score were not statistical different. The following parameters including operative time, blood loss, incision length, postoperative hip - knee - ankle angle and KSS function score were recorded prospectively. [ Results ] The following period was 3 - 24 months. The postoperative hip - knee - ankle was （ 1.44± 0. 25 ）° in PSI group and （2. 28 ± 0. 30）°in conventional group, and it was statistical significant. The blood loss during operation was （177.1 ± 13.34） ml in PSI and （219. 7 ±9. 72） ml in conventional group, but it had no statistical significance. The KSS score at the third month after the operation was found no statistically significant difference between the two groups. [ Conclusion] Patient - specific instrumentation for total knee arthroplasty improves accuracy in coronal alignment and decrease blood loss compared with conventional instru- mentation.