个体化术前模拟截骨在全膝关节置换胫骨平台假体选择中的应用

Application of individual preoperative simulation osteotomy on selecting tibia prosthesis in total knee arthroplasty

背景:胫骨平台假体过大或者过小均会影响膝关节稳定性及置换后长期疗效,只有通过置换前分析提高胫骨平台假体骨质覆盖率才能进一步降低胫骨假体松动、下沉的发生率。目的:通过对初次全膝关节置换患者行CT三维重建及模拟截骨,从而选择相应的假体,最大化胫骨平台假体骨质覆盖率。方法:纳入76例(84膝)行初次全膝关节置换的患者,随机分为试验组38例41膝和对照组38例43膝。试验组所有患者置换前行CT平扫及三维重建,模拟胫骨平台截骨,通过对胫骨平台数据进行对比分析,选择相应的合适的假体,最大化胫骨平台假体骨质覆盖率;对照组患者未行CT三维重建。置换后对两组患者胫骨平台的骨质覆盖进行评估,并随访评价修复效果。结果与结论:75例患者得到随访,随访时间13-56个月,试验组1例患者因假体周围骨折退出研究。通过置换后随访分析,试验组与对照组之间平台假体覆盖率分别为(89.87±4.14)%,(83.15±5.21)%;置换后纽约特种外科医院(HSS)评分分别为(87.48±8.69)分和(82.37±10.14)分,两组差异有显著性意义(P<0.05)。而在关节活动度和置换后并发症方面,两组之间差异无显著性意义(P>0.05)。提示通过对行全膝关节置换患者行CT三维重建及模拟截骨,从而选择合适的假体类型,可以提高胫骨平台假体骨质覆盖率,有助于取得满意的修复效果。

BACKGROUND： Inappropriate size of tibia prosthesis will affect the stability and long term curative effect of knee joint. Raising the tibia prosthesis bone coverage through preoperative analysis may further reduce the incidence of loosing and sinking of tibia prosthesis. OBJECTIVE： To select the appropriate prosthesis and maximize the tibia prosthesis bone coverage rate through the three dimensional reconstruction of CT and preoperative tibia osteotomy simulation among the patients preliminarily treated with total knee arthroplasty. METHODS： Totally 76（84 knees） patients treated with total knee arthroplasty were enrolled and randomly divided into test group（38 cases, 41 knees） and control group（38 cases, 43 knees）. All the patients in the test group were underwent CT scan and three-dimensional reconstruction of CT before operation. Preoperative tibia osteotomy was stimulated. The most appropriate tibia prosthesis was selected by comparatively analyzing the data of tibia osteotomy, and maximizing the tibial plateau prosthesis bone coverage. Three-dimensional reconstruction of CT was absence in the control group by contrast. Tibia plateau bone coverage of patients in these two groups after replacement was evaluated. The repair effect was evaluated during the follow-up. RESULTS AND CONCLUSION： Totally 75 patients were followed up for 13 to 56 months. One patient in the test group withdrew from the study because of periprosthetic fractures. Analyzing from the follow-up after replacement, tibia plateau prosthesis coverage rates of test group and control group were（89.87±4.14）%,（83.15±5.21）% respectively; New York Hospital for Special Surgery scores were respectively（87.48±8.69） points and（82.37±10.14） points, the difference was statistically significant（P〈0.05）. However, there were no significant differences in the range of motion and postoperative complications between test and control groups（P〉0.05）. These results suggest that choosing the most appropriate type of tibia prosthesis by applying three-dimensional reconstruction of CT and preoperative tibia osteotomy on patients treated with total knee arthroplasty can improve tibial plateau prosthesis bone coverage rate and is conductive to achieve a satisfactory repair effect.