便携式计算机导航iASSIST技术在全膝关节置换术中的应用

Application of computer-assisted navigation(iASSIST Technology) in total knee arthroplasty

目的探讨便携式计算机导航(i ASSIST技术)的准确性和优缺点。方法自2016年6~9月,选择我院严重退变性膝关节骨关节炎患者23例(24膝)行全膝关节置换术,随机分为导航组和传统组,其中应用便携式计算机导航(导航组)11例(12膝),应用传统机械定位技术(传统组)12例(12膝),两组患者的年龄、BMI、术前力线误差、KSS评分行配对t检验,差异无统计学意义(P>0.05)。先比较两组患者包括术后KSS评分、术中、术后出血量、术后3天血色素下降量、手术持续时间等在内的术后一般情况。术后3个月行X线检查,再比较两组患者下肢力线偏差以及冠状面和矢状面的假体位置偏差角度。结果导航组术后平均KSS评分(85.83±4.303)优于传统组(80.08±5.178),差异有统计学意义(t=2.959,P=0.007);导航组平均术中、术后出血量(482.50±48.453)ml小于传统组(707.50±78.059)ml,差异有统计学意义(t=8.484,P=0.000);导航组平均术后3天血色素下降值(10.42±2.021)g/L小于传统组(19.08±2.778)g/L,差异有统计学意义(t=8.739,P=0.000);导航组手术持续时间(67.42±4.999)min长于传统组(63.33±5.015)min,差异无统计学意义(t=1.998,P=0.058);两组3个月导航组髋膝踝角平均偏差角度(1.24±0.452)°小于传统组(2.33±0.619)°,差异有统计学意义(t=4.885,P=0.000);导航组冠状面股骨组件角平均偏差角度(0.86±0.193)°小于传统组(2.01±0.474)°,差异有统计学意义(t=7.788,P=0.000);导航组冠状面胫骨组件角平均偏差角度(1.06±0.258)°小于传统组(1.32±0.225)°,差异有统计学意义(t=2.617,P=0.016);导航组矢状面股骨组件屈曲角平均偏差角度(6.43±1.435)°小于传统组(9.43±1.395)°,差异有统计学意义(t=5.208,P=0.000);导航组矢状面胫骨组件角平均偏差角度(2.13±0.259)°小于传统组(3.25±0.582)°,差异有统计学意义(t=6.112,P=0.000)。结论便携式计算机导航(i ASSIST技术)有定位准确、手术损伤小、学习周期短等优点。

Objective To explore the accuracy, advantages and disadvantages of computer-assisted navigation （ iASSIST Technology ）. Methods Twenty-three patients （ 24 knees ） with severe degenerative knee osteoarthritis in our hospital underwent total knee arthroplasty from June 2016 to September 2016. They were randomly divided into the navigation group （ 12 knees of 11 cases ） and the traditional group （ 12 knees of 12 cases ）. The two groups were matched with age, BMI, preoperative force line error and KSS score by paired t test, and the results showed no significant differences between the 2 groups （ P 〉 0.05 ）. Postoperative general data of the 2 groups were compared： postoperative KSS score, intraoperative and postoperative bleeding, amount of hemoglobin decrease at day 3 post-operation, and the duration of surgery. X-ray examination was performed 3 months after the operation. The line deviation of the lower extremity and the position deviation angle of the coronal and sagittal planes between the 2 groups were then compared. Results The average KSS score of the navigation group was （ 85.83± 4.303 ）, which was significantly higher than that of the traditional group （ 80.08 ± 5.178 ） （ t = 2.959, P = 0.007 ）. The mean postoperative blood loss in the navigation group （ 482.50 ± 48.453 ） ml was less than that in the traditional group （ 707.50 ± 78.059 ） ml （ t = 8.484, P = 0.000 ）. The navigation group had a mean decrease of hemoglobin value 3 days post-operation （ 10.42 ± 2.021 ） g / L compared with the traditional group （19.08 ± 2.778 ） g / L, with statistical significance （ t = 8.739, P = 0.000 ）. The duration of operation in the navigation group （ 67.42 ± 4.999 min ） was longer than that in the traditional group （ 63.33 ± 5.015 min ）, with no significant differences between the 2 groups （ t = 1.998, P = 0.058 ）. The average deviation angle of the hip-knee-ankle angle of the navigation group 3 months post-operation （ 1.24 ± 0.452 ）° was smaller than that of the traditional group （ 2.33 ± 0.619 ） ° （ t = 4.885, P = 0.000 ）. The average angular deviation of the frontal femoral component in the navigation group （ 0.86 ± 0.193 ） o was smaller than that in the traditional group （ 2.01 ± 0.474 ） ° （ t = 7.788, P = 0.000 ）. The mean deviation angle of the frontal tibial component in the navigation group was （ 1.06 ± 0.258 ） ° which was smaller than that in the traditional group （ 1.32 ± 0.225 ） °, with statistical significance （ t = 2.617, P = 0.016 ）. The average deviation angle of the flexion angle of the lateral femoral component in the navigation group （ 6.43 ±1.435 ） ° was smaller than that of the traditional group （ 9.43 ±1.395 ） °（ t = 5.208, P = 0.000 ）. The mean deviation angle of the lateral tibial component in the navigation group （ 2.13 ± 0.259 ）° was smaller than that in the traditional group （ 3.25 ±0.582 ） °, with statistical significance （ t = 6.112, P = 0.000 ）. Conclusions Computer-assisted navigation （ iASSIST Technology ） has the advantages of accurate positioning, less surgical injury, short learning cycle, etc.