个性化截骨器对全膝关节置换术机械轴偏移及关节功能的影响

Effect of personalized osteotomy instrument on mechanical axis deviation and joint function in total knee

目的探究个性化截骨器对行全膝关节置换术(TKA)患者机械轴偏移及关节功能的影响。方法选择2017年2月至2018年4月我院收治的30例采用个性化截骨器行TKA的患者作为观察组,另选同期30例采用传统手术方法行全膝关节置换术的患者作为对照组,比较2组患者手术时间、术中出血量、切口长度、膝关节功能评分(HSS)、下肢机械轴夹角(HKA)、股骨远端机械轴外侧角(mLDFA)和胫骨近端机械轴内侧角(mMPTA)。结果观察组患者手术时间、术中出血量低于对照组,差异有统计学意义(P<0.05);术后2组患者膝关节HSS均升高,但组间比较差异无统计学意义(P>0.05);术后观察组患者mLDFA、HKA小于对照组,差异有统计学意义(P<0.05);若术前mLDFA>93°,则观察组患者术后mLDFA明显低于对照组,差异有统计学意义(P<0.05);若术前mLDFA≤93°,则2组患者术后mLDFA比较差异无统计学意义(P>0.05)。结论采用个性化截骨器辅助全膝关节置换术在早期关节功能改善上与传统手术无异,但能提高下肢机械轴线精确度,缩短手术时间,减少术中出血量。

Objective To investigate the effect of personalized osteotomy instrument on mechanical axis deviation and joint function in patients with total knee arthroplasty(TKA).Methods From February 2017 to April 2018,30 patients who received TKA by personalized osteotomy instrument in our hospital were enrolled as the observation group,and another 30 patients who received TKA by traditional operation method were used as the control group.The operation time,intraoperative blood loss,incision length,hospital for special surgery knee score(HSS score),hip-knee-ankle angle(HKA),mechanical lateral distal femoral angle(mLDFA)and the mechanical medial proximal tibial angle(mMPTA)between two groups were compared.Results The operation time and intraoperative blood loss in the observation group were lower than those in the control group,the differences were significant(P<0.05).The HSS scores of the knee joints in both groups were increased,whereas there was no significant difference between the two groups(P>0.05).The mLDFA and HKA of the observation group were smaller than those of control group,the differences were significant(P<0.05),and the postoperative mLDFA was lower in observation group than that in control group when the preoperative mLDFA was over 93°,the difference was significant(P<0.05).There was no significant difference in mLDFA between the two groups when the pre-mLDFA was or less than 93°(P>0.05).Conclusion The application of personalized osteotomy instrument for total knee arthroplasty is similar to the traditional operation methods in improving early joint function,while the personalized osteotomy instrument can improve the accuracy of lower extremity mechanical axis,shorten the operation time and reduce the amount of intraoperative blood loss.