计算机导航在全膝关节置换中的应用

Application of computer navigation in total knee arthroplasty

背景:随着精准医疗的发展,导航下膝关节置换越来越受到重视,其能够使假体植入更加准确,获得有更好精确的下肢力线,但同时也延长了手术时间。目的:探讨Aesculap Ortho-Pilot非影像依赖无线导航在全膝关节置换中的应用价值。方法:回顾性收集2017年4至11月安徽医科大学第一附属医院收治的42例单侧膝关节骨性关节炎患者病历资料,经同一手术医师完成初次全膝关节置换,按照手术方式分为2组:导航组在Ortho-Pilot非影像依赖无线导航辅助下进行全膝关节置换,非导航组进行常规的全膝关节置换,每组21例。记录两组手术时间、术后引流量;术后12个月拍摄负重X射线片,观察下肢机械轴线、胫骨机械轴近端内侧角、股骨机械轴远端外侧角、矢状面胫骨组件角与下肢力线偏差>3°的患者数量,同时评估患者膝关节活动度与膝关节功能HSS评分。试验获得安徽医科大学第一附属医院伦理委员会批准。结果与结论:①导航组手术时间长于非导航组(P<0.05),术后引流量少于非导航组(P<0.05);②术后12个月,导航组下肢机械轴线、股骨机械轴远端外侧角、矢状面胫骨组件角分离变量的误差均小于非导航组(P<0.05),两组胫骨机械轴近端内侧角分离变量与下肢力线>3°的病例数比较差异无显著性意义(P>0.05);③术后12个月,导航组膝关节活动度大于非导航组(P<0.05),两组膝关节功能HSS评分比较差异无显著性意义(P>0.05);④结果表明,计算机导航辅助全膝关节置换能够提高下肢力线的准确性、假体安放的准确性及膝关节活动度,但增加了手术时间,应用时应综合考虑其利弊。

BACKGROUND:With the development of precision medicine,knee replacement under navigation has been paid more and more attention.Precision medicine allows for more accurate implant placement and better limb alignment.However,precision medicine can also make surgery much longer.OBJECTIVE:To evaluate the application of Aesculap Ortho-Pilot non-image-dependent wireless navigation in total knee arthroplasty.METHODS:Data of 42 patients with unilateral knee osteoarthritis admitted to the First Affiliated Hospital of Anhui Medical University from April to November 2017 were retrospectively collected.First total knee arthroplasty was conducted by the same surgeon.According to surgical methods,the patients were divided into two groups:the navigation group(n=21)received a total knee arthroplasty under the assistance of Ortho-Pilot non-image-dependent wireless navigation,and the non-navigation group(n=21)received a regular total knee arthroplasty.Operation time and drainage volume were recorded in both groups.X-ray film of weight bearing was taken 12 months after operation.Mechanical axis of the lower extremity,the mechanical proximal medial proximal angle of the mechanical shaft of the tibia,the distal lateral angle of the femoral mechanical axis,sagittal tibial component angle and the number of alignment deviation of the lower extremity(>3°)were compared between the two groups.Knee range of motion and Hospital for Special Surgery knee score were evaluated.This study was approved by the Ethics Committee of First Affiliated Hospital of Anhui Medical University.RESULTS AND CONCLUSION:(1)Operation time was longer in the navigation group than in the non-navigation group(P<0.05).Postoperative drainage was less in the navigation group than in the non-navigation group(P<0.05).(2)At postoperative 12 months,the variables of mechanical axis of the lower extremity,lateral angle of the distal end of the mechanical axis of the femur,and angular separation of the component of the sagittal tibia were smaller in the navigation group than in the non-navigation group(P<0.05).There was no significant difference in the quantity of lower limb alignment>3°and the variables of medial angular separation of proximal end of the mechanical axis of the tibia between the two groups(P>0.05).(3)At postoperative 12 months,the range of motion was larger in the navigation group than in the non-navigation group(P<0.05).There was no significant difference in Hospital for Special Surgery knee score between the two groups(P>0.05).(4)Results suggested that total knee arthroplasty assisted by computer navigation can improve the accuracy of lower limb alignment,accuracy of prosthesis placement and knee range of motion.However,the operation time was improved,so the advantages and disadvantages should be considered comprehensively.