数字图像术前规划辅助单髁置换对固定平台假体摆位的临床指导意义

Clinical significance of preoperative planning assisted unicompartmental knee arthroplasty with digital imaging system for fixed-bearing prosthesis

背景:单髁置换是治疗膝内侧间室终末期骨关节炎的首选方案。LINK固定平台假体摆位存在众多影响因素,假体角度偏离是否影响术后疗效?辅助以术前数字图像规划能否减少此种偏离?目的:应用数字影像系统辅助LINK固定平台假体进行单髁置换治疗膝内侧间室骨关节炎,探究术前图像规划对假体放置摆位的指导意义,并明确假体偏离角度与临床疗效的关系。方法:回顾收集2017年10月至2020年1月无锡市人民医院骨科收治并同期进行LINK固定平台单髁置换的膝内侧间室骨关节炎患者共28例32膝,根据术前是否进行图像规划,分为规划组17例(18膝)和常规组11例(14膝)。回顾术中髌骨撞击、弹跳情况,通过术后X射线图像分别对股骨假体内外翻角(A角)和屈伸角(B角)、胫骨假体内外翻角(E角)和后倾角(F角)以及周围透亮线进行测量,计算并记录角度变异率、松动发生率和假体角度偏离评分。随访术后膝关节活动度和美国特种外科医院评分,记录并发症情况。结果与结论:①32膝随访6-33个月;②术中两组髌骨均无撞击和弹跳;③术后测量规划组A角[3.90(-0.66,6.78)]°,B角[4.33(2.01,8.05)]°,E角[-3.28(-7.61,-0.13)]°,F角[0.30(-2.74,2.50)]°;常规组A角[2.75(-2.73,8.29)]°,B角[6.45(1.55,18.30)]°,E角[-3.05(-6.73,0.54)]°,F角[3.30(-2.35,6.71)]°;④规划组B角偏离评分、股骨假体偏离评分、假体总体偏离评分均显著低于常规组,差异均有显著性意义(P <0.05);两组胫骨假体偏离评分相比差异无显著性意义(P> 0.05);⑤末次随访时两组膝关节活动度和美国特种外科医院评分均较术前显著改善(P <0.05),但两组间相比差异无显著性意义(P> 0.05);⑥A角偏离评分与美国特种外科医院评分存在显著负相关(r=-0.533,P=0.002);⑦规划组无并发症发生,常规组1膝出现假体松动并接受翻修;⑧结果表明数字影像系统辅助术前图像规划能够提高LINK固定平台假体安放位置的准确性,减少假体角度偏离;固定平台股骨假体内外翻角(A角)的偏离程度将影响术后膝关节功能。

BACKGROUND:Unicompartmental knee arthroplasty is the preferred treatment for end-stage medial compartment osteoarthritis.Numerous factors influence the placement of LINK fixed-bearing prosthesis.Does angle deviation have an effect on postoperative clinical efficacy?Can preoperative digital image planning reduce the deviation?OBJECTIVE:Unicompartmental knee arthro plasty with LINK fixed-bearing prosthesis assisted by digital imaging system is used to treat medial compartment osteoarth ritis patients.This thesis is to investigate the clinical significance of preope rative planning for prosthesis placement,and to clarify the relationship between deviation angle and clinical efficacy.METHODS:From October 2017 to January 2020,28 patients(32 knees)with medial compartment osteoarthritis who underwent LINK fixed-bearing unicompartmental knee arthroplasty in Depa rtment of Orthopedics of 2 Wuxi People’s Hospital were analyzed retrospectively.They were divided into planning group(n=17;18 knees)and conventional group(n=11;14 knees)on the basis of whether the preoperative imaging planning was carried out.The incidence of patellar impact and bounce was reviewed.The varus or valgus angle of femoral prosthesis(A angle),the flexion and extension angle of femoral prosthesis(B angle),the varus or valgus angle of tibial prosthesis(E angle),the posterior slope angle of tibial prosthesis(F angle)and the line of prosthetic loosening were measured on the reexamined X-ray.The angle variation rate,loosening rate and prosthesis deviation score were calculated and recorded in succession.The range of motion,the score of hospital for special surgery and the complications of knees were also followed up.RESULTS AND CONCLUSION:(1)The 32 knees were followed up for 6-33 months.(2)No indication of patellar impact or bounce occurred in both groups.(3)In planning group,A angle was measured at[3.90(-0.66,6.78)]°,with B angle[4.33(2.01,8.05)]°,E angle[-3.28(-7.61,-0.13)]°and F angle[0.30(-2.74,2.50)]°.While in conventional group,A angle was measured at[2.75(-2.73,8.29)]°,with B angle[6.45(1.55,18.30)]°,E angle[-3.05(-6.73,0.54)]°and F angle[3.30(-2.35,6.71)]°.(4)The deviation scores of B angle,femoral prosthesis and total prosthesis in planning group were significantly lower than those in conventional group(P<0.05).There came out to be no obvious differences in tibial prosthesis scores between planning group and conventional group(P>0.05).(5)In contrast to preoperative pe riod,last follow-up demonstrated apparent improvements in both range of motion and hospital for special surgery scores of two groups(P<0.05).However,no specific evidence seemed to exist to certify the difference in range of motion and hospital for special surgery scores between two groups at the latest follow up(P>0.05).(6)A significant negative correlation was verified between A angle deviation score and hospital for special surgery score(r=-0.533,P=0.002).(7)No complications occurred in planning group,while one case in conventional group developed prosthesis loosening and underwent revision.(8)The results confirmed that digital imaging system-assisted preoperative planning can improve the accuracy of prosthesis placement of LINK fixed bearing and reduce the angle deviation.The deviation of A angle from femoral prosthesis has great impacts on postoperative knee functions.