OrthoPilot计算机导航辅助全膝关节置换术的早期学习曲线

The early learning curve of OrthoPilot computer navigation assisted total knee arthroplasty

目的探讨OrthoPilot计算机导航辅助全膝关节置换术(total knee arthroplasty,TKA)的早期学习曲线。方法回顾性分析2017年11月至2018年7月同一手术团队在OrthoPilot计算机导航辅助下完成的最初连续40例TKA的临床资料。将40例患者按手术顺序分为前期组(第1~20例)和后期组(第21~40例)。前期组男3例,女17例;年龄(69.85±6.86)岁(范围54~80岁);体重指数(24.10±2.88)kg/m2;术前美国特种外科医院(Hospital for Special Surgery,HSS)评分(48.80±5.33)分;膝关节活动度87.05°±11.02°;力线偏移7.40°±5.59°。后期组男1例,女19例;年龄(66.65±7.92)岁(范围56~83岁);体重指数(22.85±3.15)kg/m2;术前HSS评分(49.00±5.47)分;膝关节活动度85.80°±11.65°;力线偏移8.22°±5.21°。比较两组患者手术时间、切口长度、术前与术后血红蛋白差值、术后住院天数、髋-膝-踝角、机械轴股骨远端外侧角、机械轴胫骨近端内侧角、矢状面股骨组件角、矢状面胫骨组件角及膝关节线汇聚角较术中重建目标角度的偏移及临床评分。结果所有患者均获得随访,随访时间(27.38±2.73)个月(范围24~33个月),随访期内无一例发生感染、松动等严重并发症。前期组和后期组平均手术时间分别为(112.35±25.49)min与(82.10±10.96)min,胫骨截骨时间分别为(11.95±3.27)min与(7.35±2.23)min,股骨规划+截骨时间分别为(20.95±6.91)min与(16.60±4.78)min,试模+植入假体时间分别为(39.65±7.72)min与(25.10±5.72)min,差异均有统计学意义。前期组与后期组术后髋-膝-踝角偏移(0.70°±0.80°vs.0.80°±1.06°)、机械轴股骨远端外侧角偏移(0.89°±0.91°vs.1.00°±0.86°)、机械轴胫骨近端内侧角偏移(0.77°±0.53°vs.0.76°±1.03°)、矢状面股骨组件角偏移(0.73°±0.48°vs.0.87°±1.06°)、矢状面胫骨组件角偏移(0.95°±0.58°vs.1.16°±1.14°)及膝关节线汇聚角偏移(0.27°±0.25°vs.0.39°±0.18°)差异均无统计学意义。前期组术前和术后3 d HSS评分分别为(48.80±5.33)分与(60.05±5.10)分,后期组术前和术后3 d HSS评分分别为(49.00±5.47)分与(60.75±4.47)分,术后均较术前提高。术后2年时前期组与后期组间膝关节活动度(113.20°±9.82°vs.113.50°±12.44°)和关节遗忘评分(78.00°±10.98°vs.76.65°±10.29°)差异均无统计学意义。结论OrthoPilot计算机导航辅助TKA存在20例与手术时间相关的早期学习曲线,在导航使用初期即可获得良好的精确度和可重复性,并可获得满意的影像学和临床结果。

Objective To explore the early learning curve of OrthoPilot navigation assisted total knee arthroplasty(TKA).Methods Data of 40 consecutive cases of OrthoPilot navigation assisted TKA completed by the same surgical team in our department were retrospectively analyzed.According to the operation order,40 cases were divided into the original phase group(the first 20 cases)and the subsequent phase group(the second 20 cases).In original phase group,the average age was 69.85±6.86 years with mean body mass index 24.10±2.88 kg/m2,preoperative HSS score 48.80±5.33,preoperative knee ROM 87.05°±11.02°and preoperative alignment deviation of 7.40°±5.59°.In subsequent phase group,the average age was 66.65±7.92 years with mean body mass index 22.85±3.15 kg/m2,preoperative HSS score 49.00±5.47,preoperative knee ROM 85.80°±11.65°and preoperative alignment deviation of 8.22°±5.21°.Perioperative data such as operative duration,incision length,hemoglobin drop and postoperative hospital stay,radiographic outcomes including hip-knee-ankle angle(HKAA),mechanical lateral distal femoral angle(mLDFA),mechanical medial proximal tibial angle(mMPTA),sagittal femoral component angle(sFCA),sagittal tibial component angle(sTCA),joint line convergence angle(JLCA),and functional scores were compared between the two groups.Results All 40 cases were followed up for 24-33 months(mean,27.38±2.73 months).No severe postoperative complications such as infection and loosening occurred during the follow-up.The mean operative duration was 112.35±25.49 min in original phase group versus 82.10±10.96 min in subsequent phase group(P<0.05).The durations of tibial cutting was 11.95±3.27 min in original phase group versus 7.35±2.23 min in subsequent phase group(P<0.05);the femoral planning+cutting time was 20.95±6.91 min in original phase group versus 16.60±4.78 min in subsequent phase group,and trial+prosthesis implantation time was 39.65±7.72 min in original phase group versus 25.10±5.72 min in subsequent phase group,which was significantly higher in original phase group.There was no significant difference in other perioperative data such as incision length,hemoglobin drop and postoperative hospital stay between the two groups.As for radiographic outcomes,there was no statistical difference between the two groups in the postoperative angular deviation of HKAA(0.70°±0.80°vs.0.80°±1.06°),mLDFA(0.89°±0.91°vs.1.00°±0.86°),mMPTA(0.77°±0.53°vs.0.76°±1.03°),sFCA(0.73°±0.48°vs.0.87°±1.06°),sTCA(0.95°±0.58°vs.1.16°±1.14°)and JLCA(0.27°±0.25°vs.0.39°±0.18°).In original phase group,the HSS scores preoperative and 3 days postoperative were 48.80±5.33 and 60.05±5.10 respectively,and those in subsequent phase were 49.00±5.47 and 60.75±4.47 respectively,and both groups showed satisfactory functional recovery.There was no significant difference in HSS scores at all follow-up time points between two phases,as well as ROM(113.20°±9.82°vs.113.50°±12.44°)and FJS-12 scores(78.00°±10.98°vs.76.65°±10.29°)at 2 years postoperatively.Conclusion In this study,we described a time-related early learning curve for OrthoPilot navigation-assisted TKA,in which the operative duration tended to be shorter after the first 20 cases.However,benefiting from good operative accuracy and repeatability,satisfactory radiographic and functional outcomes can be obtained in early stage of the learning curve.