计算机导航辅助人工全膝关节置换术的近期疗效

Early effectiveness of computer navigation-assisted total knee arthroplasty

目的通过与传统人工全膝关节置换术(total knee arthroplasty,TKA)比较,探讨计算机导航辅助TKA的早期疗效。方法回顾分析2017年10月—2018年7月于计算机导航辅助系统下行初次TKA的44例(50膝)患者(导航组)临床资料,并与同期行传统TKA的45例(50膝)患者(对照组)进行比较。两组患者性别、年龄、身体质量指数、病变类型、侧别、病程、骨关节炎Kellgren-Lawrence分级以及术前美国特种外科医院(HSS)评分、膝关节活动度(range of motion,ROM)、髋-膝-踝角(hip-knee-ankle angle,HKA)偏移等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组手术时间、切口长度、手术前后血红蛋白差值、术后住院时间,以及并发症发生情况。所有患者采用HSS评分、ROM、关节遗忘评分(FJS-12)评价膝关节功能恢复情况,单侧患者同时行术后计时起走测试、简易躯体能力测试(SPPB)。于术后1 d X线片测量HKA、机械轴股骨远端外侧角(mechanical lateral distal femoral angle,mLDFA)、机械轴胫骨近端内侧角(mechanical medial proximal tibial angle,mMPTA)、矢状面股骨组件角(sagittal femoral component angle,sFCA),矢状面胫骨组件角(sagittal tibial component angle,sTCA),计算上述指标与目标值差值(指标偏移);测量膝关节线汇聚角(joint line convergence angle,JLCA)。结果两组手术均顺利完成,术后切口均Ⅰ期愈合。导航组手术时间及切口长度均长于对照组(P<0.05);手术前后血红蛋白差值及术后住院时间比较,差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间27~40个月,平均33.6个月。两组各1例术后发生胫后静脉血栓形成,对照组1例发生膝关节反复肿胀。两组术后HSS评分随时间延长逐渐升高(P<0.05);术后1、2年导航组HSS评分以及2年时膝关节ROM及FJS-12评分均高于对照组(P<0.05)。术后7 d两组计时起走测试及SPPB结果比较,差异均无统计学意义(P>0.05);术后2年,导航组计时起走测试较对照组缩短(t=–2.226,P=0.029),SPPB比较差异无统计学意义(t=0.429,P=0.669)。术后1 d X线片测量示导航组HKA偏移小于对照组(t=–7.392,P=0.000);其中导航组50膝(100%)HKA偏移均≤3°、对照组36膝(72%)≤3°,差异有统计学意义(χ^(2)=16.279,P=0.000)。导航组mLDFA偏移、mMPTA偏移、sFCA偏移、sTCA偏移及JLCA均小于对照组(P<0.05)。结论与传统TKA相比,计算机导航辅助TKA的假体植入位置和下肢力线重建更精确,可获得更好的早期疗效;但存在一定学习曲线,应用早期手术时间与切口长度均延长。

Objective To estimate the early effectivenss of computer navigation-assisted total knee arthroplasty(TKA) by comparing with traditional TKA. Methods The clinical data of 89 patients(100 knees) underwent primary TKA between October 2017 and July 2018 were analyzed retrospectively, including 44 patients(50 knees) who completed the TKA under the computer-assisted navigation system as the navigation group and 45 patients(50 knees) treated with traditional TKA as the control group. There was no significant difference between the two groups(P>0.05) in gender, age,body mass index, diagnosis, side, disease duration, Kellgren-Lawrence classification of osteoarthritis, and preoperative American Hospital for Special Surgery(HSS) score, range of motion(ROM), hip-knee-ankle angle(HKA) deviation. The operation time, incision length, difference in hemoglobin before and after operation, postoperative hospital stay, and the complications were recorded and compared between the two groups. The HSS score, ROM, and joint forgetting score(FJS-12) were used to evaluate knee joint function in all patients. Unilateral patients also underwent postoperative time of up and go test and short physical performance battery(SPPB) test. At 1 day after operation, the HKA, mechanical lateral distal femoral angle(mLDFA), mechanical medial proximal tibial angle(mMPTA), sagittal femoral component angle(sFCA), and sagittal tibial component angle(sTCA) were measured and calculated the difference between the above index and the target value(deviation);and the joint line convergence angle(JLCA) was also measured. Results The operations of the two groups were successfully completed, and the incisions healed by first intention. The operation time and incision length of the navigation group were longer than those of the control group(P<0.05);the difference in difference of hemoglobin before and after the operation and the postoperative hospital stay between groups was not significant(P>0.05). Patients in the two groups were followed up 27-40 months, with an average of 33.6 months. Posterior tibial vein thrombosis occurred in 1 case in each of the two groups, and 1 case in the control group experienced repeated knee joint swelling. The HSS scores of the two groups gradually increased after operation(P<0.05);HSS scores in the navigation group at 1 and 2 years after operation, and knee ROM and FJS-12 scores at 2 years were significantly higher than those in the control group(P<0.05). There was no significant difference in the postoperative time of up and go test and SPPB results between the two groups at 7 days after operation(P>0.05);the postoperative time of up and go test of the navigation group was shorter than that of the control group at 2 years(t=–2.226, P=0.029), but there was no significant difference in SPPB(t=0.429, P=0.669). X-ray film measurement at 1 day after operation showed that the deviation of HKA after TKA in the navigation group was smaller than that of the control group(t=–7.392, P=0.000);among them, the HKA deviations of 50 knees(100%) in the navigation group and 36 knees(72%) in the control group were less than 3°, showing significant difference between the two groups(χ2=16.279, P=0.000). The JLCA and the deviations of mLDFA, mMPTA,sFCA, and sTCA in the navigation group were smaller than those in the control group(P<0.05). Conclusion Compared with traditional TKA, computer navigation-assisted TKA can obtain more accurate prosthesis implantation position and lower limb force line and better early effectiveness. But there is a certain learning curve, and the operation time and incision length would be extended in the early stage of technology application.