新型计算机导航系统辅助人工全膝关节置换术的近期疗效

Short-term effectiveness of novel computer navigation system assisted total knee arthroplasty

目的探讨新型计算机导航系统(Knee 3软件;Brainlab公司,德国)辅助人工全膝关节置换术(total knee arthroplasty,TKA)的早期疗效。方法 2020年7月—12月,采用Knee 3软件辅助19例(19膝)TKA。男4例,女15例;年龄52~79岁,平均66.3岁。骨关节炎18例,类风湿性关节炎1例。膝关节内翻畸形16例,外翻畸形3例。术前美国西部Ontario与McMaster大学骨关节炎指数(WOMAC)疼痛、僵硬、功能评分分别为(12.4±3.4)、2(1,4)、22(18,29)分,总分37(29,43)分。术中测试伸膝位及屈膝90°位内、外侧间隙,评估是否达间隙平衡。记录手术时间、术中出血量、术后输血和手术并发症发生情况。术后6周X线片测量髋-膝-踝角(hip-knee-ankle angle,HKA)、股骨远端外侧角和胫骨近端内侧角,评价下肢力线和假体对线。采用WOMAC疼痛、僵硬和功能评分评价膝关节疼痛及功能,患者自评手术满意度。结果术中测量显示18例(94.7%)患者达伸膝位内、外侧间隙平衡,18例(94.7%)达屈膝90°位内、外侧间隙平衡,19例(100%)达伸膝位和屈膝90°位内侧间隙平衡,18例(94.7%)达伸膝位和屈膝90°位外侧间隙平衡。手术时间100~200 min,平均126 min。术中出血量100~400 mL,平均205 mL。术后患者均获随访,随访时间4~8个月,平均6.2个月。术后发生下肢远端深静脉血栓形成1例,脑梗死1例。X线片测量示HKA 178°~182°,平均179.8°;股骨远端外侧角80°~87°,平均83.5°;胫骨近端内侧角87°~93°,平均89.5°。末次随访时,WOMAC疼痛、僵硬和功能评分分别为(3.6±1.9)、0(0,2)、4(2,6)分,总分9(5,10)分,均较术前改善(P<0.05)。患者自评手术满意度,12例达非常满意、7例满意,总体满意率达100%。结论 Knee 3软件辅助TKA有助于获得良好膝关节平衡和理想下肢力线,早期疗效较好,患者满意度高。

Objective To investigate the short-term effectiveness of novel computer navigation system(Knee 3 software;Brainlab, Germany) assisted total knee arthroplasty(TKA). Methods Between July 2020 and December 2020,19 patients underwent unilateral TKA assisted with Knee 3 software. There were 4 males and 15 females. The mean age was 66.3 years(range, 52-79 years). Eighteen patients were diagnosed with osteoarthritis and 1 patient with rheumatoid arthritis. Sixteen patients had varus knees and 3 patients had valgus knees. Preoperative Western Ontario and McMaster University Osteoarthritis Index(WOMAC) pain, stiffness, function, and total scores were 12.4±3.4, 2(1, 4), 22(18, 29),and 37(29, 43), respectively. Intraoperatively, the medial and lateral gaps in knee extension and in 90° of knee flexion were recorded. The operation time, intraoperative blood loss, blood transfusion, and complications were recorded. The hipknee-ankle angle(HKA), lateral distal femoral angle, and medial proximal tibial angle were measured to evaluate lower limb alignment and prostheses’ s alignment using X-ray films at 6 weeks after operation. Patient’s satisfaction rate and WOMAC pain, stiffness, function, and total scores were investigated. Results Eighteen patients(94.7%) had mediallateral gap balancing in knee extension, 18 patients(94.7%) had medial-lateral gap balancing in 90° of knee flexion, 19 patients(100%) had medial gap balancing between knee extension and 90° of knee flexion, and 18 patients(94.7%) had lateral gap balancing between knee extension and 90° of knee flexion. The mean operation time was 126 minutes(range,100-200 minutes). The mean intraoperative blood loss was 205 mL(range, 100-400 mL). Patients were followed up 4-8 months, with an average of 6.2 months. Postoperative complications included 1 deep vein thrombosis of lower extremities and 1 cerebral infarction. X-ray films showed that the mean HKA, lateral distal femoral angle, and medial proximal tibial angle were 179.8°(range, 178°-182°), 83.5°(range, 80°-87°), and 89.5°(range, 87°-93°), respectively. At last follow-up,WOMAC pain, stiffness, function, and total scores were 3.6±1.9, 0(0, 2), 4(2, 6), and 9(5, 10), respectively, which improved when compared with preoperative scores(P<0.05). Twelve patients were very satisfied with the operation results and 7 patients were satisfied with the operation results. The overall satisfaction rate was 100%. Conclusion Knee 3 software can help to obtain good gap balancing and optimal lower limb alignment, with high patient’s satisfaction and good short-term effecectiveness.