计算机导航辅助下人工全膝关节置换术  

Preliminary clinical report of computer assisted imaging guided TKA

作　　者：冷重光[1] 赵江涛[1] 陈崇民[1] 李忠强[1] 张红娜[1] 赵阳[1] 

机构地区：[1]沈阳市骨科医院骨科,110044

出　　处：《中华骨科杂志》2006年第10期666-670,共5页Chinese Journal of Orthopaedics

摘　　要：目的通过分析计算机导航辅助下人工全膝关节置换术中定位与软组织平衡的辅助检测作用,与传统手术进行疗效差异的比较,探讨计算机导航辅助手术的安全性、可靠性及其优势与不足。方法自2004年10月至2005年10月行计算机辅助人工全膝关节置换术18例22膝(导航组),男7例8膝,女11例14膝;年龄35～74岁,平均67岁。导航组采用计算机辅助下行人工全膝关节置换手术。从2003年10月至2004年10月用传统手术的52例中随机抽取17例22膝(非导航组),男5例6膝,女12例16膝;年龄56～78岁,平均65岁。非导航组采用髓内定位杆(股骨)、髓外定位杆(胫骨)定位,常规手术行人工全膝关节置换。全部44膝均为初次置换,两组患者的原始疾病、年龄、HSS评分行配对t检验,差异无统计学意义(P>0.05)。对比两组术前、术后的力线、软组织平衡、并发症、出血量、手术时间及随访情况,进行统计学处理。结果全部病例随访3～12个月,平均10个月。导航组力线误差大多在2°～3°,非导航组3°～6°。软组织平衡角度变量导航组大多在2°以内,非导航组2°～4°;软组织平衡分离变量导航组大多在2～4mm,非导航组5～7mm。导航组出血量大多在550～700ml,非导航组700～900ml;导航组手术时间大多在75～100min,非导航组45～60min。经SPSS10.0统计软件处理,两组在术后力线、软组织平衡角度变量和分离变量、出血量、手术时间,其差异均有统计学意义(P<0.05)。结论计算机导航辅助人工全膝关节置换术,使假体的植入位置更为准确,术后下肢力线和软组织平衡更佳,并能减少出血量,早期疗效满意,但延长了手术时间。Objective To analyze the differences of clinical results between CAS and routine NCAS localization in TKA and to evaluate the safety and reliability of CAS in TKA in order to take advantages and avoid disadvantages of this new technology. Methods From October of 2004 to October of 2005, 18 cases （20 joints） of TKA in Group Ⅰ which were perform utilizing computer assisted imaging guidance system （CAS） and there were 7 males and 11 females with an average age of 67 years. From October of 2003 to October of 2004, 17 cases （22 joints） of TKA in Group Ⅱ which were performed with conventional method previously （NCAS） and there were 5 males and 12 females with an average age of 65 years （56-78）. The differences between two groups in clinical results, mechanical axes, soft-tissues balance, coincidence, blood loss, and operating time were statistically analyzed. Results All cases were followed for an average of 10 months （3-12）. The mechanical axes error was 2-3 degrees in CAS group and 3-6 degrees in NCAS group. Soft-tissues balance angle was within 2 degree in CAS group and 2-4 degrees in NCAS group. The distance variable was 2-4 mm in CAS group and 5-7 mm in NCAS group. The blood loss was 550-700 ml in CAS group and 700-900 ml in NCAS group. The surgery time was 75-100 min in CAS group and 45-60 min in NCAS group. There were statistically significant differences between two groups. There were no major complications such as fat embolism occurred in both groups. Conclusion Utilizing computer assisted imaging guidance in TKA can obtain reliable and sound clinical results with better mechanical axes and soft-tissues balance. It is a safe and reliable procedure in TKA.

关 键 词：关节成形术 置换 膝 外科手术 计算机辅助 治疗结果 

分 类 号：R687.4[医药卫生—骨科学]