计算机导航辅助技术和传统工具下全膝关节置换术后髌骨轨迹的放射学比较  

Comparison of the radiographic changes in patellar tracking after total knee arthroplasty between computer assisted imaging guidance system and conventional localization tools

作　　者：白波[1] 张树栋 

机构地区：[1]山东省烟台市滨州医学院(烟台校区),08级硕士研究生264001 [2]烟台山医院

出　　处：《中华关节外科杂志（电子版）》2011年第3期27-31,共5页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：山东省科技攻关项目(2008143-3)

摘　　要：目的对比分析计算机导航辅助人工全膝关节置换术(TKA)与传统手术术后髌骨的轨迹,探讨是否单纯通过此项技术能改善髌骨轨迹和减少膝前痛。方法自2008年1月至2009年12月,导航组采用计算机辅助下行TKA手术41例47膝,男19例22膝,女22例25膝,年龄61～82岁,平均年龄69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TKA。传统手术的44例患者中48膝,男20例23膝,女24例25膝,年龄66～79岁,平均年龄73岁。全部85例患者均为初次TKA手术,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、术后的髌骨倾斜角、髌骨外移度及患者膝前痛发生率,进行统计学处理。结果对全部患者进行6～12个月的回访,导航组术后髌骨外侧倾斜角(4.2°±3.9°),传统手术组为(5.1°±3.4°);导航组术后髌骨外移度(1.9±0.2)mm,传统组为(2.7±0.4)mm;导航组手术前后患者膝前痛发生率分别为83%、11%,传统手术组分别为88%、23%。经SPSS13.0统计软件处理,两组在术后髌骨倾斜角、髌骨外移度、膝前痛的发生率间的差异均有统计学意义(P<0.05)。结论计算机导航辅助TKA与传统手术相比,能够使截骨更加精确,术后下肢力线更佳,进一步获得更满意的髌骨轨迹,膝前痛改善的比率导航组与传统手术组间的差异有统计学意义。Objective To analyze differences of the patella tracking between computer assisted imaging guidance system （ CAS ） and routine non-computer assisted imaging guidance system （ NCAS ） localization after total knee arthroplasty （TKA） and to find out if the computer-navigation can improve the patellar tracking and reduce the incidence of anterior knee pain. Methods From January 2008 to December 2009, 41 cases with 47 knees （19 males, 22 joints; 22 femals, 25 joints） underwent TKA by CAS and the age averaged 69 years （ranging from 61 to 82 years）. 44 cases with 48 knees （20 males, 23 joints; 24 females, 25 joints） underwent TKA using conventional method previously （NCAS） and the age averaged 73 years （ranging from 66 to 79 years ）. The patellar tilt angle （PTA）, the lateral patellar displacement （LPD） and the incidence of anterior knee pain （AKP） were statistically analyzed before and after operation. Results All cases were followed up for 6 - 12 months. PTA was （4. 2°± 3.9°） in CAS group and （5.1° ± 3.4° ） in NCAS group. LPD was （ 1.9 ± 0. 2） mm in CAS group and （2.7 ± 0.4 ）mm in NCAS group. The incidences of AKP before and after operation in CAS group were 83% and 11% respectively, while in NCAS group were 88% and 23% respectively. There were statistically significant differences between the two groups. Conclusions Application of computer assisted imaging guidance in TKA can obtain accurate resection and it can also reduce the incidence of AKP effectively.

关 键 词：关节成形术 置换 膝 治疗 计算机辅助 髌骨 

分 类 号：R687.4[医药卫生—骨科学]