计算机导航系统和3D打印截骨导板对全膝关节置换术失血量的影响  

Blood loss in total knee arthroplasty using computer-assisted navigation or 3D-printed patient-specific instruments

作　　者：李杨[1] 耿霄[1] 田华[1] 陶立元[2] Li Yang;Geng Xiao;Tian Hua;Tao Liyuan(Department of Orthopedics,Peking University Third Hospital,Beijing 100191,China;Research Center of Clinical Epidemiology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科,北京100191 [2]北京大学第三医院临床流行病学研究中心,北京100191

出　　处：《中华医学杂志》2020年第33期2601-2606,共6页National Medical Journal of China

基　　金：2016年北京大学第三医院临床重点项目——培育探索项目(BYSY2016010)。

摘　　要：目的分析在全膝关节置换术(TKA)中使用计算机导航(CAS)系统、3D打印个性化截骨导板(PSI)与传统手术器械(CI)在围手术期失血量上的差异。方法于2018年1至12月前瞻性连续纳入90例因膝关节骨性关节炎在北京大学第三医院骨科接受初次单侧TKA的患者,随机序列法分为3组(每组30例):CAS-TKA组、PSI-TKA组和CI-TKA组。记录并比较3组患者的术中失血量、总失血量、隐性失血量、血红蛋白(Hb)和血细胞比容(Hct)的下降值以及输血率的差异。3组间比较采用单因素方差分析,组间两两比较采用LSD法检验。结果所有患者的术中失血量中位数为6 ml(5~8 ml)。CAS-TKA组、PSI-TKA组、CI-TKA组的平均总失血量和隐性失血量分别为(1147.0±301.8)和(1140.1±301.9)ml、(1044.3±454.1)和(1038.5±454.0)ml、(1154.0±483.6)和(1145.3±482.7)ml,3组间差异均无统计学意义(F=0.639、0.616,均P>0.05)。所有患者在术后均未接受输血。3组患者在Hb和Hct下降值上的差异亦均无统计学意义(均P>0.05)。结论与传统手术器械相比,CAS和PSI并未增加TKA的总失血量,且两种技术均展现出减少TKA失血量的趋势。Objective To compare the perioperative blood loss in patients undergoing a total knee arthroplasty(TKA)across three different techniques:computer-assisted navigation surgery(CAS),patient specific instrumentation(PSI)and conventional instrumentation(CI).Methods Ninety consecutive patients with severe knee osteoarthritis who underwent unilateral primary TKA in Peking University Third Hospital Orthopedics Department from January 2018 to December 2018 were enrolled in this prospective study.The patients were randomly divided into three groups(30 case in each group):CAS-TKA group,PSI-TKA group and CI-TKA group.The study measured intraoperative blood loss,total blood loss,hidden blood loss,decreases of hemoglobin and hematocrit,and the post-TKA blood transfusions in the three groups.One-way ANOVA was used to detect the differences among the cohorts,and LSD was used for the post-hoc test.Results The overall intraoperative blood loss of all patients was 6 ml(5~8 ml).The mean total blood loss and hidden blood loss in CAS-TKA group,PSI-TKA group and CI-TKA group was(1147.0±301.8)and(1140.1±301.9)ml,(1044.3±454.1)and(1038.5±454.0)ml,(1154.0±483.6)and(1145.3±482.7)ml,respectively;there was no significant differences among the three groups(F=0.639,0.616,both P>0.05).There were no patients who received allogeneic blood transfusion.There were no significant differences in decrease of hemoglobin and hematocrit among the three groups neither(both P>0.05).Conclusions Compared with conventional TKA,CAS and PSI does not increase the total blood loss of TKA.However,they both demonstrate a potential benefit in reducing blood loss of TKA.

关 键 词：关节成形术 置换 膝 失血 3D打印 计算机导航辅助技术 个性化截骨导板 

分 类 号：R687.4[医药卫生—骨科学]