计算机导航辅助与传统全膝关节置换术的影像学评价比较  

Imaging evaluation of computer-assisted total knee arthroplasty compared to the conventional one

作　　者：王德华 厉轲 张森 王子明 黄伟[1,2] WANG Dehua;LI Ke;ZHANG Sen;WANG Ziming;HUANG Wei(Department of Orthopaedics,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016;Orthopaedic Laboratory of Chongqing Medical University,Chongqing 400016;Joint and Limb Surgery,Army Specialty Medical Center,Chongqing 400042,China)

机构地区：[1]重庆医科大学附属第一医院骨科,重庆400016 [2]重庆医科大学骨科实验室,重庆400016 [3]陆军特色医学中心关节四肢外科,重庆400042

出　　处：《中华骨与关节外科杂志》2023年第4期317-324,共8页Chinese Journal of Bone and Joint Surgery

基　　金：重庆市科卫联合医学科研项目(2022DBXM002)。

摘　　要：目的:探讨计算机导航辅助全膝关节置换术(CAS-TKA)与传统全膝关节置换术(TKA)在下肢力线和假体位置上的差异。方法:回顾性分析2021年3月至2022年3月行TKA的96例患者资料,年龄50~80岁,平均(67.4±6.7)岁。根据手术方式分为CAS-TKA组(48例)和传统TKA组(48例),比较两组患者术前一般资料和下肢力线、手术时间、术中术后下肢力线及假体位置的差异。结果:两组患者年龄、性别、体重指数、手术侧别、术前髋膝踝角(HKA)、股骨远端外侧角(mLDFA)及胫骨近端内侧角(mMPTA)差异均无统计学意义(P>0.05)。CAS-TKA组手术时间较传统TKA组明显增加(P<0.05)。CAS-TKA组术中和术后下肢力线及冠状位假体位置差异无统计学意义(P>0.05)。术后CAS-TKA组的HKA、mLDFA与传统TKA组比较,差异无统计学意义(P>0.05);CAS-TKA组的mMPTA较传统TKA组更偏中性对齐,差异有统计学意义(P<0.05)。CAS-TKA组术后HKA内外翻超过3°的偏移率显著低于传统TKA组(P<0.05),mLDFA和mMPTA内外翻超过3°的偏移率亦低于传统TKA组,但差异无统计学意义(P>0.05)。两组股骨假体屈曲角及切迹发生率比较,差异无统计学意义(P>0.05),但胫骨后倾角较传统TKA组更接近理想值(P<0.05)。结论:CAS-TKA可以获得更好的下肢力线及假体位置,显著改善传统TKA带来的高离群效应。Objective:To investigate the differences of lower limb alignment and prosthesis position after total knee arthroplasty between computer-assisted surgical total knee arthroplasty(CAS-TKA)and TKA of the conventional method.Methods:A retrospective analysis was conducted on the data of 96 patients with a mean age of(67.4±6.7)years(range,50-80 years)who underwent TKA at two centers from March 2021 to March 2022.The patients were divided into the CAS-TKA group(48 patients)and the conventional TKA group(48 patients)according to the surgical procedure.The general information and lower limb alignment before surgery,the operative time,the differences in lower limb alignment and prosthesis position after surgery were compared between the two groups.Results:There were no statistical differences in age,gender,body mass index,side of surgery,preoperative hip-knee-ankle angle(HKA),lateral distal femoral angle(mLDFA)and medial proximal tibial angle(mMPTA)between the two groups.The operative time significantly increased in the CAS-TKA group compared to the conventional TKA group,with a statistically significant difference(P<0.05).No statistical difference was noted in the CAS-TKA group regarding intraoperative and postoperative lower limb alignment and coronal prosthesis position.The postoperative hip-knee-ankle angle and mechanical lateral distal femur angle in the CAS-TKA group were not statistically different from those in the conventional TKA group(P>0.05);the mechanical medial proximal tibia angle in the CAS-TKA group was more neutrally aligned than that in the conventional TKA group,and the difference was statistically significant(P<0.05).The deviation rate of HKA over 3°was significantly lower in CAS-TKA group than in conventional TKA group(P<0.05),and the deviation rate of mLDFA and mMPTA over 3°was also lower than that in conventional TKA group,but the difference was not statistically significant(P>0.05).The incidence of femoral prosthesis flexion angle and notching were not statistically different in the CAS-TKA grou

关 键 词：全膝关节置换术 计算机导航 传统器械 下肢力线 假体位置 

分 类 号：R687.4[医药卫生—骨科学]