便携式导航与传统手术器械下的20例全膝关节置换术后早期疗效随访对比

doi:10.6040/j.issn.1671-7554.0.2021.1467

摘要/Abstract

摘要： 目的探讨一种新型基于加速度计原理便携式导航系统下的全膝关节置换术与传统手术器械下的全膝关节置换术的手术时间、下肢力线(髋膝踝角度偏差)、股骨远端外侧角、临床效果的差异。方法通过随访2018年5月至2018年12月于山东大学齐鲁医院骨科行全膝关节置换术患者20例,其中男5例、女15例,56~79岁,平均(67.85±6.53)岁,根据采用手术方式不同分为导航组和传统组,每组10例,10膝,比较两组患者的术前一般资料、手术时间、术后下肢力线、股骨远端外侧角、膝关节功能评分等参数的差异。结果两组平均随访时间为(39.58±1.86)个月,两组患者的性别、年龄、体质量指数、术前髋膝踝角角偏差值之间,差异均无统计学意义(P>0.05)。两组在手术时间［(111.50±12.70)min vs(109.00±15.42)min,t=0.40,P=0.70］、失血量［(644.56±231.40)mL vs(604.67±250.44)mL,t=0.37 P=0.72］、股骨远端外侧角［(89.50±0.80)°vs(89.62±1.34)°,t=-0.24,P=0.81］、髋-膝-踝角度偏差［(1.96±0.93)° vs(1.83±1.03)°,t=0.28, P=0.79］、KSS评分［(94.68±3.63)vs(87.54±10.01),t=2.01, P=0.07］等方面差异无统计学意义。两组患者手术后HKA角度偏差［导航组:(9.85±4.53)° vs(1.96±0.93)°,t=5.85, P<0.001;传统组:(8.83±4.14)° vs(1.84±1.03)°, t=5.40, P<0.001］、KSS评分［导航组:(47.22±22.34)vs(94.68±3.63),t=-6.14, P<0.001;传统组(47.22±20.17)vs(87.54±10.01),t=-8.19, P<0.001］均较术前有明显改善(P<0.05)。结论便携式导航与传统手术相比并不能显著改善下肢力线、减少术中失血量、提高膝关节KSS评分,但便携式导航操作方便,并不显著延长手术时间。

关键词: 关节置换, 便携式导航, 膝关节骨关节炎, 传统器械, 膝

Abstract: Objective To explore the differences in operation time, mechanical axis of the lower limb, mechanical lateral distal femoral angle(mlDFA)and functional outcomes between portable accelerometer-based navigation device(PAD)and conventional instrument in total knee arthroplasty(TKA). Methods A total of 20 patients undergoing TKA at our hospital during May 2018 and Dec. 2018 were involved, including 5 males and 15 females, aged 56-79 years, mean(67.85±6.53)years. Based on the different surgical methods, they were divided into the navigation group(n=10)and conventional group(n=10). The differences in preoperative general data, operation time, deviation of hip-knee-ankle(HKA)angle, mlDFA and Knee Society Scoring System(KSS score)were compared between the two groups. Results The mean follow-up was(39.58±1.86)months. There were no significant differences in gender, age, body mass index(BMI), KSS score and preoperative deviation of HKA angle between the PAD group and conventional group(P>0.05), no significant differences in mean operation time［(111.50±12.70)min vs(109.00±15.42)min, t=0.40, P=0.70］, total blood loss［(644.56±231.40)mL vs(604.67±250.44)mL, t=0.37, P=0.72］, mlDFA［(89.50±0.80)° vs(89.62±1.34)°, t=-0.24, P=0.81］, deviation of HKA angle［(1.96±0.93)° vs(1.83±1.03)°, t=0.28, P=0.79］, and KSS score［(94.68±3.63)vs(87.54±10.01), t=2.01, P=0.07］ between the two groups. After surgery, the deviation of HKA angle［navigation group:(9.85±4.53)° vs(1.96±0.93)°, t=5.85, P<0.001; conventional group(8.83±4.14)° vs(1.84±1.03)°, t=5.40, P<0.001］ and KSS score［navigation group:(47.22±22.34)vs(94.68±3.63), t=-6.14, P<0.001; conventional group:(47.22±20.17)vs(87.54±10.01), t=-8.19, P<0.001］ were significantly improved. Conclusion There are no significant differences between the navigation group and conventional group in terms of mechanical axis, total blood loss and functional outcomes of the knee. PAD has advantage of technical simplicity without prolonging the operation time.

Key words: Arthroplasty, Portable accelerometer-based navigation device, Osteoarthritis, Conventional instrument, Knee

中图分类号:

R684.3

马良,张元凯,姜淑伟. 便携式导航与传统手术器械下的20例全膝关节置换术后早期疗效随访对比[J]. 山东大学学报 (医学版), 2022, 60(6): 75-81.

MA Liang, ZHANG Yuankai, JIANG Shuwei. Comparison of portable accelerometer-based navigation versus conventional instrumentation for total knee arthroplasty in 20 patients: the outcomes at early follow-up[J]. Journal of Shandong University (Health Sciences), 2022, 60(6): 75-81.

参考文献

[1] 裴福兴. 中国髋、膝关节置换的现状及展望[J]. 中国骨与关节杂志, 2012, 1(1): 4-8. PEI Fuxing. The Current status and future perspective of hip and knee arthroplasty in China[J]. Chinese Journal of Bone and Joint, 2012, 1(1): 4-8.
[2] 边焱焱, 程开源, 常晓, 等. 2011至2019年中国人工髋膝关节置换手术量的初步统计与分析[J]. 中华骨科杂志, 2020, 40(21): 1453-1460. BIAN Yanyan, CHENG Kaiyuan, CHANG Xiao, et al. Reports and analysis of amount of hip and knee arthroplasty in China from 2011 to 2019[J]. Chinese Journal of Orthopaedics, 2020, 40(21): 1453-1460.
[3] 国家统计局, 国务院第七次全国人口普查领导小组办公室. 第七次全国人口普查公报(第五号): 人口年龄构成情况[J]. 中国统计, 2021(5): 10-11. National Bureau of Statistics of China, Office of the Leading Group of the State Council for the Seventh National Population Census. Communique of the seventh national population census(no.5): age composition[J]. China Statistics, 2021(5): 10-11.
[4] Vaidya NV, Deshpande AN, Panjwani T, et al. Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(2): 621-626.
[5] 孙厚义, 郑恺, 张韦成, 等. OrthoPilot计算机导航辅助全膝关节置换术的早期学习曲线[J]. 中华骨科杂志, 2021, 41(6): 350-358. SUN Houyi, ZHENG Kai, ZHANG Weicheng, et al. The early learning curve of OrthoPilot computer navigation assisted total knee arthroplasty[J]. Chinese Journal of Orthopaedics, 2021, 41(6): 350-358.
[6] Smith BR, Deakin AH, Baines J, et al. Computer navigated total knee arthroplasty: the learning curve[J]. Comput Aided Surg, 2010, 15(1/2/3): 40-48.
[7] Gross JB. Estimating allowable blood loss: corrected for dilution[J]. Anesthesiology, 1983, 58(3): 277-280.
[8] Bierbaum BE, Callaghan JJ, Galante JO, et al. An analysis of blood management in patients having a total hip or knee arthroplasty[J]. J Bone Joint Surg Am, 1999, 81(1): 2-10.
[9] Lotke PA, Faralli VJ, Orenstein EM, et al. Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion[J]. J Bone Joint Surg Am, 1991, 73(7): 1037-1040.
[10] 吴德胜, 邓仲豪, 陈宇皤, 等. 便携式导航辅助全膝关节置换术的初步临床疗效[J]. 中华骨科杂志, 2018, 38(17): 1036-1044. WU Desheng, DENG Zhonghao, CHEN Yupo, et al. Preliminary clinical effects of total knee arthroplasty with iASSIST navigation system[J]. Chinese Journal of Orthopaedics, 2018, 38(17): 1036-1044.
[11] 于清波, 鄂正康, 辛红伟, 等. 计算机导航下全膝关节置换术对术中出血量及关节功能恢复的影响[J]. 中国骨伤, 2020, 33(1): 15-20. YU Qingbo, E Zhengkang, XIN Hongwei, et al. Effect of total knee arthroplasty under computer navigation on intraoperative blood loss and joint function recovery[J]. China Journal of Orthopaedics and Traumatology, 2020, 33(1): 15-20.
[12] 邱冰, 唐本森, 邓必勇, 等. 基于三维反求技术和计算机辅助技术的3D打印导板在全膝关节置换术中的初步应用[J]. 中华创伤骨科杂志, 2016, 18(1): 35-41. QIU Bing, TANG Bensen, DENG Biyong, et al. Intelligentized surgery based on 3D printing technology for personalized total knee arthroplasty[J]. Chinese Journal of Orthopaedic Trauma, 2016, 18(1): 35-41.
[13] 周宗科, 翁习生, 孙天胜, 等. 中国骨科手术加速康复: 围术期血液管理专家共识[J]. 中华骨与关节外科杂志, 2017, 10(1): 1-7. ZHOU Zongke, WENG Xisheng, SUN Tiansheng, et al. Expert consensus in enhanced recovery after orthopedic surgery in China: perioperative blood management[J]. Chinese Journal of Bone and Joint Surgery, 2017, 10(1): 1-7.
[14] 曾伟南, 杨静, 沈彬, 等. 华西医院骨科关节置换术加速康复围手术期血液管理临床实践及成效[J]. 川北医学院学报, 2021, 36(9): 1175-1180. ZENG Weinan, YANG Jing, SHEN Bin, et al. Clinical practice and effect of perioperative blood management for enhanced recovery after surgery of the department of orthopedics of West China Hospital[J]. Journal of North Sichuan Medical College, 2021, 36(9): 1175-1180.
[15] Wang KP, Yuan WH, An JD, et al. Sealing the intramedullary femoral canal for blood loss in total knee arthroplasty: a meta-analysis of randomized controlled trials[J]. J Knee Surg, 2021, 34(2): 208-215.
[16] Kumar N, Saleh J, Gardiner E, et al. Plugging the intramedullary canal of the femur in total knee arthroplasty: reduction in postoperative blood loss[J]. J Arthroplasty, 2000, 15(7): 947-949.
[17] Li X, Qi XB, Han X, et al. Effects of sealing the intramedullary femoral canal in total knee arthroplasty: a randomized study[J]. Medicine(Baltimore), 2017, 96(29): e7388. doi:10.1097/MD.0000000000007388.
[18] 徐志宏, 陈东阳, 史冬泉, 等. 计算机导航下与传统人工全膝关节置换术的疗效比较[J]. 中国修复重建外科杂志, 2014, 28(9): 1066-1071. XU Zhihong, CHEN Dongyang, SHI Dongquan, et al. Comparison of total knee arthroplasty with computer navigation systems and conventional techniques[J]. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(9): 1066-1071.
[19] 王鑫光, 耿霄, 李杨, 等. 便携式导航与计算机导航辅助在全膝关节置换力线对准和手术时间的比较[J]. 北京大学学报(医学版), 2021, 53(4): 728-733. WANG Xinguang, GENG Xiao, LI Yang, et al. Comparison of alignment and operative time between portable accelerometer-based navigation device and computer assisted surgery in total knee arthroplasty[J]. Journal of Peking University(Health Sciences), 2021, 53(4): 728-733.
[20] Longstaff LM, Sloan K, Stamp N, et al. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function[J]. J Arthroplasty, 2009, 24(4): 570-578.
[21] Lording T, Lustig S, Neyret P. Coronal alignment after total knee arthroplasty[J]. EFORT Open Rev, 2016, 1(1): 12-17.
[22] Mielke RK, Clemens U, Jens JH, et al. Navigation in knee endoprosthesis implantation: preliminary experiences and prospective comparative study with conventional implantation technique[J]. Z Orthop Ihre Grenzgeb, 2001, 139(2): 109-116.
[23] Kinney MC, Cidambi KR, Severns DL, et al. Comparison of the iAssist handheld guidance system to conventional instruments for mechanical axis restoration in total knee arthroplasty[J]. J Arthroplasty, 2018, 33(1): 61-66.
[24] 魏辉, 杨述华, 刘先哲. 便携式计算机导航iASSIST技术在全膝关节置换术中的应用[J]. 中国骨与关节杂志, 2018, 7(4): 245-250. WEI Hui, YANG Shuhua, LIU Xianzhe. Application of computer-assisted navigation(iASSIST Technology)in total knee arthroplasty[J]. Chinese Journal of Bone and Joint, 2018, 7(4): 245-250.
[25] 杨国敬, 张力成, 李方才. 13例人工关节置换术并发脂肪栓塞综合征诊治分析[J]. 中华急诊医学杂志, 2005, 14(5): 432-433.
[26] 张毅敏, 梁国穗, 冯国培, 等. 扩髓对髓内压和肺部脂肪栓塞的影响[J]. 中华骨科杂志, 1999(8): 44-47. ZHANG Yimin, LIANG Guosui, FENG Guopei, et al. The effect of reaming on intramedullary pressure and pulmonary fat embolization[J]. Chinese Journal of Orthopaedics, 1999(8): 44-47.
[27] 赵佳琦, 季秀凤, 章建全, 等. 全膝关节置换术中经食管超声心动图实时监测脂肪栓子的应用价值[J]. 中华超声影像学杂志, 2010, 19(12): 1035-1038. ZHAO Jiaqi, JI Xiufeng, ZHANG Jianquan, et al. Dynamic monitoring of fat emboli on transesophageal echocardiogram during total knee arthroplasty[J]. Chinese Journal of Ultrasonography, 2010, 19(12): 1035-1038.

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