个性化股骨远端截骨导向器与传统手术工具在微创入路膝关节置换术中的应用对比

摘要

目的 比较个性化股骨远端截骨导向器与传统手术工具在微创入路全膝关节置换术(minimally invasive total knee arthroplasty,MIS-TKA)中的应用.方法 选取2016年1月～12月入住我科拟行单侧人工全膝关节置换术的患者68例,随机分为个性化股骨远端截骨导向器组(个性化组)和传统手术组,每组各34例,记录并比较两组的止血时间,失血量,全下肢及股骨、胫骨假体力线,膝关节美国纽约特种外科医院(HSS)评分.结果 个性化截骨器组止血带时间比传统手术组止血带时间明显缩短(P=0.07);两组在失血量方面差异无统计学意义(P＞0.05).在冠状位力线上,两组术后股骨假体力线离群值差异有统计学意义(P=0.040),而全下肢力线及胫骨力线离群值两组之间差异无统计学意义(P＞0.05),但是传统手术组离群值仍比个性化截骨器组高.结论 个性化股骨远端截骨导向器可以明显缩短MIS-TKA手术时间,改善术后假体力线,而且该技术操作简单,缩短了学习曲线,对于经验不足的外科医生尤为适合,但仍需大样本量、长时间的随访研究来验证其远期效果.%Objective To compare the application of patient-specific distal femoral bone cutting guides and conventional instruments in minimally invasive total knee arthroplasty(MIS-TKA).Methods Sixty-eight patients undergoing unilateral total knee arthroplasty from January 2016 to December 2016 in our department were selected and randomly divided into two groups.In one group,patient-specific distal femoral bone cutting guides were used.In the second group,conventional instruments were used.The tourniquet time,blood loss,full lower limb and femoral,tibial component alignments,HSS score were recorded and compared.Results The tourniquet time in the patient-specific cutting guides group was significantly shorter than that in the conventional group(P=0.07).There was no significant difference in the blood loss between the two groups(P ＞ 0.05).In the coronal alignment,There was a statistically significant difference in femoral component outliers between the two groups(P=0.040).There was no significant difference in lower extremity and tibial prosthesis outliers(P＞0.05).However,However,the outliers in the conventional surgery group are still higher than those in the patient-specific cutting guides group.Conclusion The patient-specific distal femoral bone cutting guides can significantly shorten the MIS-TKA operation time,improve the postoperative prosthetic alignment,and the operation is simple.The technology shortens the learning period,is particularly suitable for inexperienced surgeons.However,large samples and long-term follow-up studies are needed to test their long-term effects.