便携式导航辅助全膝关节置换术的初步临床疗效

摘要

目的 探讨iASSIST便携式导航在全膝关节置换(total knee arthroplasty,TKA)术中的应用价值.方法 筛选2016年4月至2017年4月因膝关节骨关节炎接受初次单侧TKA手术的患者74例,其中iASSIST导航辅助TKA手术37例37膝(导航组),常规TKA手术37例37膝(常规组).比较两组术后6个月负重位X线片的下肢机械轴线(mechanical axis,MA)、股骨机械轴远端外侧角(mechanical lateral distal femoral angle,mLDFA)、胫骨机械轴近端内侧角(mechanical medial proximal tibial angle,mMPTA)、矢状面股骨组件角(sagittal femoral component angle,sFCA)、矢状面胫骨组件角(sagittal tibialcomponent angle,sTCA).记录手术时间、术中失血量、术后住院天数以及术后6、12、24周的西安大略麦克马斯特大学(Western Ontario and McMaster Universities,WOMAC)骨关节炎指数、膝关节协会评分(Knee Society Score,KSS)临床评分和功能评分.结果 导航组与常规组术后6个月MA分别为180.85°±0.88°与182.23°±1.09°、mLDFA分别为90.52°±0.78°与91.09°±0.96°、mMPTA分别为90.34°±1.25°与91.13°±1.46°,差异均有统计学意义(P＜0.05).导航组与常规组术后6周WOMAC指数分别为(58.54±1.45)分与(56.54±1.77)分、KSS临床评分分别为(53.14±1.13)分与(49.35±1.11)分、KSS功能评分分别为(61.24±1.30)分与(59.81±1.29)分,差异均有统计学意义(P＜0.05).导航组与常规组术后12周WOMAC指数分别为(43.54±1.19)分与(41.92±1.42)分、KSS临床评分分别为(67.11±1.51)分与(62.08±1.46)分、KSS功能评分分别为(68.14±1.11)分与(66.38±1.26)分,差异均有统计学意义(P＜0.05).导航组术中失血量(113.11±57.29) ml,常规组(147.57±68.77) ml,差异有统计学意义(P＜0.05).导航组手术时间、术后住院天数、术后24周WOMAC指数、KSS临床评分和功能评分与常规组比较差异均无统计学意义(P＞0.05).结论 iASSIST便携式导航辅助TKA能够恢复精准的下肢机械轴线,保证准确的假体植入位置,术后早期膝关节功能更好.%Objective To explore the application value of iASSIST portable navigation in total knee arthroplasty.Methods Seventy-four patients with knee osteoarthritis from April 2016 to April 2017 were retrospectively recruited.Thirty-seven patients (37 knees) underwent TKA with iASSIST navigation,while 37 patients (37 knees) underwent conventional TKA.Five parameters were measured on the weight-bearing radiographs at six months after TKA,including mechanical axis (MA),mechanical lateral distal femoral angle (mLDFA),mechanical medial proximal tibial angle (mMPTA),sagittal femoral component angle (sFCA) and sagittal tibial component angle (sTCA).Duration of operation,blood loss volume,postoperative hospital day,Western Ontario and McMaster Universities (WOMAC) osteoarthritis index,Knee Society Score (KSS) clinical score and functional score at 6 weeks,12 weeks and 24 weeks after surgery were also recorded.Results The accuracy of MA (180.85°±0.88° versus 182.23°±1.09° in the conventional group,P＜0.05),mLDFA (90.52° ±0.78° versus 91.09° ±0.96° in the conventional group,P＜0.05),and mMPTA (90.34°± 1.25° versus 91.13°± 1.46° in the conventional group,P＜0.05) was improved significantly in navigation group.The WOMAC osteoarthritis index at 6 weeks postoperatively in the navigation group and in the conventional group were 58.54±1.45 and 56.54± 1.77 respectively.The KSS clinical score in the navigation group and in the conventional group were 53.14± 1.13 and 49.35± 1.11 respectively.The KSS functional score in two groups were 61.24± 1.30 and 59.81 ± 1.29 respectively (P＜0.05).The WOMAC osteoarthritis index at 12 weeks postoperatively in the navigation group and in the conventional group were 43.54± 1.19 and 41.92± 1.42 respectively.At 12 weeks,the KSS clinical score in two groups were 67.11 ± 1.51 and 62.08± 1.46 respectively.The KSS functional score in two groups were 68.14±1.11 and 66.38±1.26 respectively (P＜0.05).The blood loss volume in the navigation group and in the conventional group were 113.11±57.29 ml and 147.57±68.77 ml respectively (P＜0.05).There were no significant difference in the duration of operation,postoperative hospital day,WOMAC osteoarthritis index,knee clinical score and functional score at 24 weeks postoperatively between two groups (P＞0.05).Conclusion More accurate restoration in mechanical axis and optimal implantation can be achieved with the help of iASSIST navigation.This navigation system can also achieve better knee function in the early stage after TKA.