iASSIST智能导航系统与三维打印个性化膝关节截骨导板技术在人工全膝关节置换术中的应用效果比较

摘要

目的 比较iASSIST智能导航辅助人工全膝关节置换(iASSIST-TKA)与三维(3D)打印个性化膝关节导板辅助人工全膝关节置换(PSI-TKA)的应用效果.方法 收集2016年4月至9月南京医科大学附属南京医院骨科采用全膝关节置换术(TKA)治疗的47例膝关节骨关节炎患者的临床资料,男性20例,女性27例,年龄57~77岁,平均(63.8±8.2)岁.采用电脑随机分组,iASSIST-TKA组23例,PSI-TKA组24例.比较两组患者术后冠状面髋-膝-踝(HKA)角、冠状面股骨组件(FFC)角、冠状面胫骨组件(FTC)角、矢状面股骨组件屈曲(LFC)角、矢状面胫骨组件(LTC)角的偏移值;比较两组的手术时间、术中出血量、术后引流量和住院时间;比较两组患者术后1 d、7 d、14 d、1个月、3个月的视觉模拟评分(VAS)与膝关节评分(KSS).计量资料组间比较采用t检验,计数资料组间比较采用Fisher确切概率法或χ2检验,配对设计差值及等级资料采用秩和检验.结果 两组患者术后HKA角、FFC角、FTC角、LFC角、LTC角的偏移值均<3°(-2°~2°),两组间各测量角的偏移值差异无统计学意义(Z=-0.610~0.000,P=0.542~1.000).与PSI-TKA组相比,iASSIST-TKA组手术时间长[(80.7±8.8)min比(60.2±7.8)min]、引流量多[(210.7±32.1)ml比(185.5±30.2)ml]、平均住院时间短[(5.4±2.4)d比(6.7±1.6)d],差异均有统计学意义(t=-2.190~8.460,P=0.000~0.033);iASSIST-TKA组和PSI-TKA组术中出血量[(18.4±5.4)ml比(17.3±6.2)ml]相比差异无统计学意义(t=0.650,P=0.521).与iASSIST-TKA组相比,PSI-TKA组术后1 d、7 d的VAS降低(4.8±0.6比5.5±0.9、3.6±0.8比4.3±0.9),KSS临床评分(49.3±5.5比44.2±6.4、54.9±4.0比50.8±4.2)和功能评分(44.1±2.9比41.2±3.5、49.6±3.8比46.6±3.2)均增加,差异均有统计学意义(t=-3.420~3.150,P=0.001~0.007);术后14 d、1个月、3个月的VAS及KSS评分差异无统计学意义(t=-1.390~0.530,P=0.170~1.000).结论 采用iASSIST-TKA及PSI-TKA治疗膝关节骨关节炎的手术精度均较好,采用iASSIST-TKA的患者手术时间较长,术后早期恢复慢于采用PSI-TKA的患者,而采用PSI-TKA的患者住院时间更长.%Objective To compare the application of iASSIST assisted total knee arthroplasty (TKA) and three-dimentional(3D) printing personal specific instrument (PSI) assist TKA in the treatment of osteoarthritis (OA).Methods Clinical data of 47 patients with OA admitted at Department of Orthopaedic Surgery in Nanjing Medical University Nanjing Hospital between April and September 2016 were retrospectively reviewed, including 20 males and 27 females, aging from 57 to 77 years with mean age of (63.8±8.2) years.They were randomly divided into iASSIST-TKA group (23 patients) and PSI-TKA group (24 patients).The data such as hip knee ankle (HKA) angle, frontal femoral component (FFC) angle, frontal tibial component (FTC) angle, lateral femoral component (LFC) angle, lateral tibial component (LTC) angle, time of operation, post-operative wound drainage, period of hospitalization, visual analog scale (VAS) and Knee Society Score (KSS) at 1 day, 7 days, 14 days, 1 month and 3 months were recorded and compared between the two groups.T test was used to compare measurement data, Fisher exact test and χ2 test were applied to enumeration data in comparison among groups, and Kruskal-Wallis test was applied to ranked data.Results The deviation values of HKA, FFC, LFC, FTC and LTC angles were all below 3°(-2° to 2°), and there were no significant difference between iASSIST-TKA group and PSI-TKA group (Z=-0.610 to 0.000,P=0.542 to 1.000).Compared to PSI-TKA group, the time of operation was long((80.7±8.8) minutes vs.(60.2±7.8) minutes), the amount of post-operative wound drainage was increased((210.7±32.1) ml vs.(185.5±30.2)ml) and the period of hospitalization decreased((5.4±2.4) d vs.(6.7±1.6) d) in iASSIST-TKA group, there were significant difference(t=-2.190 to 8.460,P=0.000 to 0.033).There were no significant difference in intra-operative blood drainage((18.4±5.4) ml vs.(17.3±6.2) ml) between the two groups(t=0.650,P=0.521).PSI-TKA group had a superior VAS score(4.8±0.6 vs.5.5±0.9, 3.6±0.8 vs.4.3±0.9), KSS clinical score(49.3±5.5 vs.44.2±6.4, 54.9±4.0 vs.50.8±4.2) and KSS function score(44.1±2.9 vs.41.2±3.5, 49.6±3.8 vs.46.6±3.2) in 1 day and 7 days post-operation(t=-3.420 to 3.150,P=0.001 to 0.007).There were no significant difference in VAS and KSS score in 14 days, 1 month and 3 months post-operation(t=-1.390 to 0.530,P=0.170 to 1.000) between the two groups.Conclusions The iASSIST-TKA and PSI-TKA can help to make TKA procedure more accurately.iASSIST-TKA may take longer time of operation and have slower recovery, PSI-TKA may need more X-ray input and longer period of hospitalization.The long-term research of both techniques may be valuable for the further clinical usage.