CAJ | 학술논문

目的探讨运用软组织平衡导航系统实时定量观测膝内翻全膝关节置换术(TKA)内侧软组织松解的效果. 方法 2006年10月至2010年9月25例膝关节骨庆节炎伴膝内翻畸形患者接受软组织平衡导航TKA,其中男6例,女19例；年龄49～78岁,平均65岁.标准切骨后置入软组织平衡实时时导航系统,根据导航系统显示逐步进行内侧软组织松解.观察松解范围和内外侧软组织应力变化及临床随访效果. 结果本组患者手术时间平均为62 min(48～80min),术中出血量平均为320mL(100～500mL).所有患者术后随访12～54个月,平均36.4个月.随访期内无感染、松动等原因导致的翻修.膝关节HSS功能评分由术前( 53.4±12.8)分改善至术后(89.2±17.3)分,差异有统计学意义(t=17.411,P=0.000);下肢力线由术前内翻16.4°±10.0°纠正至术后内翻1.8°±2.1 °,差异有统计学意义(t=7.526,P=0.000).伸膝位和屈膝位软组织松解前、后的内外侧应力差值差异均有统计学意义(P＜0.05).单纯松解内侧副韧带后束时,伸膝位内外侧应力差值减少幅度(42.33％±20.88％)较屈膝位(12.33％±9.75％)明显,差异有统计学意义(t=6.714,P=0.000).松解MCL前束+后束时屈膝位内外侧应力差值减少幅度(59.42％±21.46％)较伸膝位(50.33％±18.82％)明显,差异有统计学意义(t=2.492,P=0.021). 结论在进行TKA时,软组织平衡实时导航系统能定量反映较组织松解时的张力变化和平衡状态,有助于提高手术精度.
목적 탐토운용연조직평형도항계통실시정량관측슬내번전슬관절치환술(TKA)내측연조직송해적효과. 방법 2006년10월지2010년9월25례슬관절골경절염반슬내번기형환자접수연조직평형도항TKA,기중남6례,녀19례；년령49～78세,평균65세.표준절골후치입연조직평형실시시도항계통,근거도항계통현시축보진행내측연조직송해.관찰송해범위화내외측연조직응력변화급림상수방효과. 결과 본조환자수술시간평균위62 min(48～80min),술중출혈량평균위320mL(100～500mL).소유환자술후수방12～54개월,평균36.4개월.수방기내무감염、송동등원인도치적번수.슬관절HSS공능평분유술전( 53.4±12.8)분개선지술후(89.2±17.3)분,차이유통계학의의(t=17.411,P=0.000);하지력선유술전내번16.4°±10.0°규정지술후내번1.8°±2.1 °,차이유통계학의의(t=7.526,P=0.000).신슬위화굴슬위연조직송해전、후적내외측응력차치차이균유통계학의의(P＜0.05).단순송해내측부인대후속시,신슬위내외측응력차치감소폭도(42.33％±20.88％)교굴슬위(12.33％±9.75％)명현,차이유통계학의의(t=6.714,P=0.000).송해MCL전속+후속시굴슬위내외측응력차치감소폭도(59.42％±21.46％)교신슬위(50.33％±18.82％)명현,차이유통계학의의(t=2.492,P=0.021). 결론 재진행TKA시,연조직평형실시도항계통능정량반영교조직송해시적장력변화화평형상태,유조우제고수술정도.
Objective To use soft-tissue balancing navigation for real-time quantitative observation of medial soft-tissue releasing in total knee arthroplasty (TKA) for the varus knee. Methods From October 2006 through September 2010,25 patients with knee osteoarthritis plus knee varus received TKA under soft-tissue balancing navigation.The soft-tissue balancing navigation system was used in the knee after routine bone cutting.The soft tissue stresses and balancing status observed and documented before and during the releasing under the guidance of the navigation system.Clinical outcomes were followed up. Results In this series,the mean operating time was 62 minutes (from 48 to 80 minutes) and the mean intraoperative blood loss was 320 mL ( from 100 to 500 mL).An average follow-up of 36.4 months (from 12 to 54 months)revealed no revision due to infection or loosening.The mean HSS scores were imuproved significantly from preoperative 53.4 ± 12.8 to 89.2 ± 17.3 at the last follow-up( t =17.411,P =0.000 ).The alignment of the lower limb decreased significantly from preoperative varus of 16.4°± 10.0° to postopcrative varus of 1.8° ± 2.1°(t=7.526,P=0.000).The differences in the medial and lateral stresses of the soft tissue at the knee extension and flexion were significant between pre-releasing and post-releasing ( P ＜ 0.05).In releasing the posterior portion of medial collateral ligament (MCL),the decreasc in medial and lateral stresses at the knee extension (42.33％ ± 20.88％ ) was significantly greater than that at the knee flexion ( 12.33％ ± 9.75％ ) ( t =6.714,P =0.000).In releasing both the anterior and posterior portions of MCL.the decrease in medial and lateral stresses at the knee extension (50.33％ ± 18.82％ ) was significantly smaller than that at the knee flexion (59.42％ ± 21.46％ ) ( t =2.492,p =0.021 ). Conclusion The soft-tissue balancing uavigation system is capable of real-time quantitative measurement of the soft tissue stress and balance in TKA for the varus knee.