CAJ | 학술논문

目的回顾性分析计算机导航定位和软组织平衡辅助与传统髓内、外定位人工膝关节表面置换术的术后疗效,探讨计算机导航定位在关节外科手术中的安全性、可行性及有效性.方法自2004年10月至2007年9月应用计算机导航定位与软组织平衡辅助行人工膝关节置换术77例107膝,男9例12膝,女68例95膝;年龄35～78岁,平均68岁.骨关节炎86膝,类风湿关节炎12膝,强直性脊柱炎8膝,化脓性关节炎致膝关节骨性强直1膝.同期行传统髓内、外定位人工膝关节表面置换术81例107膝,两组患者的原始疾病、年龄、HSS术前评分无统计学差异.比较两组术后力线、软组织平衡、并发症、膝平均出血量、膝平均手术时间.结果手术切口均一期甲级愈合.术后2周膝关节活动度68°～110°,平均93°.全部病例随访3～25个月,平均16个月.导航组下肢力线误差、软组织平衡关节线角度变量、关节间隙距离分离变量都小于非导航组.导航组术中术后出血量(779.354±81.712)ml,与非导航组(786.612±82.764)ml比较差异无统计学意义;手术时间(83.643±12.235)min,与非导航组(64.844±11.281)min比较差异有统计学意义(P＜0.05).术后2周导航组HSS改良评分(93±5.6)分,与非导航组(82±4.7)分比较差异有统计学意义(P＜0.05).两组均未发生脂肪栓塞和下肢深静脉血栓,各有1例感染.结论计算机导航技术用于膝关节表面置换,假体植入更精确,术后下肢力线和软组织平衡恢复更好.手术时间延长,但未增加出血量和感染的发生.
목적 회고성분석계산궤도항정위화연조직평형보조여전통수내、외정위인공슬관절표면치환술적술후료효,탐토계산궤도항정위재관절외과수술중적안전성、가행성급유효성.방법 자2004년10월지2007년9월응용계산궤도항정위여연조직평형보조행인공슬관절치환술77례107슬,남9례12슬,녀68례95슬;년령35～78세,평균68세.골관절염86슬,류풍습관절염12슬,강직성척주염8슬,화농성관절염치슬관절골성강직1슬.동기행전통수내、외정위인공슬관절표면치환술81례107슬,량조환자적원시질병、년령、HSS술전평분무통계학차이.비교량조술후력선、연조직평형、병발증、슬평균출혈량、슬평균수술시간.결과 수술절구균일기갑급유합.술후2주슬관절활동도68°～110°,평균93°.전부병례수방3～25개월,평균16개월.도항조하지력선오차、연조직평형관절선각도변량、관절간극거리분리변량도소우비도항조.도항조술중술후출혈량(779.354±81.712)ml,여비도항조(786.612±82.764)ml비교차이무통계학의의;수술시간(83.643±12.235)min,여비도항조(64.844±11.281)min비교차이유통계학의의(P＜0.05).술후2주도항조HSS개량평분(93±5.6)분,여비도항조(82±4.7)분비교차이유통계학의의(P＜0.05).량조균미발생지방전새화하지심정맥혈전,각유1례감염.결론 계산궤도항기술용우슬관절표면치환,가체식입경정학,술후하지력선화연조직평형회복경호.수술시간연장,단미증가출혈량화감염적발생.
Objective To analyze the difference of curative effect between computer assisted navigation and conventional total knee arthroplasty in bone cut and soft tissue balance,and discuss the security,feasibility and validity of computer assisted navigation system.Methods From October 2004 to September 2007,77 patients(107 knees,group I)were undergone computer assisted navigation TKA in both bone cut and soft tissue balance,which included 9 males(12 knees)and 68 females(95 knees),with the mean age of 68 years(ranging from 35 to 78 years).81.cases(107 knees)undergone conventional TKA were set up control group(Group Ⅱ).There were no significant differences in initial disease,age and pre-operation HSS score between the two groups.To compare the mechanical axes,soft-tissue balance,combine fat embolism and DVT,bleeding,and operating time after operation in two groups.Results All cases were followed up for 3 to 25 months,with the average 16 months.The mechanical axes error,soft-tissues balance error in angle and distance variable were less in Group Ⅰ than those in group Ⅱ.There Was no significant difference in the bleeding between two groups.and the operating time was significant longer in group Ⅰ.After 2 weeks operation,the HSS score in group Ⅰ(93±5.6)wag significant greater than that in group Ⅱ(82±4.7).No fat embolism and DVT Was found in all cases.Each group has 1.case infection.Conclusion Computer a ssisted navigation TKA can get precise position,better mechanical axes,soft-tissues balance in the artificial joint.