CAJ | 학술논문

目的通过比较和评价电磁导航辅助全膝关节置换术(total knee arthroplasty,TKA)中导航与X线测定的下肢力线和位置的差异和一致性,确定导航系统是否可以作为X线评估的替代工具来评估TKA术前、术后的下肢力线和假体位置. 方法对2006年7月-2006年12月电磁导航辅助初次TKA的患者40例61膝进行前瞻性研究,其中男4例,女36例;年龄58 ～ 79岁[(66.9±8.1)岁].术中记录导航确定的术前和术后下肢机械轴线角、股骨远端和胫骨近端截骨在冠状面的倾斜角(导航α和β角).采用组内相关系数法(intraclass correlation corefficient,ICC)分析两种方法测定同一评估指标结果的一致性;导航数据与术前、术后3个月下肢全长X线片上测得的机械轴线角,股骨、胫骨假体冠状面的倾斜角(X线a和β角)相比较. 结果导航确定的术前下肢机械轴线角平均+9.60°,X线测量为平均+9.99°.导航确定的术后下肢机械轴线角平均+1.23°,X线测量为平均+1.64°.采用非参数检验,两项指标两组差异均无统计学意义.导航和X线测定的α角分别为平均89.98°和88.96°(P＜0.05).导航和X线测定的β角分别为平均90.21°和89.59°(P＜0.05).术前和术后下肢机械轴线角、α和β角偏差值在3°范围内的ICC系数分别为0.887,0.754,0.632,0.640. 结论在可接受的偏差范围内,术中导航的评估数据可以反映X线评估的术前、术后下肢力线和假体位置.但两者保持一致性方面的优势在于对术前和术后下肢力线的评估上.
목적 통과비교화평개전자도항보조전슬관절치환술(total knee arthroplasty,TKA)중도항여X선측정적하지력선화위치적차이화일치성,학정도항계통시부가이작위X선평고적체대공구래평고TKA술전、술후적하지력선화가체위치. 방법 대2006년7월-2006년12월전자도항보조초차TKA적환자40례61슬진행전첨성연구,기중남4례,녀36례;년령58 ～ 79세[(66.9±8.1)세].술중기록도항학정적술전화술후하지궤계축선각、고골원단화경골근단절골재관상면적경사각(도항α화β각).채용조내상관계수법(intraclass correlation corefficient,ICC)분석량충방법측정동일평고지표결과적일치성;도항수거여술전、술후3개월하지전장X선편상측득적궤계축선각,고골、경골가체관상면적경사각(X선a화β각)상비교. 결과 도항학정적술전하지궤계축선각평균+9.60°,X선측량위평균+9.99°.도항학정적술후하지궤계축선각평균+1.23°,X선측량위평균+1.64°.채용비삼수검험,량항지표량조차이균무통계학의의.도항화X선측정적α각분별위평균89.98°화88.96°(P＜0.05).도항화X선측정적β각분별위평균90.21°화89.59°(P＜0.05).술전화술후하지궤계축선각、α화β각편차치재3°범위내적ICC계수분별위0.887,0.754,0.632,0.640. 결론 재가접수적편차범위내,술중도항적평고수거가이반영X선평고적술전、술후하지력선화가체위치.단량자보지일치성방면적우세재우대술전화술후하지력선적평고상.
Objective To compare the discrepancy and consistency in mechanical axis and component position measured by electromagnetic navigation and radiograph in total knee arthroplasty (TKA)to assess whether the navigation system can be used as a substitute for radiograph.Methods A perspective study was performed on 40 cases (61 knees) undergone primary TKA under electromagnetic navigation from July 2006 to December 2006.There were 4 males and 36 females,at a mean age of (66.9 ±8.1) years (range,58-79 years).Mechanical axis angle,distal femoral and proximal tibial cut slope in coronal view (angles cα,β) were recorded both pre-and post-operatively with an intraoperative navigation system and compared against the mechanical axis angle,coronal femoral and tibial slope (angles α,β)measured via full-length radiograph of the lower limb preoperatively and at postoperative 3 months.Consistency in measurement of the same parameters with the two methods was assessed using intraclass coefficiency correlation (ICC).Results Mechanical axis determined by navigation and radiograph showed a mean valgus angle of 9.60° and 9.99° preoperatively and of 1.23° and 1.64° postoperatively,but the two pair parameters revealed no significant differences in the non-parametric test.Mean angle α determined by navigation and radiograph was 89.98° and 88.96° respectively (P ＜ 0.05),and mean angleβ was 90.21 ° and 89.59°respectively (P ＜ 0.05).With deviation value ≤3°,ICC for pre-and post-operative mechanical axis angles,angle α and angleβ was 0.887,0.754,0.632,0.640 respectively.Conclusions Within the acceptable range of deviation,intraoperative navigation data can reflect the pre-and post-operative mechanical axis and prosthesis position evaluated by radiograph.However,the advantages over the consistency of the two measurement methods rest with the evaluation of pre-and post-operative mechanical