CAJ | 학술논문

目的探讨导航辅助技术在人工膝关节置换术中应用优势.方法 2007年8月至2008年5月天津市天津医院关节外科中心选择膝关节评分表(KSS)-A类患者60例(67膝),进行人工全膝关节置换术,应用导航辅助技术(导航组)19例22膝,平均年龄64.5岁.应用传统置换技术(非导航组)41例45膝,平均年龄66岁.全部67膝均为初次置换,两组患者术前一般资料、力线和关节活动功能差异均无统计学意义(均P＞1.05).比较两组患者手术时间、出血量及住院时间.术后3个月行膝关节X线检查,测量假体的摆放角度和下肢力线.术后1、3、6个月采用KSS评分标准行膝关节功能评价.结果导航组的手术时间平均88.6 min,非导航组平均为67.6 min(P ＜0.05);导航组出血量平均555.3 ml,非导航组647.6ml(P＜1.05);导航组平均住院7.74 d,非导航组平均住院8.68 d(P ＜0.05);导航组术后下肢力线平均外翻1.045°,非导航组平均外翻2.356°,导航组术后力线误差在±3°以内21例(95.5％),而非导航组术后力线误差在±3°以内36膝(80％).术后3个月以内,导航组KSS评分高于非导航组(P＜0.05);至术后6个月,导航组平均86.8分,非导航组84.3分,组间差异无统计学意义(P＞0.05).结论导航辅助技术可提高膝关节假体安放的准确性,术后功能恢复快,住院时间短,但术后6个月时KSS膝关节评分导航组并不占优势.
목적 탐토도항보조기술재인공슬관절치환술중응용우세.방법 2007년8월지2008년5월천진시천진의원관절외과중심선택슬관절평분표(KSS)-A류환자60례(67슬),진행인공전슬관절치환술,응용도항보조기술(도항조)19례22슬,평균년령64.5세.응용전통치환기술(비도항조)41례45슬,평균년령66세.전부67슬균위초차치환,량조환자술전일반자료、력선화관절활동공능차이균무통계학의의(균P＞1.05).비교량조환자수술시간、출혈량급주원시간.술후3개월행슬관절X선검사,측량가체적파방각도화하지력선.술후1、3、6개월채용KSS평분표준행슬관절공능평개.결과 도항조적수술시간평균88.6 min,비도항조평균위67.6 min(P ＜0.05);도항조출혈량평균555.3 ml,비도항조647.6ml(P＜1.05);도항조평균주원7.74 d,비도항조평균주원8.68 d(P ＜0.05);도항조술후하지력선평균외번1.045°,비도항조평균외번2.356°,도항조술후력선오차재±3°이내21례(95.5％),이비도항조술후력선오차재±3°이내36슬(80％).술후3개월이내,도항조KSS평분고우비도항조(P＜0.05);지술후6개월,도항조평균86.8분,비도항조84.3분,조간차이무통계학의의(P＞0.05).결론 도항보조기술가제고슬관절가체안방적준학성,술후공능회복쾌,주원시간단,단술후6개월시KSS슬관절평분도항조병불점우세.
Objective To assess the early postoperative clinical and radiographic outcomes after navigation-assisted or standard instrumentation total knee arthroplasty (TKA).Methods From August 2007 to May 2008,60 KSS-A type patients underwent 67 primary TKA operations by the same surgical team.Twenty-two operations were performed with the Image-free navigation system with an average age of 64.5 years while the remaining 45 underwent conventional manual procedures with an average age of 66 years.Their preoperative demographic and functional data had no statistical differences (P ＞0.05).The operative duration,blood loss volume and hospitalization days were compared for two groups.And radiographic data included coronal femoral component angle,coronal tibial component angle,sagittal femoral component angle,sagittal tibial component angle and coronal tibiofemoral angle after one month.And functional assessment scores were evaluated at 1,3 and 6 months postoperatively.Results Operative duration was significantly longer for computer navigation (P ＜ 0.05).The average blood loss volume was 555.26 ml in computer navigation group and 647.56 ml in conventional manual method group (P ＜ 0.05).And hospitalization stay was shorter in computer navigation group than that in conventional method group (7.74 vs 8.68 days) (P =0.04).The alignment deviation was better in computer-assisted group than that in conventional manual method group (P ＜ 0.05).The percentage of patients with a coronal tibiofemoral angle within ± 3 of ideal value was 95.45％ for computer-assisted mini-invasive TKA group and 80％ for conventional TKA group (P =0.003).The Knee Society Clinical Rating Score was higher in computer-assisted group than that in conventional manual method group at 1 and 3 montha post-operation.However,no statistical inter-group difference existed at 6 months post-operation.Conclusion Navigation allows a surgeon to precisely implant the components for TKA.And it offers faster functional recovery and shorter hospitalization stay.At 6 months post-operation,there is no statistical inter-group difference in KSS scores.