3D打印技术在全膝关节置换术中的应用及对患者膝关节活动度、HSS评分、下肢力线的影响研究

目的:探讨3D打印技术在全膝关节置换术(TKA)中的应用及对患者膝关节活动度、HSS评分、下肢力线的影响。方法:TKA患者80例为研究对象,按电脑随机法分为观察组和对照组,各40例。对照组给予常规TKA术治疗,观察组则在TKA手术基础上以3D打印技术进行辅助治疗,对比两组手术指标、膝关节活动度、HSS评分和下肢力线变化情况。结果:观察组手术时间和术中出血量低于对照组(P<0.05);两组住院时间对比无统计学差异(P>0.05);两组术前1周膝关节活动度、下肢力线变化和膝关节HSS评分对比无统计学差异(P>0.05);术后1周两组膝关节活动度均有所提高且下肢力线降低(P<0.05);观察组术后1周膝关节活动度高于对照组且下肢力线低于对照组(P<0.05);术后1周和术后3个月两组HSS评分均有所提高且观察组HSS评分高于对照组(P<0.05);两组并发症发生率对比无统计学差异(P>0.05)。结论:将3D打印技术用于TKA术中可改善患者膝关节活动、下肢力线以及HSS评分且安全性高。     

基于快速成型及3D打印技术全膝关节置换术治疗双膝骨性关节炎临床研究

目的:比较基于快速成型及3D打印技术全膝关节置换(TKA)术与传统术式治疗双膝骨性关节炎的效果。方法:选取双膝骨性关节炎患者80例,按照手术方式差异分为观察组(48例)与对照组(32例)。观察组采用基于快速成型及3D打印技术的TKA术治疗。对照组采用传统术式治疗。比较两组围手术期指标(手术时间、失血量、术后48 h引流量)。比较两组手术前后膝关节活动度、膝关节功能(HSS)评分及力线[下肢机械轴夹角(HKA)和冠状位股骨远端机械轴外侧角(mLDFA)]。比较两组并发症发生情况。结果:两组失血量比较差异无统计学意义(P>0.05)。观察组手术时间明显短于对照组,术后48 h引流量明显少于对照组(均P<0.05)。术前,两组膝关节活动度、HSS评分、HKA、冠状位mLDFA比较差异无统计学意义(均P>0.05)。术后6周,观察组膝关节活动度、HSS评分显著高于对照组,HKA与冠状位mLDFA明显小于对照组(均P<0.05)。观察组并发症总发生率明显低于对照组(P<0.05)。结论:相较于传统术式,基于快速成型及3D打印技术TKA术能缩短手术时间,减少术后引流量...     

计算机导航技术在全膝关节置换中对下肢力线重建的作用

在人工全膝关节置换术中重建良好的下肢力线是手术成败的关键,传统手术在定位、截骨过程中多凭借医师的经验,易出现术后下肢力线的偏差,而计算机辅助导航全膝关节置换术后通过录入下肢的解剖标志,从而生成直接的线条图像,以指导术者更精确地截骨,从而确保下肢力线的准确性。在此就计算机导航技术和传统手术在重建下肢力线方面进行比较及总结,并对其优缺点和存在的争议进行阐述。     

股骨假体旋转力线与TKA术后疼痛相关性分析

目的：综述全膝关节置换术（TKA）股骨假体旋转力线与术后疼痛相关性,减少假体力线不良的术后并发症。方法：查阅近年TKA术中股骨假体旋转定力线基础及临床研究相关文献,进行综合分析。结果：股骨假体旋转力线不良可造成髌骨轨迹异常、屈曲间隙不稳和胫股假体剪切扭力增加,导致髌股关节综合症,假体磨损、松动、膝前疼痛等。结论：股骨假体旋转力线是全膝关节置换术的重要环节,是引发术后疼痛最主要的关节内因素。     

膝关节置换术后下肢力线和假体位置的测量方法及参考范围

全膝关节置换术(TKA)是一项成熟的可缓解和治疗终末期膝关节骨关节炎和类风湿关节炎的手段。TKA术后下肢力线的重建以及假体的位置均与患者术后的满意度、假体的长期生存率密切相关,也是决定其临床效果的重要因素和评价指标。临床可通过X线、二维CT(2D-CT)、三维CT(3D-CT)等影像学技术对TKA术后下肢力线和假体的位置进行测量和评估,但目前尚无公认的金标准。2D-CT测量较X线在分析假体位置或松动、假体周围骨吸收、骨折、感染等方面的敏感性更高,而3D-CT对于轴面旋转的测量具有独特优势。相信随着计算机导航和机器人辅助技术的发展,3D-CT测量会逐渐成为TKA术后常用的测量方法。     

3 D打印技术对全膝关节置换术患者围手术期临床指标及预后情况的影响分析

目的观察3D打印技术辅助全膝关节置换术(TKA)对膝关节病患者围手术期临床指标及预后情况的影响。方法该文为前瞻性研究,纳入2021年1月至2022年6月至信阳一五四医院接受TKA治疗的50例膝关节病患者为研究对象,基于抽签法,将患者均分为试验组和对照组,各25例,两组均接受TKA术治疗,试验组采用3D打印技术辅助手术,比较两组患者的围手术期临床指标、膝关节功能恢复情况及术后并发症发生情况。结果在不同治疗方案下,试验组的手术耗时及术中出血量均低于对照组(P<0.05);术前两组患者的膝关节功能、膝关节活动度及下肢力线近似(P>0.05);术后,试验组的膝关节活动度大于对照组,下肢力线角度小于对照组,美国膝关节协会综合评分(AKS)、膝关节功能Lysholm评分、膝关节IKDC主观症状评分均高于对照组,术后并发症发生率[8.00%(2/25)]低于对照组[20.00%(5/25)](P<0.05)。结论采用3D打印技术辅助TKA术可提高患者手术效率,对进一步改善患者膝关节功能及症状并降低术后并发症发生风险有积极作用。     

全膝关节置换术后下肢力线与膝关节功能及临床疗效的关系探究

目的:探讨全膝关节置换术(TKA)后下肢力线与膝关节功能及临床疗效的关系.方法:选取本院2017年2月～2019年10月96例膝关节炎行全膝关节置换手术患者,手术前后均测量股骨胫骨机械轴夹角(MFTA),以术后MFTA分为︱MFTA︱≤3°组(n=77例)以及︱MFTA︱>3°组(n=19例),并将︱MFTA︱≤3°组...     

人工全膝关节置换术中假体旋转力线定位的研究进展

人工全膝关节置换术后旋转力线对于患者术后功能和假体使用寿命十分重要。近年来,针对膝关节假体旋转力线的评估方法和手术技术在不断发展,特别是计算机导航辅助手术的应用,使得关节假体的旋转力线更为精确。本文就膝关节假体旋转力线的评估、旋转力线对术后功能的影响,以及计算机导航的最新应用进展做一综述。     

间接复位联合有限切开治疗Schatzker Ⅴ、Ⅵ型胫骨平台合并胫骨干骨折的疗效观察

目的探讨SchatzkerⅤ型、Ⅵ型胫骨平台合并胫骨干骨折的治疗方法及疗效。方法对18例SchatzkerⅤ型、Ⅵ型胫骨平台合并胫骨干骨折的患者,根据受伤机制选择合适的内固定方式,采用间接复位技术联合有限切开恢复下肢力线及关节面的平整,记录骨折愈合时间、膝关节活动度、HSS评分、下肢力线及关节面情况。结果获6~24个月随访,骨折全部愈合,临床愈合时间平均4.8个月。术后6个月膝关节屈曲平均118.6°,伸膝平均5.6°,HSS评分平均82.6分;均未发生二期平台塌陷;无膝关节机械轴对线不良。结论对于SchatzkerⅤ、Ⅵ型胫骨平台合并胫骨干骨折,根据受伤机制选择合适的内固定方式,采用间接复位技术联合有限切开,保证下肢力线良好的前提下尽量恢复关节面的平整,可取得满意疗效。     

计算机辅助下的全膝关节置换术早期疗效分析

目的：通过对计算机辅助下的全膝关节置换术与传统膝关节置换术在术后1年的近期疗效对比,探讨计算机辅助下的膝关节置换术的优势。方法2013年9月至2014年9月将60例患者分成两组,分别进行计算机辅助下的全膝关节置换术（导航组）和传统的全膝关节置换术（传统组）。并对每例患者进行术前、术后1年的KSS评分、WOMAC评分、Oxford评分、下肢全长X线片进行统计分析。结果患者随访时间12～14个月,平均12个月,导航组的下肢机械轴为—0.033o±1.470o,传统组的下肢机械轴为0.600o±2.989o;获得3o以内的内外翻力线的比例分别为86.70％和73.30％,术后 KSS 评分两组分别为（88.80±3.71）分和（82.63±4.15）分;WOMAC评分为（23.57±3.64）分和（30.00±4.89）分、Oxford评分为（18.53±3.66）分和（21.83±3.99）分,上述4项数据两组间差异均有统计学意义（ P＜0.05）。结论通过计算机辅助下的全膝关节置换术,可获得更精确的下肢力线,且临床康复效果更具有优势。     

全膝关节置换术研究进展

全膝关节置换术（TKA）在全世界每年都在快速增长,经过几十年的发展取得了很大进展。但是术后出现假体松动、伸屈和负重后出现畸形、疼痛等并发症,已经引起了广大骨科医生足够的重视。选择高质量的假体、设计个体化的假体和制定精确化的手术,成为骨科医生必须解决的问题。本文对近年来人工膝关节手术指征、假体、生物力学模型以及手术方式的演变进行阐述,并结合目前最新发展的技术对TKA未来发展的方向进行展望和预测。     

鸿鹄机器人辅助全膝关节置换的早期学习曲线

目的 回顾性分析鸿鹄骨科机器人辅助人工膝关节置换(TKA)的手术时间和影像学数据,探讨机器人辅助TKA的临床效果和学习曲线。方法 对同一手术组开展的25例机器人辅助TKA手术进行分析,将手术时间通过累积和分析法(CUSUM)进行分析,绘制机器人辅助TKA的学习曲线,根据学习曲线分为两个不同阶段,比较两个阶段的手术时间、出血量、住院天数、髋-膝-踝角等影像学数据和临床评分。结果 CUSUM分析结果显示,机器人辅助TKA的学习曲线最大转折点在第13例手术,基于此将学习曲线划分为学习提高阶段和熟练掌握阶段,两个阶段患者的一般资料、术后髋-膝-踝角等影像学数据、美国特种医院(HSS)评分、膝关节活动范围(ROM)和关节置换术后忘记评分(FSJ-12)差异无统计学意义(P>0.05),但熟练掌握阶段与学习提高阶段相比,整体手术时间减少23 min,空间摆位时间下降4.4 min,光学靶标安装下降5.0 min;在手术操作平均耗时上,定位下肢力线和关节面配准的时间分别降低2.9 min和5.2 min,机械臂截骨操作时间降低14.1 min。结论 利用CUSUM方法准确分析了机器人辅助TKA...     

The management of the patella in total knee arthroplasty

Total knee arthroplasty (TKA) is a well-established procedure, and has proven to be durable and effective for the treatment of advanced arthritis of the knee joint. Early TKAs did not include patellar replacement and anterior knee pain was reported after the procedure had been carried out. The incorporation of patellar resurfacing during TKA reduces anterior knee pain, although new complications have emerged. These complications include component failure, instability, fracture, tendon rupture and soft tissue impingement. Such complications are attributed to inferior implant design and improper surgical techniques. Fear of sustaining these complications has prohibited surgeons from routine patellar resurfacing during TKA. Whether or not to resurface the patella during primary TKA is still a controversial topic. There are authors who recommend routine resurfacing, some who do not recommend resurfacing and some who suggest selective resurfacing. The rationale for and against patellar resurfacing during primary TKA has been individually justified and reported in the literature. The selection of suitable implants and adherence to proper surgical technique are the fundamental principles for the success of TKA. Patella resurfacing during TKA is recommended when inflammatory arthritis, an eburnated articular surface and patellofemoral maltracking are present; patella preservation is recommended when there is a small patella, normal articular surface and normal patellar tracking. In long-term follow-up, 60% of nonresurfaced patellas continued to have good tracking after TKA. The correct choice of patellar component size, as well as implant design, medial placement of the patellar component, rule of no thumb and lateral retinaculum release when needed, should be adhered to when performing patellar resurfacing during TKA.     

针刀整体松解术配合手法治疗膝骨性关节炎临床研究

目的:观察针刀整体松解术配合手法治疗膝骨性关节炎的临床疗效。方法:将130例膝骨性关节炎患者随机分为观察组与对照组各65例。观察组采用针刀整体松解术配合手法治疗,对照组采用电针治疗,两组患者治疗前后进行X线检查,并观察膝关节角度、关节间隙及骨质增生的变化。结果:治疗后两组患者下肢力线、关节间隙及骨质增生指数均较治疗前改善,且差异有统计学意义(P0.05);与对照组治疗后比较,观察组改善更明显(P0.05)。结论:针刀整体松解术配合手法治疗膝骨性关节炎可以纠正下肢的力线,增大膝关节间隙,使骨质增生变小,疗效显著。     

Early experiences with robot-assisted total knee arthroplasty using the DigiMatch? ROBODOC? surgical system

INTRODUCTION

The use of robotics in total knee arthroplasty (TKA) has been shown to minimise human error, as well as improve the accuracy and precision of component implantation and mechanical axis alignment. The present study aimed to demonstrate that robot-assisted TKA using ROBODOC^® is safe and capable of producing a consistent and accurate postoperative mechanical axis.

METHODS

We prospectively recruited 27 consecutive patients who underwent robot-assisted TKA between May and December 2012. Two patients were excluded from the study due to intraoperative technical problems with the robot. Long-leg radiography and computed tomography were performed prior to surgery, and used for mechanical axis measurements and component sizing. DigiMatch™ ROBODOC^® Surgical System software version 4.3.6 (Curexo Technology Corp, Fremont, CA, USA) was used in all cases to perform bone cuts in accordance with the preoperative plan.

RESULTS

The postoperative coronal mechanical alignment was within 3 degrees, with a mean alignment of –0.4 ± 1.7 degrees, confirming the accuracy of the preoperative surgical plan and bone cuts. The mean operating time was 96 ± 15 min, and preoperative planning yielded 100% implant sizing accuracy.

CONCLUSION

Robotics has the potential to enable surgeons to consistently attain ideal postoperative alignment. The use of bone movement monitors and an integrated navigation system enhances the safety profile of ROBODOC^® by minimising errors. However, the role of the surgeon in TKA is still vital, as the surgeon is ultimately in charge of planning the surgery, its execution and ensuring soft tissue balance during TKA.     

Total knee arthroplasty using computer assisted navigation in patients with severe valgus deformity of the knee

Background Severe valgus deformity often has bone defect and laxity of the medial ligamentous, and total knee arthroplasty in severe valgus knee is, in most cases, more challenging for surgeons. The usefulness of a computer assisted navigation system in reestablishing the mechanical axis has been well established. Hence, the interest for surgeons is how the navigation system makes the procedure of total knee arthroplasty with severe valgus knee easier. Methods From June 2006 to March 2008 in Department of Joint Surgery, Shanghai Sixth People＇s Hospital, 6 patients （7 knees） with severe valgus knee underwent total knee arthroplasty using the Stryker Navigation system, which is an active wireless and imageless system. All the patients were followed up for 12 to 18 months after surgery. The X-ray radiographs for whole limbs were obtained on all patients to determine preoperative and postoperative alignments. Results A primary, posterior stabilized prosthesis was utilized in all cases. The average preoperative overall mechanical axis of the seven knees was 19.6°±4.6° of valgus （range 16°to 29°）, and the average postoperative mechanical axis was 0.4°±0.7° （range 0.8° varus to 1.4° valgus ）. Conclusions The navigation system is a very effective and useful tool for accurate intraoperative restoration of alignment in the face of significant deformity with valgus knee. To prevent component malposition, we did not reduce the knee before solidification of bone cement but controlled alignment using the navigation system up to implantation of the final component.     

Risk factors for lower limb swelling after primary total knee arthroplasty

Background  Total knee arthroplasty (TKA) is a successful surgical technique for patients with advanced knee osteoarthritis; however, some peri-operative complications can not be predicted or avoided completely. This study aimed to investigate the factors affecting limb swelling after primary total knee arthroplasty, to guide and improve patient rehabilitation.

Methods  Using a hospital database, we retroactively analyzed the mean changes in limb circumferences of 286 consecutive patients who underwent primary unilateral total knee arthroplasty between October 2007 and August 2009. The lower limb circumference change was calculated and analyzed statistically. The influence of age, gender, body mass index, the presence of deep vein thrombosis, methods of anti-coagulation, operation time, hidden blood loss, and type of prosthesis on post-operative lower limb swelling was studied.

Results  Swelling was most pronounced from the third to the fifth post-operative day and usually occurred in both lower limbs. Swelling was significantly more pronounced in the operated limb than in the non-operated limb. The swelling above the knee was also significantly greater than that below the knee. The change in limb circumference at 10 cm above the knee was significantly different between the patients with body mass index ≤25 kg/m² and those with body mass index >25 kg/m². However, the change in limb circumference at 10 cm below the knee was not significantly different between the two groups. There was no statistically significant difference in limb swelling between different age groups (P >0.05). Similarly, gender, methods of anti-coagulation, the presence of deep vein thrombosis, the type of prosthesis, and operation time did not significantly affect post-operative limb swelling. Multivariate linear regression showed that the factors affecting post-operative limb swelling were body mass index and hidden blood loss.

Conclusions  Lower limb swelling after total knee arthroplasty is related to early post-operative hidden blood loss. The patient’s hemoglobin level should be monitored. The degree of limb swelling is correlated with the patient’s body mass index and the amount of hidden blood loss. Early intramuscular deep vein thrombosis formation has little effect on limb swelling.

     

伤科活血方联合屈膝体位对全膝关节置换术后失血及功能康复的影响研究

[目的]探讨全膝关节置换术(TKA)患者口服伤科活血方联合应用60°屈膝位对于术后出血量、关节活动度及功能康复的影响.[方法]将90例初次行单侧TKA治疗的原发性退行性膝骨关节炎患者随机分为屈曲位联合伤科活血方组(Ⅰ组)、屈曲位组(Ⅱ组)和伸直位组(Ⅲ组),每组各30例.3组患者术后均向关节腔注射氨甲环酸并夹闭引流管2...     

中国人采用胫骨结节及胫前肌腱定位的髓外截骨法术后胫骨假体冠状位力线的测量与分析

目的：探讨在全膝关节置换术中,采用胫骨结节中内1/3及胫前肌腱定位、髓外系统进行截骨、术后胫骨假体在冠状位上的力线情况,并分析产生不良力线的原因。方法：回顾性分析2014年6月至12月间接受初次全膝关节置换术的188例患者的临床资料,共完成212个膝关节手术,均由同一手术工作组实施。胫骨侧截骨采用髓外定位方法,参考标志近端为胫骨结节中内1/3,远端为胫前肌腱。术前、术后2周在下肢全长片上测量下肢器械轴夹角和胫骨假体冠状位力线。结果：定义良好冠状位力线为胫骨假体平台连线中垂线同下肢机械轴夹角在±3°范围内,结果显示191个（90.1%）胫骨假体的力线良好。术后外翻截骨5个,内翻截骨16个。术前存在内翻畸形的196个膝关节中,术后17个（8.7%）存在假体不良力线;术前16个外翻膝中,4个术后有不良力线（25.0%）;卡方检验经校正后（χ2=2.778,P=0.096）无统计学相关性。术前内/外翻畸形大于20°的膝关节有22个,术前下肢机械轴和术后胫骨假体力线绝对值的中位数（最小值,最大值）分别为21.95°（20.00°,26.90°）和1.85°(0.10°, 7.10°),190个畸形小于20°膝关节术前下肢机械轴和术后胫骨假体力线绝对值的中位数（最小值,最大值）分别为10.65°（0.50°,19.80°）和1.10°（0.00°,4.60°）, 结果经秩和检验显示术前重度畸形同术后胫骨假体不良力线存在相关性（Z=2.11,P=0.035）。结论：在全膝关节置换术中,采用胫骨结节中内1/3和胫长肌肌腱为近/远端解剖标志,依靠髓外定位系统进行截骨,临床可行性高,多可取得满意的结果;本方法可能产生内翻截骨,且在重度畸形的患者中更易出现力线不良。     

基于力学理念的康复训练联合Ilizarov技术矫形对老年膝骨关节炎患者膝关节稳定性和下肢负重的影响

目的 探讨基于力学理念的康复训练联合Ilizarov技术矫形对老年膝骨关节炎患者膝关节功能、稳定性和下肢负重的影响。方法 回顾性研究唐山市第二医院骨伤科2019年12月至2021年6月收治的120例60岁以上膝骨关节炎患者临床资料,所有患者均按照治疗方法不同分为观察组和对照组,对照组接受Ilizarov技术矫形干预,观察组接受基于力学理念的康复训练联合Ilizarov技术矫形干预。测量并比较2组患者术前及术后不同时期（3个月、6个月、12个月）的膝关节功能[美国膝关节协会量表（KSS）评分、美国特种外科医院（HSS）膝关节功能系统评分、膝关节活动度（ROM）]、疼痛程度[疼痛视觉模拟评分（VAS）]、下肢负重位力学轴线[髋-膝-踝角（HKA）和胫股角（FTA）]。结果 2组患者术后3个月、6个月、12个月稳定性、活动度及总分维度等不同方面KSS评分均持续升高,疼痛、缺陷扣分等维度持续下降,且组间差异有统计学意义（P <0.05）。2组患者术后3个月、6个月、12个月膝关节ROM及HSS评分均持续升高,而VAS评分则持续下降,且组间差异有统计学意义（P <0.05）。2组患者...