计算机导航人工膝关节置换术的临床结果

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.

Clinical outcome of 77 patients in computer assisted navigation total knee arthroplasty

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.