计算机导航系统辅助下全髋关节表面置换的初步经验

目的 初步评估计算机辅助下行全髋关节表面置换的手术方法及假体植入的精确性.方法 对40例患者分成导航组(20例)和对照组(20例),分别采用计算机导航系统辅助和标准常规技术完成全髋关节表面置换术.比较两组手术时间、术中失血量、Harris髋关节评分(HHS),以及髋臼杯外展角和前倾角的偏移度及股骨假体柄干角和前倾角的偏移度.结果 手术时间导航组较对照组长38.7min(P＜0.05),术中平均出血量导航组较对照组多109.4 ml(P＜0.05).随访平均14.5个月,HHS评分两组比较差异无统计学意义(P＞0.05).对照组髋臼杯外展角偏移度(7.3°±4.3°)大于导航组(1.9°±1.3°)(P＜0.05),对照组髋臼杯前倾角偏移度(3.9°±2.3°)大于导航组(2.4°±1.5°)(P＜0.05).导航组股骨假体柄干角偏移度(1.5°±1.0°)小于对照组(11.3°±1.3°)(P＜0.05),导航组股骨假体前倾角偏移度(1.8°±2.3°)小于对照组(6.5°±5.3°)(P＜0.05).结论 计算机导航系统辅助下行全髋关节表面置换术可以提高假体植入的精确性,避免股骨颈皮质骨切迹,降低股骨颈骨折的风险.

The application of computer-assisted navigation in the placement of component in total hip resurfacing arthroplasty

Objective To primarily evaluate the operative methods of total hip resurfacing arthroplasty and the accuracy of prosthesis implantation assisted by computer-assisted navigation system.Methods Forty patients scheduled for total hip resurfacing arthroplasty were randomly assigned to undergo either conventional implantation of Birmingham resurfacing prosthesis(control group)or computer-assisted implantation of such a prosthesis (computer-assisted group).The operative time,the operative blood loss and the Harris hip score (HHS)were compared between the control group and the computer-assisted group.The deviation between the ideal abduction angles and the actual angles of the implanted acetabular cup was calculated,as well as that deviation of the cup anteversion angles.The deviation between the neck shaft angle (NSA) and actual implanted short stem shaft angle (SSA)and that between the anteversion angle of femoral neck and the anteversion angle of actual implanted short stem were measured.These deviations were also compared between the control group and the computer-assisted group respectively.Results The operative time of the computer-assisted procedures was longer than that of the conventional procedures (P＜0.01).The operative blood loss in computer-assisted operations was 109.4ml(P＜0.05)more than that in conventional ones.No significant difference was detected with respect to the improvement of Harris hip score in a mean of 14.5 months follow-up.The deviation of the cup abduction angle and anteversion angle was significantly lesser in computer-assisted group than in control group (P＜0.05).The deviation of the femoral stem-shaft angle and anteversion angle were significantly lesser in computer-assisted group than in control group (P＜0.05).Conclusion This study has shown the accuracy of prosthesis positioning using a computer-assisted navigation in a prospective randomized controlled protocol.