【摘要】 目的通过对计算机导航辅助下人工全膝关节置换病例的随访,与传统手术病例进行比较,探讨导航辅助手术的优势与不足。方法自2006年1月~2011年1月,行计算机辅助人工全膝关节置换术的47例61膝(导航组),与随机抽取传统手术治疗的60例82膝(传统组)作对照。所有病例均为初次置换,术前内外翻畸形均<15°。对比两组手术时间、术后X线资料、软组织平衡变量、术后出血引流量、膝关节活动度、功能评分以及并发症等。全部病例随访时间6~72月,平均34个月。结果手术时间:导航组为80~120 min;传统组为65~100 min,有统计学差异(P<0.05)。髋膝踝经线(mFTA):导航组为(0.94±0.96)°,传统组(1.76±1.53)°,有统计学差异(P<0.05)。两组α、β、γ、δ及Q角,无显著差异(P>0.05),但导航组分布类似于标准正态分布,取值较为集中,极值范围小。软组织平衡角度变量:导航组为2°以内;传统组为2~4°,有统计学差异(P<0.05)。软组织平衡分离变量:导航组为2~4 mm;传统组为5~7 mm,有统计学差异(P<0.05)。术后24 h引流量:导航组为600~850 mL,传统组为550～800 mL,无显著差异(P>0.05)。术后6个月并发症发生率、膝关节活动度、KSS评分及OXFORD评分两组无显著差异(P>0.05)。结论红外计算机导航辅助下全膝关节置换能够提高截骨精确性,使假体位置安装更精确、软组织平衡更佳,同时降低了假体位置和下肢轴线偏差的风险,值得临床推广应用。更多还原

【Abstract】 Objective Through the visit to the patients of total knee replacement with infrared rays computer-navigation and compare it with traditional surgery,this paper explores the advantages and disadvantages of computer-navigation assisted surgery.Methods From January of 2006 to January of 2011,47 cases(61 joints)of total knee arthroplasty with computer-navigation(CAS Group)to compare with 61 cases(82 joints)which were extracted randomly from traditional surgical treatment(Traditional Group).All cases were for the initial replacement,both fully varus and extroversive deformity in pre-operation are less than 15 degrees.To compare the operation time,pre-operation X-ray materials,soft tissue balance variant,blood-loss,ranges of motion of joints,function evaluation and complications of the two groups.All cases were followed for 6~72 months,average of 34 months.Results The operation time: 80~120 min in CAS group and 65~100 min in traditional group,there is statistical significance(P<0.05).The machnical femoral axis to tibial axis angle(mFTA):(0.94±0.96) degrees in CAS group and(1.76±1.53) degrees in traditional group,there is statistical significance(P<0.05).There are no statistical significance of α、β、γ、δ and Q angle(P>0.5),but CAS group distribution looks like standard normal distribution,because its computing is concentrative and extremumc range is smaller.Soft tissue balance angle variable: 2 degrees in CAS group and 2~4 degrees in traditional group,there is statistical significance(P<0.05).Soft tissue balance variants for separation: 2~4 mm in CAS group and 5~7 mm in traditional group,there is statistical significance(P<0.05).24 hours flow after operation: 600~850 mL in CAS group and 550~800 mL in traditional group,there is no statistical significance(P>0.5).There are statistical significance for the 6 months after operation morbidity,range of motion of knee,KSS evaluation and OXFORD evaluation.Conclusion Total knee replacement with infrared rays computer-navigation can not only improve the accuracy for osteotomy surgery,keep the installment position of prosthesis accurate and the better soft tissue balance,but also reduce the risk of prosthesis position and lower limb axis deviations,it is worthy to be popularized in clinical applications.更多还原