[1]赵云超,李晓明,王恒俊,等.计算机导航全膝关节置换术与传统全膝关节置换术的短期疗效观察[J].中国中医骨伤科杂志,2024,32(02):25-31.[doi:10.20085/j.cnki.issn1005-0205.240205]
　ZHAO Yunchao LI Xiaoming WANG Hengjun ZHOU Hao GUO Donghui ZHOU Tingting DU Changyu.Short Term Efficacy of Computer Guided Total Knee Arthroplasty and Traditional Total Knee Arthroplasty[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(02):25-31.[doi:10.20085/j.cnki.issn1005-0205.240205]
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计算机导航全膝关节置换术与传统全膝关节置换术的短期疗效观察()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年02期
页码:
25-31
栏目:
临床研究
出版日期:
2024-02-15

文章信息/Info

Title:
Short Term Efficacy of Computer Guided Total Knee Arthroplasty and Traditional Total Knee Arthroplasty
文章编号:
1005-0205(2024)02-0025-07
作者:
赵云超1; 2; 李晓明1; 2; 王恒俊1; 周浩1△; 郭东辉1; 周婷婷1; 2; 杜长宇3
1河北省沧州中西医结合医院(河北 沧州,061000); 2河北省中西医结合骨关节病研究重点实验室(筹); 3华北理工大学
Author(s):
ZHAO Yunchao1; 2 LI Xiaoming1; 2 WANG Hengjun1 ZHOU Hao1△ GUO Donghui1 ZHOU Tingting1; 2 DU Changyu3
1Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province,Cangzhou 061000,Hebei China; 2Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research(Preparing),Cangzhou 061000,Hebei China; 3North China University of Science and Technology,Tangshan 063000,Hebei China.
关键词:
计算机导航全膝关节置换术;  短期疗效;  假体角度;  力线;  膝关节功能;  关节活动度
Keywords:
computer guided total knee arthroplasty;  short-term efficacy;  prosthesis angle;  force line;  knee joint function;  joint mobility
分类号:
R687.4
DOI:
10.20085/j.cnki.issn1005-0205.240205
文献标志码:
A
摘要:
目的:比较计算机导航系统(Knee3软件,Brainlab公司,德国)全膝关节置换术与传统全膝关节置换术的短期疗效。方法:回顾性研究2020年12月至2022年5月就诊的124例全膝关节置换术患者,随访时间为3个月,全部获得随访。其中传统全膝关节置换术患者63例,计算机辅助导航全膝关节置换术患者61例。记录术前资料,包括性别、年龄、体重指数、血红蛋白浓度(HGB)、髋-膝-踝角、关节活动度、疼痛视觉模拟量表(VAS)评分、牛津膝关节功能评分。记录术中资料,包括麻醉方式、手术时间与术中出血量。记录术后资料,包括血红蛋白浓度、手术并发症VAS评分、膝关节影像学假体角度(α,β,γ,σ)、髋-膝-踝角、关节活动范围及牛津膝关节功能评分。结果:手术时间传统组为(1.62±0.40)h,导航组为(1.97±0.52)h,差异有统计学意义(P<0.05); 出血量传统组为(150.32±60.69)mL,导航组为(128.85±57.01)mL,差异有统计学意义(P<0.05); 术后第3天VAS评分传统组为(3.63±0.73)分,导航组为(2.98±0.98)分,差异有统计学意义(P<0.05); 出院前传统组血红蛋白浓度为(103.44±11.89)g/L,导航组为(108.82±9.38)g/L,差异有统计学意义(P<0.05)。术后3个月随访,α,β,γ,σ,髋-膝-踝角、关节活动范围及牛津膝关节功能评分两组差异有统计学意义(P<0.05)。结论:计算机导航辅助全膝关节置换术降低了术后早期疼痛,减少术中出血量,减轻术后贫血程度,提高假体角度与下肢力线的精准度,但对短期的关节活动度与膝关节功能的改善无明显优势。
Abstract:
Objective:To retrospectively study the short-term efficacy of total knee arthroplasty with computer navigation system(Knee3 software,Brainlab,Germany)and traditional total knee arthroplasty.Methods:A retrospective study was conducted on 124 patients who underwent total knee arthroplasty between December 2020 and May 2022.All were followed up for 3 months.63 patients underwent traditional total knee arthroplasty and 61 patients underwent total knee arthroplasty under computer-assisted navigation.Preoperative data were recorded,including gender,age,body mass index,hemoglobin concentration,hip-knee-ankle angle,range of motion,visual analogue scale(VAS)score,Oxford knee score.Intraoperative data was recorded,including anesthesia mode,operation time and intraoperative blood loss,and postoperative data was recorded,including hemoglobin concentration,surgical complications,VAS score,knee prosthesis angle(α,β,γ,σ),hip-knee-ankle angle,range of motion and Oxford knee score.Results:The operation time was(1.62±0.40)h in the traditional group,(1.97±0.52)h in the navigation group(P<0.05),the amount of bleeding was(150.32±60.69)mL in the traditional group,(128.85±57.01)mL in the navigation group(P<0.05),and VAS score(3.63±0.73)points in the traditional group,(2.98±0.98)points in the navigation group(P<0.05).The hemoglobin in the traditional group was(103.44±11.89)g/L,and(108.82±9.38)g/L in the navigation group before discharge(P<0.05).There was difference in knee prosthesis angle(α,β,γ,σ),hip-knee-ankle angle,range of motion and Oxford knee score at a follow-up of 3 months after surgery(P<0.05).Conclusion:Total knee arthroplasty with computer navigation system can reduce early postoperative pain,intraoperative bleeding,and postoperative anemia and improve the accuracy of prosthesis placement angle and lower limb force line.There is no advantage in short-term improvement of joint range of motion and knee joint function.

参考文献/References:

[1] WINTHER S B,KLAKSVIK J,WIK T S,et al.Higher dissatisfaction rate following revision compared with primary total knee arthroplasty:1-year follow-up of 2 151 primary and 235 aseptic revision surgeries[J].Orthopedics,2023,46(1):52-57.
[2] 熊昌军,李朋,张延超,等.胫骨侧个性化髓外定位技术行人工全膝关节置换术后胫骨假体冠状位力线的评价研究[J].中国修复重建外科杂志,2022,36(2):177-182.
[3] 吴鹏,郎俊哲,吴聪聪,等.胫骨冠状面弯曲导致全膝关节置换术后胫骨假体力线不良[J].中国骨伤,2022,35(1):56-58.
[4] 唐杞衡,周一新,郭盛杰,等.新型计算机导航系统辅助人工全膝关节置换术的近期疗效[J].中国修复重建外科杂志,2021,35(10):1281-1285.
[5] 王宸,冯利君,赵金廷.计算机导航间隙平衡技术对全膝关节置换术后患者下肢恢复的影响[J].中国骨伤,2022,35(1):43-48.
[6] 程国芳,何宝林,王小伟,等.计算机导航辅助与传统手术行人工膝关节置换的疗效比较[J].临床骨科杂志,2018,21(5):558-561.
[7] 江正,尹宗生,陆鸣,等.计算机导航在全膝关节置换中的应用[J].中国组织工程研究,2020,24(15):2317-2322.
[8] 中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版)[J].中华骨科杂志,2018,38(12):705-715.
[9] SAVOV P,MIELKE E,WINDHAGEN H,et al.Higher revision rate for posterior cruciate-retaining than posterior-stabilized total knee arthroplasty for the treatment of valgus osteoarthritis[J].Archives of Orthopaedic and Trauma Surgery,2021,141(2):305-312.
[10] 周建国,刘世伟,袁长红,等.后交叉韧带保留型假体全膝关节置换治疗膝骨性关节炎合并膝外翻畸形[J].中国组织工程研究,2022,26(6):892-897.
[11] 侯森荣,杨伟毅,罗明辉,等.全膝关节置换后不放置引流管的相关管理策略[J].中国组织工程研究,2020,24(33):5371-5378.
[12] AZAR F M,BEATY J H.Campbell's operative orthopaedics[M].14th ed.Toronto:Elsevier,2021:433.
[13] RODRIGUEZ-MERCHAN E C.Patient satisfaction following primary total knee arthroplasty:contributing factors[J].Archives of Bone and Joint Surgery,2021,9(4):379-386.
[14] HUANG Y L,LEE M,CHONG H C,et al.Reasons and factors behind post-total knee arthroplasty dissatisfaction in an Asian population[J].Annals Academy of Medicine Singapore,2017,46(8):303-309.
[15] GRAICHEN H,LUDERER V,STRAUCH M,et al.Navigated,gap-balanced,adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections[J].Knee Surgery Sports Traumatology Arthroscopy,2023,31(3):768-776.
[16] KWAK D S,KIM Y D,CHO N,et al.Restoration of the joint line configuration reproduces native mid-flexion biomechanics after total knee arthroplasty:a matched-pair cadaveric study[J].Bioengineering(Basel),2022,9(10):564.
[17] ELBULUK AMEER M,JERABEK SETH A,SUHARDI VINCENTIUS J,et al.Head-to-head comparison of kinematic alignment versus mechanical alignment for total knee arthroplasty[J].Journal of Arthroplasty,2022,37(8S):S849-S851.
[18] WINNOCK DE GRAVE P,LUYCKX T,CLAEYS K,et al.Higher satisfaction after total knee arthroplasty using restricted inverse kinematic alignment compared to adjusted mechanical alignment[J].Knee Surgery Sports Traumatology Arthroscopy,2022,30(2):488-499.
[19] KINOSHITA T,HINO K,KUTSUNA T,et al.Rotational soft-tissue balance is highly correlated with rotational kinematics in total knee arthroplasty[J].Journal of Knee Surgery,2023,36(1):47-53.
[20] TSUBOSAKA M,KAMENAGA T,KURODA Y,et al.Accelerometer-based portable navigation system is useful for tibial bone cutting in modified kinematically aligned total knee arthroplasty[J].Journal of Knee Surgery,2021,34(8):870-876.
[21] NISHIHARA N,MASUDA H,SHIMAZAKI N,et al.Correction of varus alignment with peripheral osteophyte removal during total knee arthroplasty:an assessment with computer navigation[J].Journal of Knee Surgery,2023,36(3):292-297.
[22] IACONO V,FARINELLI L,NATALI S,et al.The use of augmented reality for limb and component alignment in total knee arthroplasty:systematic review of the literature and clinical pilot study[J].Journal of Experimental Orthopaedics,2021,8(1):52.
[23] LEELASESTAPORN C,THUWAPITCHAYANANT M,SIRITHANAPIPAT P,et al.Reliability of imageless computer-assisted navigation for femoral rotational alignment in total knee arthroplasty[J].Malaysian Orthopaedic Journal,2021,15(1):79-84.
[24] ZAMPOGNA B,CAMPI S,TORRE G,et al.Outcomes of computer-assisted total knee arthroplasty compared to conventional TKA:a bicentric controlled retrospective clinical study[J].Journal of Clinical Medicine,2021,10(15):3352.
[25] LARRAINZAR-GARIJO R,MOLANES-LOPEZ E M,MURILLO-VIZUETE D,et al.Mechanical alignment in knee replacement homogenizes postoperative coronal hip-knee-ankle angle in varus knees:a navigation-based study[J].Journal of Knee Surgery,2022,35(12):1285-1294.
[26] 王宸,冯利君,赵金廷.计算机导航间隙平衡技术对全膝关节置换术后患者下肢恢复的影响[J].中国骨伤,2022,35(1):43-48.
[27] 程国芳,何宝林,王小伟,等.计算机导航辅助与传统手术行人工膝关节置换的疗效比较[J].临床骨科杂志,2018,21(5):558-561.
[28] 杨硕,冯硕,徐崇俊,等.全膝关节置换后下肢力线及假体力线与疗效和假体松动率的关系[J].中国组织工程研究,2019,23(24):3780-3785.
[29] 林汉文,温俊茂,黄超原,等.骨性关节炎患者下肢力线改变与疼痛部位的关系:影像学评价[J].中国组织工程研究,2017,21(7):1110-1114.
[30] FEROE A G,CHAKRABORTY A K,ROSENT-HAL D I,et al.Fracture through tracking pin sites following a robotic-assisted total knee arthroplasty[J].Skeletal Radiology,2022,51(11):2217-2221.
[31] NOVOA-PARRA C D,SANJUAN-CER-VERÓ R,FRANCO-FERRANDO N,et al.Complications of computer-assisted navigation in total knee replacement:retrospective cohort of eight hundred and seventy eight consecutive knees[J].International Orthopaedics,2020,44(12):2621-2626.
[32] 于清波,鄂正康,辛红伟,等.计算机导航下全膝关节置换术对术中出血量及关节功能恢复的影响[J].中国骨伤,2020,33(1):15-20.
[33] 邓波,洪海南,范勇勇,等.全膝关节置换全程与仅在安装假体时使用止血带疗效及安全性比较的Meta分析[J].中国组织工程研究,2021,25(18):2908-2914.
[34] 陈光洪,李俊青,赵圆圆,等.超声引导星状神经节阻滞对膝关节置换术止血带反应的影响[J].蚌埠医学院学报,2021,46(1):55-57.

备注/Memo

备注/Memo:
基金项目:河北省中医药管理局2020年度中医药科研计划项目(2020494)
△通信作者 E-mail:zhaoyunchaook@126.com
更新日期/Last Update: 2024-02-15