膝骨性关节炎导航与徒手胫骨高位截骨比较△

Navigation assisted high tibial osteotomy versus conventional counterpart for knee osteoarthritis

摘要:

[目的]比较导航下胫骨高位截骨术（high tibial osteotomy, HTO）与传统徒手 HTO 的临床疗效。[方法]回顾性分析本院 HTO 治疗的 40 例膝骨性关节炎患者的临床资料。根据术前医患沟通结果，20 例采用导航技术，20 例为徒手组。比较两组围手术期、随访及影像资料。[结果]两组患者均顺利完成手术。虽然导航组手术时间显著长于徒手组 [(118.3±9.6) min vs (86.0± 14.5) min, P＜0.001]，但前者在透视次数 [(23.9±2.9) 次 vs (30.6±2.0) 次, P＜0.001]、切口总长度 [(6.4±0.8) cm vs (8.2±1.0) cm, P＜0.001]、 术中失血量 [(68.5±16.3) mL vs (104.5±21.4) mL, P＜0.001]、下地行走时间 [(3.4±0.5) d vs (4.8±0.84) d, P＜0.001] 及住院时间 [(6.8±1.0) d vs (8.6±1.4) d, P＜0.001] 均显著优于徒手组。两组患者均获 12 个月随访。导航组完全负重活动时间显著早于徒手组 [(41.1±4.8) d vs (54.2±6.8) d, P＜0.001]。随时间推移，两组 VAS、Lysholm、HSS 评分及膝关节 ROM 均显著改善（P＜0.05）。术后 1 个月，导航组 Lysholm [(69.2±3.2) vs (64.6±4.1), P＜0.001]、HSS 评分 [(67.3±3.1) vs (62.0±1.7), P＜0.001] 显著优于徒手组，术后 6 个月及 12 个月，两组 Lysholm、HSS 评分的差异无统计学意义（P＞0.05）。影像方面，与术前相比，末次随访时，两组患者的股胫角（femorotibial an- gle, FTA）、胫骨近端内侧角（medial proximal tibial angle, MPTA）、机械轴偏移（mechanical axis deviation, MAD）均显著改善（P＜ 0.05）；导航组胫骨后倾角（posterior tibial slope, PTS）无显著变化（P＞0.05），而徒手组 PTS 显著增加（P＜0.05）。末次随访时，导航组 FTA [(172.7±1.0)° vs (174.9±1.7)°, P＜0.001]、PTS [(6.5±1.0)° vs (7.9±1.7)°, P=0.002]、MAD [(4.2±2.9) mm vs (7.9±4.5) mm, P=0.004] 显著优于徒手组。[结论]导航下 HTO 相较于徒手 HTO，在术中精度、创伤减少和力线矫正方面具有显著优势。

Abstract:

[Objective] To compare the clinical efficacy of navigation assisted high tibial osteotomy (NA-HTO) versus conventional free-hand HTO (FH-HTO). [Methods] A retrospective research was done on 40 patients who had knee osteoarthritis treated by HTO in our hospital. According to the preoperative doctor-patient communication, 20 patients received NA-HTO, while other 20 patients underwent FH-HTO. The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had corresponding surgical procedures conducted successfully. Although the NA-HTO consumed significantly longer operation timer than the FHHTO group [(118.3±9.6) min vs (86.0±14.5) min, P＜0.001], the former was significantly better than the latter in terms of fluoroscopic times [(23.9±2.9) vs (30.6±2.0), P＜0.001), total incision length [(6.4±0.8) cm vs (8.2±1.0) cm, P＜0.001], intraoperative blood loss [(68.5±16.3) mL vs (104.5±21.4) mL, P＜0.001], ambulation time [(3.4±0.5) days vs (4.8±0.84) days, P＜0.001] and hospital stay [(6.8±1.0) days vs (8.6±1.4) days, P＜0.001]. The patients in both groups were followed up for more than 12 months, and the NA-HTO group resumed full weight-bearing activity significantly earlier than the FH-HTO group [(41.1±4.8) days vs (54.2±6.8) days, P＜0.001]. The VAS, Lysholm, HSS scores and knee ROM were significantly improved in both groups over time (P＜0.05). The NA-HTO group was significantly superior to the FH-HTO group in Lysholm [(69.2±3.2) vs (64.6±4.1), P＜0.001] and HSS scores [(67.3±3.1) vs (62.0±1.7), P＜0.001] one month postoperatively, whereas which became not statistically significant between the two groups 6 and 12 months after surgery (P＞0.05). Regarding imaging, the femoro-tibial angle (FTA), medial proximal tibial angle (MPTA) and mechanical axis deviation (MAD were significantly improved at the last followup compared to those preoperatively (P＜0.05). However, the posterior tibial slope (PTS) remained not significantly changed in the NA-HTO group (P＞0.05), while significantly increased in the FH-HTO group (P＜0.05). At the last follow-up, the NA-HTO was also proved significantly superior to the FH_HTO group regarding FTA [(172.7±1.0)° vs (174.9±1.7)°, P＜0.001], PTS [(6.5±1.0)° vs (7.9±1.7)°, P=0.002] and MAD [(4.2±2.9) mm vs (7.9±4.5) mm, P=0.004]. [Conclusion] Compared with the conventional freehand HTO, the navigation assisted HTO has significant advantages in intraoperative accuracy, trauma reduction and alignment correction.