两种导航辅助全膝关节置换的比较△

Comparison of two navigations used as assistance in total knee arthroplasty

摘要:

[目的] 比较计算机辅助 (computer assisted surgery, CAS) 和便携式导航 (portable accelerometer-based navigation de- vice, PAD)下全膝关节置换术(total knee arthroplasty, TKA)的临床效果。[方法]回顾性分析 2018 年 11 月—2021 年 8 月于本院接受导航辅助 TKA 术的 30 例患者的临床资料。根据医患沟通结果，12 例采用 CAS，18 例采用 PAD。比较两组围手术期、 随访及影像结果。[结果]两组患者均顺利完成手术，两组手术时间、术后第 3 d 累计失血量、住院时间的差异均无统计学意义 (P＞0.05)。两组均获随访 12 个月以上。与术前相比，末次随访时两组 VAS 评分均显著减少(P＜0.05)，膝关节 HSS 评分均显著增加(P＜0.05)。相应时间点，两组间 VAS 和 HSS 评分的差异均无统计学意义(P＞0.05)。影像方面，与术前相比，术后两组 HKAA 均显著减少(P＜0.05)；术前、术后两组 HKAA 角差异无统计学意义(P＞0.05)。与术前相比，术后两组 mMPTA 角均显著增加 (P＜0.05)，但相应时间点，两组间 mMPTA 角的差异均无统计学意义(P＞0.05)。与术前相比，术后 CAS 组 mLDFA 显著增加(P＜ 0.05)，而 PAD 组的 mLDFA 无变化(P＞0.05)；相应时间点，两组间 mLDFA 角的差异均无统计学意义(P＞0.05)。[结论] CAS 和 PAD 辅助 TKA 手术在围手术期情况、下肢力线矫正精确度和临床疗效方面没有明显差异，临床上可根据情况灵活选择。

Abstract:

[Objective] To compare the clinical outcomes of total knee arthroplasty (TKA) assisted by computer assisted surgery (CAS) versus portable accelerometer-based navigation device (PAD). [Methods] A retrospective study was performed on 30 patients who under- went navigation-assisted TKA in our hospital from November 2018 to August 2021. According to doctor-patient communication, 12 patients had CAS used, while the remaining 18 patients had PAD applied. The documents of perioperative period, follow-up and imaging measur- ments were compared between the two groups. [Results] All the patients had TKA performed successfully with no significant differences in terms of operation time, cumulative blood loss on the third day after operation, and length of hospital stay between the two groups (P＞0.05). All of them in both groups were followed up for more than 12 months. Compared with that preoperatively, the VAS scores significantly de- creased (P＜0.05), while the HSS scores significantly increased at the latest follow-up in both groups (P＜0.05), which proved not significantly different between the two groups at any corresponding time points (P＞0.05). Radiographically, the hip-knee-ankle angle (HKAA) signifi- cantly decreased in CAS group and PAD group postoperatively compared with that preoperatively (P＜0.05). The preoperative and postopera- tive HKAA in both groups were not significantly different (P＞0.05). The mechanical medial proximal tibial angle (mMPTA) significantly in- creased in both groups postoperatively compared with that preoperatively (P＜0.05), which proved not significantly different between the two groups at any matching time points (P＞0.05). The mechanical lateral femoral angle (mLDFA) was significantly increased in the CAS group (P＜0.05), whereas which was of no change in the PAD group postoperatively compared with that preoperatively (P＞0.05). At any correspond- ing time points, there was no significant difference in mLDFA between the two groups (P＞0.05). [Conclusion] There were no significant dif- ferences between CAS and PAD used for assistance in TKA in terms of perioperative conditions, accuracy of lower extremity alignment and clinical efficacy. Therefore, both CAS and PAD can be selected flexibly according to the concrete situation.