| 遥感导航系统在全膝关节置换术的应用 |
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Received:July 12, 2024
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| 作者 | Author | 单位 | Unit | E-Mail |
| 李园源 |
LI Yuan-yuan |
中国中医科学院望京医院骨关节一科, 北京 100102 |
The First Department of Osteoarthropathy, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing 100102, China |
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| 何名江 |
HE Ming-jiang |
中国中医科学院望京医院骨关节一科, 北京 100102 |
The First Department of Osteoarthropathy, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing 100102, China |
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| 单鹏程 |
SHAN Peng-cheng |
中国中医科学院望京医院骨关节一科, 北京 100102 |
The First Department of Osteoarthropathy, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing 100102, China |
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| 胡佩岩 |
HU Pei-yan |
中国中医科学院望京医院骨关节一科, 北京 100102 |
The First Department of Osteoarthropathy, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing 100102, China |
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| 荆琳 |
JING Lin |
中国中医科学院望京医院骨关节一科, 北京 100102 |
The First Department of Osteoarthropathy, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing 100102, China |
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| 闫奇 |
YAN Qi |
中国中医科学院望京医院骨关节一科, 北京 100102 |
The First Department of Osteoarthropathy, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing 100102, China |
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| 唐海 |
TANG Hai |
中国中医科学院望京医院骨关节一科, 北京 100102 |
The First Department of Osteoarthropathy, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing 100102, China |
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| 汪欣月 |
WANG Xin-yue |
中国中医科学院望京医院骨关节一科, 北京 100102 |
The First Department of Osteoarthropathy, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing 100102, China |
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| 刘思冶 |
LIU Si-ye |
中国中医科学院望京医院骨关节一科, 北京 100102 |
The First Department of Osteoarthropathy, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing 100102, China |
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| 张洪美 |
ZHANG Hong-mei |
中国中医科学院望京医院骨关节一科, 北京 100102 |
The First Department of Osteoarthropathy, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing 100102, China |
wangjingzhm@sina.com |
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| 期刊信息：《中国骨伤》2024年37卷，第9期，第878-885页 |
| DOI：10.12200/j.issn.1003-0034.20240342 |
| 基金项目:北京市科技委员会基金(编号:Z201100005520058);中国中医科学院望京医院高水平中医医院建设项目(编号:WJYY-XZKT-2023-09,WJYY-XZKT-2023-27) |
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目的: 探讨遥感导航定位(remote sensing navigation alignment, RSNA)系统在全膝关节置换术(total knee arthroplasty,TKA)中的精准性及其对术后临床疗效的影响。
方法: 自2021年5月至2022年5月选取60例初次行单侧TKA的Kellgren-Lawrence(K-L)分级为Ⅲ-Ⅳ级的膝骨关节炎(knee osteoarthritis,KOA)患者,按照治疗方法分为RSNA组和传统手术组,每组30例。RSNA组男6例,女24例;年龄55~86(68.06±8.23)岁;身体质量指数(body mass index,BMI)22.15~34.58(28.20±3.01) kg·m-2; 病程2~60(18.80±14.80)个月;K-L分级Ⅲ级13例,Ⅳ级17例。传统手术组男8例,女22例;年龄57~85(67.26±6.32)岁; BMI为23.94~34.55(27.49±2.32) kg·m-2;病程3~60(21.30±16.44)个月; K-L分级Ⅲ级14例,Ⅳ级16例。分别于术前与术后3、6个月采用Western Ontario and McMaster大学骨关节炎指数(Western Ontario and McMaster Universities Osteiarthritis Index,WOMAC)和美国膝关节协会评分(Knee Society score,KSS)评价患者功能恢复情况。术前测量下肢髋膝踝角(hip-knee-ankle angle,HKAA)、股骨远端外翻角(femoral valgus angle,FVA)和股骨远端屈曲角(distal fermoral flexion angle,DFFA)。术后1周测量HKAA、HKAA偏移角并计算下肢力线不良率、股骨假体外翻角(femur prosthesis valgus angle,FPVA)和股骨假体屈曲角(femoral prosthesis flexion angle,FPFA)。
结果: 两组手术均顺利进行,术中无血管、神经损伤等严重并发症,术后伤口Ⅰ期愈合。两组均获得6个月随访。两组术前WOMAC、KSS、HKAA、FVA及DFFA比较,差异均无统计学意义(P＞0.05);术后1周RSNA组力线不良率、HKAA、HKAA偏移角、FPVA偏移角、FPFA分别为6.7%、(178.74±1.56)°、(1.25±1.56)°、(1.84±0.16)°、(4.85±2.46)°,传统手术组分别为20.0%、(176.73±3.46)°、(3.27±3.46)°、(2.44±0.26)°、(6.60±1.86)°;两组比较,差异有统计学意义(P＜0.05)。两组术后3、6个月WOMAC、KSS比较,差异无统计学意义(P＞0.05)。
结论: RSNA系统可以降低TKA术后下肢力线不良率、FPVA偏移角和FPFA,在保证术后疗效的同时较传统髓内定位手术更精准,操作更简便。 |
| [关键词]:全膝关节置换术 遥感导航定位 假体力线 定位标记 |
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| Application of remote sensing navigation system in total knee arthroplasty |
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Abstract:
Objective To explore clinical accuracy of remote sensing navigation alignment (RSNA) system in total knee arthroplasty (TKA) and its influence on postoperative clinical efficacy.
Methods From May 2021 to May 2022,60 knee osteoarthritis (KOA) patients with Kellgren-Lawrence (K-L) grade Ⅲ to Ⅳ treated by unilateral primary TKA were selected and divided into RSNA group and traditional operation group according to treatment methods,and 30 patients in each group. There were 6 males and 24 females in RSNA group,aged from 55 to 86 years old with an average of (68.06±8.23) years old;body mass index (BMI) ranged from 22.15 to 34.58 kg·m-2 with an average of (28.20±3.01) kg·m-2;the courses of disease ranged from 2 to 60 months with an average of (18.80±14.80) months;13 patients with grade Ⅲ and 17 patients with grade Ⅳ according to K-L grading. In traditional operation group,there were 8 males and 22 females,aged from 57 to 85 years old with an average of (67.26±6.32) years old;BMI ranged from 23.94 to 34.55 kg·m-2 with an average of (27.49±2.32) kg·m-2;the courses of disease ranged from 3 to 60 months with an average of (21.30±16.44) months;14 patients with grade Ⅲ and 16 patients with grade Ⅳ according to K-L grading. Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and Knee Society score(KSS) were used to evaluate functional recovery of patients. Hip-knee-ankle angle (HKAA),distal femoral valgus angle (FVA) and distal fermoral flexion angle (DFFA) were measured before operation. HKAA and HKAA deviation angle were measured at 1 week after operation,and defective rate of lower limb force line,femur prosthesis valgus angle (FPVA) and femoral prosthesis flexion angle (FPFA),respectively,were calculated.
Results There were no serious complications such as vascular and nerve injury during operation,and wound healed at stage Ⅰ. Both groups were followed up for 6 months. There were no significant difference in WOMAC index,KSS,HKAA,FVA and DFFA between two groups before operation (P＞0.05). The force line defect rate,HKAA,HKAA deviation angle,FPVA deviation angle and FPFA of RSNA group were 6.7%,(178.74±1.56) °,(1.25±1.56) °,(1.84±0.16) ° and (4.85±2.46) °,respectively;while in traditional operation group were 20%,(176.73±3.46) °,(3.27±3.46) °,(2.44±0.26) °,(6.60±1.86) °;the difference between two groups were statistically significant (P＜0.05). There were no significant difference in WOMAC index and KSS between two groups at 3 and 6 months after operation (P＞0.05).
Conclusion RSNA system could reduce defective rate of lower limb force line,FPVA deviation angle and FPFA after TKA,which is more accurate and easy to operate than traditional intramedullary localization surgery while ensuring postoperative efficacy. |
| KEYWORDS:Total knee arthroplasty Remote sensing navigation alignment Prosthesis alignment Fiducial markers |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李园源,何名江,单鹏程,胡佩岩,荆琳,闫奇,唐海,汪欣月,刘思冶,张洪美.遥感导航系统在全膝关节置换术的应用[J].中国骨伤,2024,37(9):878~885 |
| 英文格式: | LI Yuan-yuan,HE Ming-jiang,SHAN Peng-cheng,HU Pei-yan,JING Lin,YAN Qi,TANG Hai,WANG Xin-yue,LIU Si-ye,ZHANG Hong-mei.Application of remote sensing navigation system in total knee arthroplasty[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(9):878~885 |
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