虚拟影像导航系统对提高髋臼假体植入精度的临床观察

目的研究非影像手术导航系统对髋臼假体植入位置精度的影响。方法2004年2月～2006年4月收治23例(26髋)髋关节病变患者,采用在无影像手术导航下开展全髋关节置换术(total hip arthroplasty,THA)进行治疗。男14例,女9例;年龄28～55岁。其中类风湿性关节炎3例(3髋),股骨头坏死6例(7髋),骨性关节炎14例(16髋)。随机分为两组:计算机导航组11例13髋,在无影像手术导航下行THA;对照组12例13髋,采用传统THA。设定髋臼最佳植入股骨外展角45°,前倾角为15°。术后测定假体植入的角度。结果术后无骨折、脱位、感染及坐骨神经损伤。计算机导航组的髋臼前倾角为15.4±1.4°,外展角为45.5±1.3°;对照组髋臼前倾角为13.9±7.6°,外展角为43.7±6.4°;比较差异有统计学意义(P<0.01),且计算机导航组的角度值比对照组更接近和集中于设定值。23例均获随访10～40个月,平均26个月。Harris评分计算机导航组为85～100分(平均95分),优11髋,良2髋;对照组为75～100分(平均92分),优9髋,良3髋,中1髋;两组比较差异有统计学意义(P<0.05)。结论无影像手术导航系统下可以精确地植入髋臼假体,减少假体松动的发生,具有重要的临床价值。

ACCURACY IMPROVEMENT OF ACETABULAR COMPONENT PLACEMENT USING NON-IMAGE BASED SURGICAL NAVIGATION SYSTEM

OBJECTIVE: To improve the accuracy of the acetabular component placement using the non-image based surgical navigation system. METHODS: Twenty-three patients (14 males, 9 females; age, 28-55 years; 26 hips) with hip disease underwent the total hip arthroplasty (THA) using the non-image based surgical navigation system from February 2004 to April 2006. Rheumatoid arthritis was found in 3 patients (3 hips), necrosis of the femoral head in 6 patients (6 hips), and osteoarthritis in 14 patients (16 hips). All the patients were randomly divided into the following 2 groups: the navigated group (11 patients, 13 hips), treated by THA using the non-image based surgical navigation system; and the control group (12 patients, 13 hips), treated by the traditional THA. According to the design of the study, the acetabular component was placed in the best inclination angle (45 degrees) and the anteversion angle (15 degrees). The postoperative component position was examined. RESULTS: No fracture, dislocation, infection or injury to the sciatic nerve was found. In the navigated group, the inclination and the anteversion reached 15.4 +/- 1.4 degrees and 45.5 +/- 1.3 degrees, respectively. In the control group, the inclination and the anteversion were 13.9 +/- 7.6 degrees and 43.7 +/- 6.4 degrees, respectively. The inclination difference was considered statistically significant (P < 0.01). All the patients were followed up for 10-40 months,averaged 26 months. In the navigated group, the postoperative average Harris hip score was 95 (range, 85-110), with an excellent result in 11 hips and a good result in 2 hips. In the control group, the postoperative average Harris hip score was 92 (range, 75-110), with an excellent result in 9 hips, a good result in 3 hips, and a fair result in 1 hip. The Harris hip score difference was considered statistically significant (P < 0.05). There was a significantly better result obtained in the navigated group than in the control group. CONCLUSION: The acetabular component can be implanted accurately by the non-image based surgical navigation system, which can reduce the incidence of the loosening of the prostheses and has an important value in clinical practice.