计算机导航辅助全膝关节置换定位与软组织平衡

BACKGROUND: Computer assisted navigation has been applied in total knee arthroplasty, can make the prosthesis more accurately implanted, play a good role in navigation, and enhance accuracy of knee prosthesis rotation power lines. Computer-assisted navigation system appears lately in China, so few studies concern the location of total knee arthroplasty and its application in soft tissue balance. OBJECTIVE: To investigate the application of computer navigation aids located in artificial total knee arthroplasty and soft tissue balance. METHODS: A total of 40 patients (49 knees) who received total knee arthroplasty in Department of Orthopeadic Surgery of Jincheng People’s Hospital from January to September 2015 were analyzed. The patients were divided into conventional surgery group (20 cases, 24 knees) and navigation group (20 cases, 25 knees). The patients in the conventional surgery group were positioned with intramedullary femoral alignment bar and extramedullary tibial alignment bar. In the navigation group, total knee arthroplasty was performed in accordance with computer. Repair of incision and approach in both groups were identical. Positioning effect and effect of computer assisted navigation on soft tissue balance in total knee arthroplasty were analyzed. RESULTS AND CONCLUSION: (1) Operation time was longer significantly in the navigation group than in the conventional surgery group (P < 0.05). Blood loss and 24-hour drainage volume were significantly less in the navigation group than in the conventional surgery group (P < 0.05). (2) Range of motion of the knee and Hospital for Special Surgery score were significantly higher in the navigation group than in the conventional surgery group (P < 0.05). Power line error, soft tissue balance angle variable and soft tissue balance separation variables were significantly less in the navigation group than in the conventional surgery group (P < 0.05). (3) These results confirmed that computer navigation aids in total knee arthroplasty obtained ideal effect, ensured more accurate prosthesis implantation, better limb alignment, and ensured soft tissue balance. However, the computer-assisted navigation will increase operation time. For its application, we should consider the pros and cons.        

全膝关节置换中Brainlab Knee 3导航辅助间隙平衡技术的应用优势

背景：近年来,计算机导航技术辅助关节置换逐渐受到医疗领域的关注。文献报道计算机导航在全膝关节置换中的应用临床效果不一。为了探索新一代Brainlab Knee 3导航系统的临床效果,进行了此项研究。目的：分析计算机导航系统(Brainlab Knee 3)结合间隙平衡技术在全膝关节置换中的应用效果。方法：2020年11月至2021年5月大连市第二人民医院关节外科收治71例行全膝关节置换患者,导航组35例,术中采用计算机导航结合间隙平衡技术行全膝关节置换;传统组36例,术中采用传统手术器械定位截骨。比较两组患者术中内、外侧关节间隙差;膝关节活动度、 KSS评分;髋膝踝角;冠状面股骨组件角、冠状面胫骨组件角和矢状面胫骨组件角偏差值。结果与结论：(1)导航组伸直位内外侧间隙差0,1,2 mm的患者分别为19,14,2例;屈膝90°位内外侧间隙差0,1,2 mm的患者分别为18,15,2例。传统组伸直位内外侧间隙差0,1,2mm的患者分别为10,20,6例;屈膝90°位内外侧间隙差0,1,2mm的患者分别为10,15,8例。(2)导航组手术时间长于传统组(P <0.05),导航组有2例患...     

数字化导航模板辅助全膝关节置换的临床应用

目的　探讨临床数字化导航模板辅助全膝关节置换的可行性和准确性。 方法　招募20例（男8例,女12例）膝骨性关节炎患者。采集患者下肢全长MRI扫描数据,利用逆向工程软件对MRI数据进行处理,计算机内设计得到一款与股骨远端和胫骨近端匹配的可定位截骨平面和外旋轴的导航模板,最后通过快速成型机制作模板实物用于临床手术操作。手术由同一位具有关节置换经验的骨科医生行全膝关节置换手术。术前观察导航模板与股骨髁和胫骨平台匹配性,术后通过CT扫描检测截骨的准确性。 结果 导航模板与股骨髁和胫骨平台贴合紧密,无明显移动;所有患者股骨远端和胫骨近端截骨面与下肢机械轴基本垂直,外旋轴定位精确,股骨后髁截骨面与通髁轴保持平行。 结论 数字化导航模板辅助全膝关节置换具有安全可行,手术操作简单,截骨力线准确。     

人工全膝关节置换中截骨技术的研究进展

目的 探讨人工全膝关节置换术（TKA）中截骨方法的研究进展。方法 在PubMed、Springer Link、FMJS、万方网络数据库中,以“膝关节置换术”、“截骨”、“计算机导航”和“个体化模板”为关键词,查阅1988年1月—2014年6月有关人工TKA中截骨技术研究的相关文献,进行分析和总结。结果 TKA是治疗中晚期膝关节疾病的标准经典手术,术中截骨方法主要有传统器械截骨、计算机导航及个体化模板辅助截骨等。TKA中传统器械截骨,依靠机械引导装置定位及术者经验截骨,主观性强,精确度较低,手术风险大,并发症多,手术效果欠佳。与传统器械截骨相比,计算机导航辅助截骨精度可能受多种因素影响,需要的时间和并发症发生的概率更多;另外,由于其学习曲线长、设备费用昂贵、技术要求高等众多因素,限制了导航系统的推广应用。个体化模板辅助TKA技术可设计精确化的截骨方法或工具,实现个体化解剖截骨,具有提高截骨精确性、缩短手术时间、减轻手术损伤等优势,膝关节术后功能恢复更加理想。结论 随着数字骨科的不断发展,人工TKA手术方案会更加个性化,截骨更精确。数字化、个体化截骨技术可能成为今后TKA发展的新方向。     

计算机辅助导航下的微创膝关节单髁置换

背景：人工关节置换在计算机导航手术的帮助下,可以严格把握假体位置的准确性,使其精确匹配。 目的：观察计算机导航下微创膝关节单髁置换的治疗效果。 方法：回顾性分析2009-05/2010-05上海市杨浦区中心医院骨科收治的内侧间室骨性关节炎患者28例(28膝)的临床资料,均应用计算机导航辅助下的微创膝关节单髁置换进行治疗。 结果与结论：28例患者随访12~24个月。切口平均6.8 cm,置换中出血平均45.8 mL,平均置换时间91.6 min,置换后24 h平均引流量38.5 mL。下肢力线由置换前平均7.0°减少为置换后平均2.0°(P < 0.05)。置换后膝关节活动范围平均125°,较置换前平均100°明显提高(P < 0.05)。末次随访患者膝关节HSS评分平均94分,优良率94%,相比置换前评分平均78分(69~80分)有明显的改善(P < 0.05)。提示计算机导航下微创膝关节单髁置换能提高术中截骨和假体植入的精确性,有效恢复下肢力线。     

三维导航完成全膝关节置换

屏幕上完整地显示出整个关节的三维图像,观察其病变情况可精确到0．3毫米,0．5度以内,清晰可见。日前,河南省人民医院骨科主任郑稼教授成功完成河南首例导航下全膝关节置换术,一位70多岁的老人在如此精细的手术下成功置换了整个膝关节。     

机器人辅助全膝关节置换技术的应用与前景

背景：目前用于全膝关节置换的机器人系统设计的基本原理是将三维手术规划、术中危险区预警、实时数据反馈及机械臂辅助截骨等技术相结合，以实现全膝关节置换的精准化、个性化，这也恰好是它最大优势所在，因此近年来成为关节外科领域热点话题，备受关注。目的：文章将从机器人辅助全膝关节置换在关节外科领域的发展现状及其与传统全膝关节置换优劣势对比进行概述，此外，还将对机器人辅助全膝关节置换技术未来的发展进行展望。方法：应用计算机检索Pub Med、中国知网、万方和维普数据库的相关文章，英文检索词：“robot OR robotic OR robotics OR robotically OR computer,total knee arthroplasty OR total knee replacement,TKA OR TKR”，中文检索词：“机器人辅助，计算机导航，全膝关节置换术”，最终纳入64篇文献进行综述分析。结果与结论：(1)用于辅助全膝关节置换的机器人系统根据其自由度分为主动式、半主动式和被动式。半主动式系统是目前使用最为广泛的机器人系统，该系统有效提高了全膝关节置换手术的精准性和个性化程度，但...     

多模式镇痛在初次全膝关节置换中的应用

背景：全膝关节置换后围置换期急性疼痛广泛存在,阻碍了早期康复锻炼,增加并发症发生。虽然有研究者提出一系列的新方式并证实了其有效性,但滥用药物及神经阻滞的并发症无法避免,寻找一种安全而有效的镇痛方案成为当前关节置换的重要课题。 目的：观察包括关节周围注射复合麻醉药物的多模式镇痛方案在全膝关节置换患者中的疗效及安全性。 方法：回顾性分析2009-05/2011-05常州市中医医院骨科收治的行单侧全膝关节置换患者80例,分为2组,对照组(n=38),接受股神经阻滞或硬膜外自控镇痛治疗;实验组(n=42),采用包括关节周围注射复合麻醉药物的多模式镇痛方案。 结果与结论：在置换后6 h,12 h,24 h,2 d,3 d内,实验组较对照组疼痛评分降低(P < 0.05)。但在置换后第4,5天两组间疼痛评分差异无显著性意义(P > 0.05)。实验组置换后短期内疼痛减轻明显,置换后主动、被动屈膝90°时间明显缩短,且助行器辅助下地行走时间明显提前(P < 0.05)。两组不良反应发生率相似,由于引流合理使用,未见伤口感染或延迟愈合出现。提示多模式镇痛方案可作为一种安全镇痛方案,能显著减少置换后疼痛。     

Deluxe-ps膝关节假体在一期双膝关节置换过程中的应用

背景：Deluxe-PS型人工膝关节假体是根据中国人膝关节解剖特点尤其是股骨髁的形态特征而设计的,其膝关节假体股骨髁内外侧距(M-L)较进口假体少3.5 mm。 目的：探讨Deluxe-ps膝关节假体行一期双膝关节置换中的近期疗效。 方法：纳入使用Deluxe-ps型膝关节假体行一期双侧膝关节置换的膝关节炎患者15例(30膝)设为实验组,对照组为同期采用P.F.C.Sigma膝关节假体行一期双侧膝关节置换的20例患者(40膝)。采用KSS评分和关节功能HSS评分、膝关节关节活动度评估两组手术前、后膝关节功能,对比两组手术时间、及术中输血量。 结果与结论：两组患者置换后均得到12-24个月随访,平均16个月。置换后患者膝关节疼痛均缓解,关节功能恢复满意。两组膝关节置换后与置换前KSS评分、HSS评分及膝关节关节活动度比较,差异均有显著性意义(P < 0.05)。置换后,两组间KSS评分和HSS评分及膝关节关节活动度,差异均无显著性意义(P > 0.05),两组间置换过程中出血量比较,差异均无显著性意义(P > 0.05),手术时间比较,差异有显著性意义(P < 0.05)。说明采用Deluxe-ps膝关节假体行一期双膝关节置换近期疗效满意。     

计算机导航技术辅助全髋关节置换的系统分析

背景：传统手术方法依赖术者的经验和目测解剖标志来安置髋臼假体往往会产生偏差,而在术中应用计算机导航技术可以很好地提高髋臼假体位置的精确度。 目的：研究全髋关节置换应用计算机导航系统对髋臼假体植入位置精度的影响及临床意义。 方法：计算机检索Cochrane Library、MEDLINE、EMBASE、中国生物医学文献数据库、中国期刊全文数据库,手工检索相关的中文杂志,纳入符合要求的临床试验,用RevMan5.0.18软件进行统计分析。 结果与结论：共纳入9篇临床试验合计695例。Meta分析结果显示：与传统手术相比,计算机导航技术在全髋关节置换后髋臼假体位置放置更精准超[RR=0.22,95%CI(0.14~0.34),P < 0.000 01]、双下肢不等长较传统手术轻[RR=-4.61,95%CI(-7.74~-1.48),P=0.004];而外展角度[RR=-1.76,95%CI(-5.02~1.50),P=0.29]、前倾角度[RR=-1.28,95%CI(-5.68~3.12),P=0.57]、术后脱位率[RR=1.25,95%CI(0.05~31.66),P=0.89]差异均无显著性意义。提示导航技术与传统手术在髋臼位置的精确度方面差异并无显著性意义。     

初次全膝关节置换后弹力绷带的应用

文题释义：全膝关节置换：是目前治疗晚期原发性骨关节炎或者类风湿性膝关节炎的有效手段。它主要是通过外科手术将膝关节假体置入患者体内,代替原本生理结构,从而达到消除疼痛、恢复力线以及改善功能的目的。 弹力绷带：一般由自然纤维编织而成,治疗柔软,通常用于外科包扎护理。因其具有弹性高、透气性好、不会限制和影响活动、不会妨碍血液循环等独特优势,非常适合应用于关节部位的加压包扎。 背景：全膝关节置换后常规使用弹力绷带到底会不会使患者受益,目前仍缺乏足够的临床证据。 目的：探讨在初次全膝关节置换后使用弹力绑带是否对患者的预后有益。 方法：选择2017年9月至2018年9月因膝关节骨关节炎在青岛大学附属医院西海岸院区关节外科接受初次同期双侧全膝关节置换的60例患者,随机选择一侧肢体使用普通外科敷料的同时使用从脚背到大腿中部的弹力绷带加压包扎(弹力绷带组),一侧肢体只使用普通外科敷料(对照组)。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。由不参与患者管理的专业人员,在术后1,2,3和7 d分别测量患者双下肢(大腿、膝关节和小腿处)的周径、伸屈活动度以及静息、运动疼痛目测类比评分,记录术后24 h引流管引流量以及术后30 d内并发症发生情况。 结果与结论：①术后第1,2,3,7天,弹力绷带组大腿、膝关节以及小腿周径均小于对照组,膝关节活动度优于对照组,差异有显著性意义(P < 0.001);②术后第1,2天,弹力绷带组静息目测类比评分高于对照组(P < 0.001),但是术后第7天低于对照组(P < 0.001),在术后第3天,2组间差异无显著性意义;弹力绷带组运动目测类比评分在术后第1,2天要大于对照组(P < 0.001),但在术后第3,7天时2组差异无显著性意义;③2组间在伤口愈合并发症方面没有差异,但样本量过小,无法用有意义的统计学方法进行分析;④2组间在术后24 h时引流管引流量差异比较有显著性意义;⑤随访30 d内均未出现深部感染、静脉血栓以及再手术情况;⑥提示在初次膝关节置换术后应用从脚背到大腿中部的弹力绷带能有效减轻术肢肿胀及术后失血量,增加术肢的屈伸活动,有利于术后快速康复,值得推广应用。 ORCID: 0000-0001-6675-8904(张成龙) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

医学影像信息系统辅助全膝置换前计划中的作用与意义

BACKGROUND: In clinical application, Picture Archiving and Communication System gradually replaces the traditional preoperative planning mode of acetate template measurement on film, which can accurately obtain the parameters needed in the operation of total knee arthroplasty.     

全膝关节置换治疗晚期骨性关节炎

目的探讨全膝关节置换（totalknee arthroplasty,TKA）在膝关节骨性关节炎治疗中的疗效,手术要点及注意事项。方法对35例（41膝）晚期骨性关节炎患者行初次人工全膝关节置换术,采用膝前正中纵形切口和内侧髌旁入路,术后进行随访,对比术前术后膝关节功能评分（the Hospital for Special Surgery Knee Score,HSS）及膝关节活动度（range of motion,ROM）以观察疗效。结果全部病例均得到平均24个月的随访,均未出现感染、下肢静脉血栓等并发症。HSS评分由术前平均（69±7）分提高到术后平均（91±4．6）分。膝关节活动范围由术前平均95°提高到术后平均115°。结论全膝关节置换是治疗晚期膝关节骨性关节炎的最佳治疗手段。选择恰当的病例,良好的假体设计,精确的手术技术,术后积极的康复锻炼是影响术后结果的主要因素。     

Total knee arthroplasty with computer-assisted navigation more closely replicates normal knee biomechanics than conventional surgery

Background

Computer-assisted navigation in total knee arthroplasty (TKA) reduces variability and may improve accuracy in the postoperative static alignment. The effect of navigation on alignment and biomechanics during more dynamic movements has not been investigated.

全膝关节置换过程中鸡尾酒疗法联合股神经阻滞的镇痛效果

背景:全膝关节置换是挽救膝关节功能的重要措施,但术后疼痛给患者造成极大痛苦.多模式镇痛背景下,鸡尾酒疗法、股神经阻滞被广泛用于临床,镇痛效果确切;但是两种方法同时使用的镇痛效果及安全性不明,因此需要更多的临床证据.目的:观察鸡尾酒疗法联合股神经阻滞对全膝关节置换后镇痛、功能恢复的影响及安全性,为临床提供参考.方法:纳入...     

Evaluation of anteroposterior accelerometric change after bi-cruciate stabilized total knee arthroplasty and posterior stabilized total knee arthroplasty

BackgroundIn conventional total knee arthroplasty (TKA), the anterior cruciate ligament (ACL) is resected. ACL dysfunction causes knee instability and is regarded as one factor in poor TKA outcomes. In bi-cruciate stabilized (BCS) TKA, the implant reproduces ACL function and provides anterior stability. The objective of this study was to evaluate preoperative and postoperative X-rays and accelerometer gait measurements in patients who underwent BCS TKA and posterior-stabilized (PS) TKA to assess the postoperative acceleration changes of knees after these procedures and to compare them in terms of joint range of motion (ROM) and the New Knee Society Score (New KSS).MethodsThe subjects were 60 patients, 30 of whom underwent BCS TKA and 30 PS TKA. Joint ROM, New KSS, lateral X-rays of the standing extended knee, and accelerometer data were evaluated 12 months postoperatively.ResultsThere was no significant difference in joint ROM between the groups. Both had good New KSS results, but the functional activity score was significantly higher after BCS TKA than after PS TKA. X-rays showed a lower posterior offset ratio after BCS TKA than after PS TKA, with anteroposterior positioning closer to that of the normal knee.Accelerometer data showed that postoperative anteroposterior acceleration on the femoral side in the stance phase and swing phase was lower after BCS TKA than after PS TKA.ConclusionCompared with PS TKA, BCS TKA resulted in a higher functional activity score, closer positioning to that of the normal knee on lateral X-ray, and lower anteroposterior acceleration on the femoral side.     

Postoperative alignment in revision total knee arthroplasty,a comparison between intra and extra-medullary tibial alignment

BackgroundRevision total knee arthroplasty commonly involves stemmed components. If the diaphysis is engaged, this technique may be problematic for mechanical alignment (MA) in cases of tibial bowing, which are not infrequent (up to 30%).The aim of this study is to compare an intra-medullary(IM) and extra-medullary(EM) alignment method. We hypothesized that IM technique and canal-filling stems may result more frequently in valgus MA. On the other hand, an EM technique could produce less valgus knees but is at risk of creating MA outliers.MethodA retrospective radiographic analysis of revision TKAs was performed. The patients were divided to either the EM or IM alignment group and compared on the overall post-operative MA. The following parameters were measured on standing, long leg x-rays: Hip-knee-Ankle angle (HKA), mechanical lateral distal femoral angle and mechanical medial proximal tibial angle (mMPTA).Results119 cases of revision TKAs were included (EM = 80, IM = 39). There was a difference between the EM and IM group for the mean mMPTA (89.94° vs 90.92°, effect size = 0.45, p = 0.013) and HKA angle (1.64° vs 0.05°, effect size = 0.52, p = 0.0064). A higher proportion of IM patients were in overall valgus alignment (16/39, 41%) vs EM group (16/80, 20%, p = 0.0134). Both techniques showed the same proportion of outliers, defined as HKA angle more than 5 degrees from neutral mechanical alignment (11/80 vs 5/39, p = 0.286).ConclusionThe extra-medullary alignment method with short cemented stems creates less valgus mechanical alignment than the intra-medullary technique with press-fit stems, without creating more MA outliers.     

Component fracture in total knee arthroplasty

The records of 26 patients (27 knees) who sustained a fracture of a total condylar design total knee prosthesis were reviewed. Twenty-five fractures involved the tibial component and two involved the femoral component. Mean time to failure was 8.2 years for tibial components and 7.2 years for femoral components. The overall fracture prevalence rates were 0.33% and 0.03% for tibial and femoral components, respectively. Specific designs had increased fracture rates and revision arthroplasty increased the relative risk. Anatomic limb alignment exceeded 5 of varus or valgus in 24 of 25 knees with tibial component fractures. Lucencies were noted beneath all but one fractured tibial tray. However, 22 of 23 tibial components that had a keel or stem were well fixed distally and subsidence occurred only beneath the fractured portion of the prosthesis. Tibial component fractures are related to revision arthroplasty, prosthesis design, malalignment, and inadequate support beneath the tibial tray with good distal fixation.