Clinical value of gap balance technique guided by computer-assisted navigation in total knee replacement: report of 63 cases
- Journal of Third Military Medical University Vol. 41, Issue 21, Pages: 2120-2126(2019)
- 作者机构：
400042 重庆，陆军军医大学(第三军医大学)大坪医院骨科
- 作者简介：
- 基金信息：
DOI：10.16016/j.1000-5404.201905059
CLC： R182.32;R319;687.4Received：08 May 2019，
Revised：2019-07-15，
Published：15 November 2019
- 稿件说明：
移动端阅览
Chuanjiang XIE, Hongjiu QIU, Shuaifeng LI, et al. Clinical value of gap balance technique guided by computer-assisted navigation in total knee replacement: report of 63 cases[J]. Journal of Third Military Medical University, 2019, 41(21): 2120-2126.
Chuanjiang XIE, Hongjiu QIU, Shuaifeng LI, et al. Clinical value of gap balance technique guided by computer-assisted navigation in total knee replacement: report of 63 cases[J]. Journal of Third Military Medical University, 2019, 41(21): 2120-2126. DOI： 10.16016/j.1000-5404.201905059.
摘要
目的
2
对比研究计算机导航系统辅助下间隙平衡技术在全膝关节置换术中的应用价值。
方法
2
选取2018年1-6月的63例原发性膝关节骨性关节炎的患者行全膝关节置换术，分为计算机导航辅助下间隙平衡技术组(31例)和测量截骨技术组(32例)。记录计算机导航辅助下间隙平衡技术组术中屈伸间隙内外侧韧带张力大小，测量并比较两组术后下肢冠状面机械轴力线，手术切口长度，手术时间，术中出血量，术后引流量，术后并发症发生率，术后1、6、12个月的视觉模拟评分(Vas疼痛评分)及膝关节KSS评分等指标。
结果
2
计算机导航间隙平衡技术组的手术时间长于测量截骨技术组(
P
<
0.05)，切口长度、术中出血量、术后引流量、术后并发症发生率两组比较差异无统计学意义(
P
>
0.05)。计算机导航辅助下间隙平衡技术组术后下肢冠状面机械轴力线(0.63±0.54)°优于测量截骨技术组[(1.98±0.52)°，
P
<
0.05
]
；计算机导航辅助下间隙平衡技术组术后1个月的Vas疼痛评分(3.53±0.51)分优于测量截骨技术组[(4.24±0.49)分，
P
<
0.05
]
；计算机导航下间隙平衡技术组术后1个月KSS功能评分存在优于测量截骨技术组的趋势，但差异无统计学意义(
P
>
0.05)；术后6个月和12个月的Vas评分和KSS功能评分两组差异无统计学意义(
P
>
0.05)。计算机导航辅助下间隙平衡技术组中31例患者屈伸间隙内外侧韧带张力范围在70~95 N，平均84 N。
结论
2
计算机导航辅助下间隙平衡技术能精确术中截骨，提高全膝关节置换术的手术精准度，术后患者疼痛及功能在短期内恢复较好。
Abstract
Objective
2
To investigate the value of gap balance technique guided by computer-assisted navigation in total knee replacement.
Methods
2
A total of 63 patients with primary knee osteoarthritis and underwent total knee replacement from January to June 2018 were recruited in this study. They were randomly divided into experimental group (
n
=31
gap balance technique guided by computer-assisted navigation) and control group (
n
=31
osteotomy technique). The tension of medial and lateral ligaments in the flexion and extension space was recorded
and the limb alignment
incision length
operative time
blood loss volume
drainage volume
incidence of postoperative complications
and visual analogue scale (Vas) score and knee society knee score (KSS) in 1
6 and 12 months after operation were recorded and compared between 2 groups.
Results
2
The operative time in experimental group was significantly longer than that in the control group (
P
<
0.05)
but there were no significant differences in incision length
blood loss
drainage volume and incidence of postoperative complications between 2 groups (
P
>
0.05). The limb alignment was better in the experimental group than the control group [(0.63±0.54)°
vs
(1.98±0.52)
°
P
<
0.05
]
. In 1 month after operation
the experimental group achieved significantly better Vas score (3.53±0.51
vs
4.24±0.49
P
<
0.05)
but similar KSS score (69.3±5.1
vs
67.5±3.7
P
>
0.05) when compared with the control group. But
in 6 and 12 months after surgery
no statistic differences were seen in the above 2 scores (
P
>
0.05). For the patients from the experimental group
the tension of medial and lateral ligaments in the flexion and extension space ranged from 70 to 95 N
with an average of 84 N.
Conclusion
2
Gap balance technique guided by computer-assisted navigation can improve the accuracy of osteotomy in total knee replacement
with postoperative benefits of significantly reducing pain and rapid recovery during the early postoperative period
but having no obvious effect on outcome after 1 year's follow-up.
关键词
Keywords
references
TANI I, NAKANO N, TAKAYAMA K, et al . Navigated total knee arthroplasty for osteoarthritis with extra-articular deformity[J ] . Acta Ortop Bras, 2018, 26(3): 170-174. DOI:10.1590/1413-785220182603178367.
INDELLI P F, RISITANO S, HALL K E, et al . Effect of polyethylene conformity on total knee arthroplasty early clinical outcomes[J ] . Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1028-1034. DOI:10.1007/s00167-018-5170-5.
MANNING W A, BLAIN A, LONGSTAFF L, et al . A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but May lead to a more lax knee state[J ] . Knee Surg Sports Traumatol Arthrosc, 2019, 27(7): 2238-2250. DOI:10.1007/s00167-018-5164-3.
INSALL J N. Presidential address to the knee society. choices and compromises in total knee arthroplasty[J]. Clin Orthop Relat Res, 1988(226): 43-48.
MORELAND J R. Mechanisms of failure in total knee arthroplasty[J]. Clin Orthop Relat Res, 1988(226): 49-64. DOI:10.1097/00003086-198801000-00010.
MAHALUXMIVALA J, BANKES M J, NICOLAI P, et al . The effect of surgeon experience on component positioning in 673 Press Fit Condylar posterior cruciate-sacrificing total knee arthroplasties[J ] . J Arthroplasty, 2001, 16(5): 635-640. DOI:10.1054/arth.2001.23569.
REBAL B A, BABATUNDE O M, LEE J H, et al . Imageless computer navigation in total knee arthroplasty provides superior short term functional outcomes: a meta-analysis[J ] . J Arthroplasty, 2014, 29(5): 938-944. DOI:10.1016/j.arth.2013.09.018.
BARRETT W P, MASON J B, MOSKAL J T, et al . Comparison of radiographic alignment of imageless computer-assisted surgery vs conventional instrumentation in primary total knee arthroplasty[J ] . J Arthroplasty, 2011, 26(8): 1273-1284.e1. DOI:10.1016/j.arth.2011.04.037..
KLEIN G R, PARVIZI J, RAPURI V R, et al . The effect of tibial polyethylene insert design on range of motion: evaluation of in vivo knee kinematics by a computerized navigation system during total knee arthroplasty[J ] . J Arthroplasty, 2004, 19(8): 986-991. DOI:10.1016/j.arth.2004.07.002..
KRACKOW K A, BAYERS-THERING M, PHILLIPS M J, et al . A new technique for determining proper mechanical axis alignment during total knee arthroplasty: progress toward computer-assisted TKA[J ] . Orthopedics, 1999, 22(7): 698-702. DOI:10.1016/S0030-5898(05)70103-6.
BARRETT W P, MASON J B, MOSKAL J T, et al . Comparison of radiographic alignment of imageless computer-assisted surgery vs conventional instrumentation in primary total knee arthroplasty[J ] . J Arthroplasty, 2011, 26(8): 1273-1284.e1. DOI:10.1016/j.arth.2011.04.037..
BOTTROS J, GAD B, KREBS V, et al . Gap balancing in total knee arthroplasty[J ] . J Arthroplasty, 2006, 21(4 Suppl 1): 11-15. DOI:10.1016/j.arth.2006.02.084.
SCHOENMAKERS D A L, FECZKO P Z, BOONEN B, et al . Measurement of lower limb alignment: there are within-person differences between weight-bearing and non-weight-bearing measurement modalities[J ] . Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3569-3575. DOI:10.1007/s00167-017-4636-1.
BROWN M J C, DEAKIN A H, PICARD F, et al . Lower limb alignment becomes more varus and hyperextended from supine to bipedal stance in asymptomatic, osteoarthritic and prosthetic neutral or varus knees[J ] . Kn ee Surg Sports Traumatol Arthrosc, 2019, 27(5):1635-1641.DOI:10.1007/s00167-018-5273-z.
GROMOV K, KORCHI M, THOMSEN M G, et al . What is the optimal alignment of the tibial and femoral components in knee arthroplasty?[J ] . Acta Orthop, 2014, 85(5): 480-487. DOI:10.3109/17453674.2014.940573.
LORDING T, LUSTIG S, NEYRET P. Coronal alignment after total knee arthroplasty[J]. EFORT Open Rev, 2016, 1(1): 12-17. DOI:10.1302/2058-5241.1.000002.
WIESER K. CORR insights ® : femoral component varus malposition is associated with tibial aseptic loosening after TKA[J ] . Clin Orthop Relat Res, 2018, 476(2): 408-409. DOI:10.1007/s11999.0000000000000126.
IORIO R, MAZZA D, BOLLE G, et al . Computer-assisted surgery: a teacher of TKAs[J ] . Knee, 2013, 20(4): 232-235. DOI:10.1016/j.knee.2012.06.009.
KHAKHA R S, CHOWDHRY M, SIVAPRAKASAM M, et al . Radiological and functional outcomes in computer assisted total knee arthroplasty between consultants and trainees—A prospective randomized controlled trial[J ] . J Arthroplasty, 2015, 30(8): 1344-1347. DOI:10.1016/j.arth.2015.03.007.
PANJWANI T R, MULLAJI A, DOSHI K, et al . Comparison of functional outcomes of computer-assisted vs conventional total knee arthroplasty: A systematic review and meta-analysis of high-quality, prospective studies[J ] . J Arthroplasty, 2019, 34(3): 586-593. DOI:10.1016/j.arth.2018.11.028..
CIP J, WIDEMSCHEK M, LUEGMAIR M, et al . Conventional versus computer-assisted technique for total knee arthroplasty: a minimum of 5-year follow-up of 200 patients in a prospective randomized comparative trial[J ] . J Arthroplasty, 2014, 29(9): 1795-1802. DOI:10.1016/j.arth.2014.04.037.
PETURSSON G, FENSTAD A M, GØTHESENØ, et al . Computer-assisted compared with conventional total knee replacement: A multicenter parallel-group randomized controlled trial[J ] . J Bone Joint Surg Am, 2018, 100(15): 1265-1274. DOI:10.2106/JBJS.17.01338.
CLEMENT N D, MAKARAM N, BELL J, et al . Columbus ® computer navigated total knee arthroplasty: Gap balancing versus measured resection[J ] . Knee, 2017, 24(6): 1442-1447. DOI:10.1016/j.knee.2017.08.004..
DE STEIGER R N, LIU Y L, GRAVES S E. Computer navigation for total knee arthroplasty reduces revision rate for patients less than sixty-five years of age[J]. J Bone Joint Surg Am, 2015, 97(8): 635-642. DOI:10.2106/JBJS.M.01496.
DYRHOVDEN G S, FENSTAD A M, FURNES O, et al . Survivorship and relative risk of revision in computer-navigated versus conventional total knee replacement at 8-year follow-up[J ] . Acta Orthop, 2016, 87(6): 592-599. DOI:10.1080/17453674.2016.1244884.
GHOLSON J J, DUCHMAN K R, OTERO J E, et al . Computer navigated total knee arthroplasty: rates of adoption and early complications[J ] . J Arthroplasty, 2017, 32(7): 2113-2119. DOI:10.1016/j.arth.2017.01.034.
KIM Y H, PARK J W, KIM J S. The clinical outcome of computer-navigated compared with conventional knee arthroplasty in the same patients: A prospective, randomized, double-blind, long-term study[J]. J Bone Joint Surg Am, 2017, 99(12): 989-996. DOI:10.2106/JBJS.16.00791.
BURNETT R S, BARRACK R L. Computer-assisted total knee arthroplasty is currently of no proven clinical benefit: a systematic review[J]. Clin Orthop Relat Res, 2013, 471(1): 264-276. DOI:10.1007/s11999-012-2528-8.
HEESTERBEEK P J C, HAFFNER N, WYMENGA A B, et al . Patient-related factors influence stiffness of the soft tissue complex during intraoperative gap balancing in cruciate-retaining total knee arthroplasty[J ] . Knee Surg Sports Traumatol Arthrosc, 2017, 25(9): 2760-2768. DOI:10.1007/s00167-015-3694-5.
0
Views
0
下载量
0
CSCD
- L-PDFDownload
- Meta-XMLDownload
- BibTeXDownload
- EndnoteDownload
- RefMan Download
- NoteExpressDownload
- NoteFirstDownload
Publicity Resources
Related Articles
Related Author
Related Institution
- Technical support is provided by Beijing Founder electronics co., LTD 京ICP备09064830号-19
京公网安备11010802024621 - It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
- Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.
