The Use of Patient-Specific Intra-Operative Guides for Total Knee Arthroplasty (TKA) -
The Use of Patient-Specific Intra-Operative Guides for Total Knee Arthroplasty (TKA) -
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在全膝关节置换术 (TKA) 中使用针对患者的术中指南 -
DOI：
10.5455/aces.20120402071919
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发表时间：
2012
影响因子：
--
通讯作者：
P. Chandrashekar
中科院分区：
文献类型：
--
作者：
H. Delport;P. Chandrashekar
目的：我们描述了一种使用患者专用导轨进行全膝关节置换术的新技术。术后通过腿部X线片和CT扫描评估肢体和假体对位情况。
材料和方法：5例采用该技术行全膝关节置换术的患者为研究对象。所有患者均进行了术前核磁共振检查。这一MRI扫描导致了针对患者的植入物大小和位置的计划。外科医生有能力在批准和制造指南(Biomet，先锋标志性个性化关节炎护理)之前改变计划。在手术过程中，患者特定的导向器在患者的膝盖上找到其独特的位置，为远端切除导向器、4合1切割块和胫骨近端切割导向器提供准确的销钉放置。这种方法的优点是根据适当的解剖结构为每个患者提供特定的指导。不需要进行髓内径路以调整轴线。通过为单独的膝盖提供特定的指南，每个膝盖都得到了不同的处理，与其固有的解剖结构相对应。通过膝关节站立前后和侧位X线片以及假体旋转对齐的CT扫描，评估围手术期的手术时间和术后植入物的位置。
结果：平均手术时间65.6分钟。股骨假体冠状角度平均为89.2。股骨假体矢状面角度平均为88.8。胫骨冠状假体角度平均为89.4。股骨平均旋转角0.6度，胫骨平均旋转角1.2度。
结论：我们认为这项新技术具有主要的优点：手术时间更短，种植体位适当，但更多的前瞻性研究是强制性的。
Purpose: We describe a new technique of total knee replacement using patient-specific guides. Postoperatively, extremity and component alignment were evaluated by full-length leg x-rays and CT scans.
Material and methods: 5 patients who underwent Total Knee Replacement with this technique were included in the study. In every patient, a preoperative MRI was taken. This MRI scan leads to a patient-specific plan of implant size and positioning. The surgeon has the ability to alter the planning before the approval and manufacturing of guides (BIOMET, Vanguard Signature Personalised Arthritis Care). During the operation, the patient-specific guides find their unique position on the patient’s knee, providing exact pin placement for the distal resection guide, 4-in-1 cutting block and the proximal tibial cutting guide. The advantage of this method is providing each patient with a specific guide depending upon the proper anatomy. Intramedullary access for axis alignment is unnecessary. By providing specific guides for individual knees, each knee is dealt with differently, corresponding to its native anatomy. Perioperative time of surgery and postoperative implant position were evaluated by standing antero-posterior and lateral x-rays of the knee as well as a CT scan for rotational alignment of components.
Results: The mean operative time is 65.6 minutes. The mean coronal femoral component angle is 89.2. The mean sagittal femoral component angle is 88.8. The mean coronal tibial component angle is 89.4. The mean femoral rotation angle is 0.6 degrees, and the mean tibial rotation angle is 1.2.
Conclusions: We conclude that this novel technique hereby described has major benefits: less operative time and proper implant positioning, but more prospective studies are mandatory.