A prospective, randomized study of computer-assisted and conventional total knee arthroplasty - Three-dimensional evaluation of implant alignment and rotation
A prospective, randomized study of computer-assisted and conventional total knee arthroplasty - Three-dimensional evaluation of implant alignment and rotation
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DOI：
10.2106/jbjs.f.00386
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发表时间：
2007-02-01
影响因子：
5.3
通讯作者：
Perka, Carsten
中科院分区：
文献类型：
--
作者：
Matziolis, Georg;Krocker, Doerte;Perka, Carsten
背景：尽管在全膝关节置换术中使用了现代器械，但假体对线不良仍然是一个问题。计算机辅助植入技术是否可以提高植入物空间定位的准确性是一个有争议的问题。本研究的目的是确定计算机辅助全膝关节置换术在植入物定位精度方面是否上级传统手术方法。方法：60例全膝关节置换术中植入物的空间定位（32个无图像计算机辅助和28个传统投影）使用计算机断层扫描测量进行三维测定，这允许反旋和完全伸展膝关节，以避免投影相关的成像误差。结果：整体机械轴显示，传统植入的关节成形术部件在额状面中的外翻对线范围为4.8度至6.6度，相比之下，该范围明显更小，为2.9度计算机辅助矫正的外翻和内翻对线为3.1度（p = 0.004）。对于胫骨[植入物]，传统手术方法与机械轴的平均偏差（和标准偏差）为2.0 ° +/- 1.7 °，导航植入为1.4 ° +/- 0.9 °。对于传统植入方法，股骨部件相对于参考轴的旋转偏差在3.3度内旋和5.0度外旋之间，平均偏差为0.1度+/- 2.2度。在计算机辅助下植入的股骨部件显示出4.7度内旋和2.2度外旋之间的偏差，平均偏差为0.3度+/- 1.4度。结论：在这项研究中，我们的技术过滤掉投影相关的成像误差，全膝关节置换的计算机辅助植入改善了股骨部件的正面和矢状面对准，但没有改善胫骨部件。我们发现，仅参考股骨上髁轴和胫骨粗隆进行导航并不能改善假体的旋转对线。证据等级：治疗I级。证据等级的完整描述见作者说明。
Background: Despite the use of modern instruments in total knee arthroplasty, component malalignment remains a problem. Whether a computer-assisted implantation technique can improve the accuracy of the spatial positioning of an implant is a matter of debate. The objective of this study was to determine whether computer-assisted total knee arthroplasty is superior to the conventional surgical method with regard to the precision of implant positioning.Methods: The spatial positioning of the implant in sixty total knee arthroplasties (thirty-two imageless computer-assisted and twenty-eight conventional implantations) was determined three-dimensionally with use of computed tomographic measurement, which allowed derotation and full extension of the knee in order to avoid projection-related imaging errors.Results: The overall mechanical axis showed a range of between 4.8 degrees of valgus and 6.6 degrees of varus alignment in the frontal plane for conventionally implanted arthroplasty components compared with a significantly smaller range of between 2.9 degrees of valgus and 3.1 degrees of varus alignment for computer-assisted implantations (p = 0.004). In relation to the tibia[ implant, the mean deviation (and standard deviation) from the mechanical axis was 2.0 degrees +/- 1.7 degrees for the conventional surgical method and 1.4 degrees +/- 0.9 degrees for the navigated implantation. The rotational deviation from the referenced axis of the femoral component was between 3.3 degrees of internal rotation and 5.0 degrees of external rotation for the conventional implantation method, with a mean deviation of 0.1 degrees +/- 2.2 degrees. Femoral components implanted with computer assistance showed a deviation of between 4.7 degrees of internal rotation and 2.2 degrees of external rotation, with a mean deviation of 0.3 degrees +/- 1.4 degrees.Conclusions: in this study, with our technique of filtering out projection-related imaging errors, computer-assisted implantation of total knee replacements improved the frontal and sagittal alignment of the femoral component but not of the tibial component. We found that the rotational alignment of the component was not improved through navigation by solely referencing to the epicondylar axis for the femur and the tuberosity for the tibia.Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.