Patellar computer-assisted surgery and intraoperative kinematics

人们接受膝关节置换术的主要原因是为了减轻关节炎引起的疼痛。不幸的是，有些人在手术后仍然有相当大的疼痛，通常在膝盖骨附近（称为膝前疼痛）。这种疼痛的原因通常是未知的。植入物的疼痛和其他问题通常归因于由于手术期间部件的放置不佳而导致的膝盖骨（髌骨）在大腿骨（股骨）上的不正确跟踪。计算机辅助手术（CAS）使用有关患者解剖结构和外科医生工具位置的信息来指导外科医生将部件放置在最佳位置;然而，到目前为止，这主要集中在大型膝关节骨（股骨和胫骨）而不是髌骨。我们提出了四个相关的项目来回答以下问题：（1）能否开发一种新的计算机辅助方法来改善髌骨切割，它是否比传统方法更准确？(2)能否开发一种改进的方法来测量放置部件前后髌骨的运动，其准确性是否与金标准（即计算机断层扫描（CT））相当？(3)根据与非CAS入路相比所产生的切割角度的准确性、所需的额外时间和临床结果，这些系统能否在临床上成功实施？(4)使用植入物部件进行膝关节表面置换对术中测量的髌骨运动学是否有显著影响？从长期来看，我们的目标是实现髌骨对称截骨和髌骨轨迹平衡，以提高患者生活质量和植入物寿命，并使用术中运动学测量来改进植入物设计和手术技术。

The primary reason for someone to get a knee replacement is to reduce his or her pain due to arthritis. Unfortunately, some people still have considerable pain after the surgery, often in the vicinity of the kneecap (called anterior knee pain). The reasons for this pain are usually unknown. Pain and other problems with the implant are often attributed to incorrect tracking of the kneecap (patella) on the thigh bone (femur) due to less-than-optimal placement of the components during surgery. Computer-assisted surgery (CAS) uses information about the patient's anatomy and the location of the surgeon's tools to guide the surgeon to place the components in the best position; however, so far, this has focused on the large knee bones (femur and tibia) and not the patella. We are proposing four related projects to answer the following questions: (1) Can a novel computer-assisted method be developed to improve the patellar cut, and is it more accurate than the traditional approach? (2) Can an improved method be developed to measure the movement of the patella before and after placing the components and is the accuracy comparable to a gold standard, namely computed-tomography (CT)? (3) Can these systems be successfully implemented clinically, based on the accuracy of the resulting cut angle compared to the non-CAS approach, the extra time required, and the clinical results? (4) Does resurfacing the knee with implant components have a significant effect on patellar kinematics measured intraoperatively? In the longterm, our goals are to achieve symmetric patellar bone cuts and balanced patellar tracking to improve patient quality of life and implant longevity, and to use intraoperative kinematic measurements to improve implant design and surgical technique.