Sugano N, Nishii T, Miki H, Yoshikawa H, Sato Y, Tamura S
Department of Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871,Osaka, Japan.
J Bone Joint Surg Br. 2007 Apr;89(4):455-60. doi: 10.1302/0301-620X.89B4.18458.
We have developed a CT-based navigation system using infrared light-emitting diode markers and an optical camera. We used this system to perform cementless total hip replacement using a ceramic-on-ceramic bearing couple in 53 patients (60 hips) between 1998 and 2001. We reviewed 52 patients (59 hips) at a mean of six years (5 to 8) postoperatively. The mid-term results of total hip replacement using navigation were compared with those of 91 patients (111 hips) who underwent this procedure using the same implants, during the same period, without navigation. There were no significant differences in age, gender, diagnosis, height, weight, body mass index, or pre-operative clinical score between the two groups. The operation time was significantly longer where navigation was used, but there was no significant difference in blood loss or navigation-related complications. With navigation, the acetabular components were placed within the safe zone defined by Lewinnek, while without, 31 of the 111 components were placed outside this zone. There was no significant difference in the Merle d'Aubigne and Postel hip score at the final follow-up. However, hips treated without navigation had a higher rate of dislocation. Revision was performed in two cases undertaken without navigation, one for aseptic acetabular loosening and one for fracture of a ceramic liner, both of which showed evidence of neck impingement on the liner. A further five cases undertaken without navigation showed erosion of the posterior aspect of the neck of the femoral component on the lateral radiographs. These seven impingement-related mechanical problems correlated with malorientation of the acetabular component. There were no such mechanical problems in the navigated group. We conclude that CT-based navigation increased the precision of orientation of the acetabular component and control of limb length in total hip replacement, without navigation-related complications. It also reduced the rate of dislocation and mechanical problems related to impingement.
我们开发了一种基于CT的导航系统，该系统使用红外发光二极管标记物和光学相机。1998年至2001年间，我们使用该系统为53例患者（60髋）进行了采用陶瓷对陶瓷轴承对的非骨水泥型全髋关节置换术。我们对平均术后六年（5至8年）的52例患者（59髋）进行了随访。将使用导航进行全髋关节置换的中期结果与同期91例患者（111髋）未使用导航采用相同植入物进行该手术的结果进行了比较。两组在年龄、性别、诊断、身高、体重、体重指数或术前临床评分方面无显著差异。使用导航时手术时间明显更长，但在失血或与导航相关的并发症方面无显著差异。使用导航时，髋臼组件放置在Lewinnek定义的安全区内，而未使用导航时，111个组件中有31个放置在该区域之外。末次随访时Merle d'Aubigne和Postel髋关节评分无显著差异。然而，未使用导航治疗的髋关节脱位率更高。未使用导航的两例患者进行了翻修，一例为无菌性髋臼松动，一例为陶瓷衬垫骨折，两者均显示有颈部撞击衬垫的证据。另外五例未使用导航的患者在侧位X线片上显示股骨组件颈部后方有侵蚀。这七个与撞击相关的机械问题与髋臼组件的定位不良有关。导航组未出现此类机械问题。我们得出结论，基于CT的导航提高了全髋关节置换术中髋臼组件的定位精度和肢体长度控制，且无导航相关并发症。它还降低了脱位率以及与撞击相关的机械问题发生率。
