Martin Arno, Wohlgenannt Othmar, Prenn Michael, Oelsch Christian, von Strempel Archibald
Department of Orthopedic Surgery, Academic Teaching Hospital, Medical University of Innsbruck, Feldkirch, Austria.
Clin Orthop Relat Res. 2007 Jul;460:178-84. doi: 10.1097/BLO.0b013e31804ea45f.
Because we are performing TKAs on heavier, younger patients, greater stress is being put on the implants and is increasing the importance of implantation accuracy. We performed a prospective randomized study to compare the radiographic results and the 3-month clinical outcomes in 100 patients who had TKAs using an imageless navigation system with 100 patients treated using conventional implantation instruments. We measured component alignment by standard radiographs. Clinical outcomes were based on the Insall score, anterior knee pain, feeling of instability, and the step test. The mechanical axis of the limb was within 3 degrees varus/valgus in 92% of the patients who had navigated procedures versus 76% of patients who had conventional surgery. The tibial slope showed a rate of inaccuracy of 3 degrees or less for 98% of the patients in the navigated TKA group versus 80% of the patients in the conventional group. The surgical time was longer for navigated TKA than for the conventional procedure (88 +/- 16 versus 68 +/- 18 minutes, respectively). Clinical outcomes and postoperative blood loss were similar in both groups. The navigation system increased implantation accuracy but did not prevent outliers and did not solve the problems associated with identifying and obtaining accurate component rotation.
由于我们正在对更重、更年轻的患者进行全膝关节置换术（TKA），植入物承受的压力更大，这也增加了植入准确性的重要性。我们进行了一项前瞻性随机研究，比较了100例使用无图像导航系统进行TKA的患者与100例使用传统植入器械治疗的患者的影像学结果和3个月的临床结局。我们通过标准X线片测量组件对线情况。临床结局基于Insall评分、膝关节前侧疼痛、不稳定感和台阶试验。在接受导航手术的患者中，92%的患者肢体机械轴内翻/外翻在3度以内，而接受传统手术的患者这一比例为76%。在导航全膝关节置换术组中，98%的患者胫骨坡度不准确率在3度或以下，而传统组这一比例为80%。导航全膝关节置换术的手术时间比传统手术长（分别为88±16分钟和68±18分钟）。两组的临床结局和术后失血量相似。导航系统提高了植入准确性，但不能防止出现异常值，也不能解决与识别和获得准确组件旋转相关的问题。
