Dutton Andrew Quoc, Yeo Seng-Jin, Yang Kuang-Ying, Lo Ngai-Nung, Chia Kui-Un, Chong Hwei-Chi
Department of Orthopaedic Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore.
J Bone Joint Surg Am. 2008 Jan;90(1):2-9. doi: 10.2106/JBJS.F.01148.
There is little information on the feasibility of computer navigation when using a minimally invasive approach for total knee arthroplasty, during which the anatomic landmarks for registration may be obscured. The purpose of the present study was to determine the radiographic accuracy of this technique and to compare the rate of functional recovery between patients who underwent computer-assisted minimally invasive arthroplasty and those who underwent conventional total knee arthroplasty.
One hundred and eight consecutive patients were randomized to undergo computer-assisted minimally invasive total knee arthroplasty or conventional total knee arthroplasty. Perioperative pain management was standardized. The clinical parameters, long-leg radiographs, and functional assessment scores were evaluated for six months postoperatively.
Patients who underwent computer-assisted minimally invasive total knee arthroplasty had a significantly longer operative time (by a mean of twenty-four minutes) and a significantly shorter inpatient stay (3.3 compared with 4.5 days) in comparison with those who underwent conventional arthroplasty (p </= 0.001). Significantly more patients in the computer-assisted minimally invasive total knee arthroplasty group were able to walk independently for more than thirty minutes at one month (p = 0.04). The percentage of patients with a coronal tibiofemoral angle within +/-3 degrees of the ideal was 92% for the computer-assisted minimally invasive total knee arthroplasty group, compared with 68% for the conventional total knee arthroplasty group (p = 0.003).
Although specific clinical parameters reflect an early increased rate of functional recovery in association with computer-assisted minimally invasive total knee arthroplasty within the first postoperative month, the main advantage of this technique over conventional total knee arthroplasty is improved postoperative radiographic alignment without increased short-term complications.
对于全膝关节置换术采用微创方法时计算机导航的可行性，相关信息较少，在此过程中用于注册的解剖标志可能会被遮挡。本研究的目的是确定该技术的放射学准确性，并比较接受计算机辅助微创关节置换术的患者与接受传统全膝关节置换术的患者之间的功能恢复率。
108例连续患者被随机分为接受计算机辅助微创全膝关节置换术或传统全膝关节置换术。围手术期疼痛管理标准化。术后6个月评估临床参数、长腿X线片和功能评估评分。
与接受传统关节置换术的患者相比，接受计算机辅助微创全膝关节置换术的患者手术时间明显更长（平均长24分钟），住院时间明显更短（分别为3.3天和4.5天）（p≤0.001）。在计算机辅助微创全膝关节置换术组中，明显更多的患者在1个月时能够独立行走超过30分钟（p = 0.04）。计算机辅助微创全膝关节置换术组中冠状位胫股角在理想角度±3度范围内的患者百分比为92%，而传统全膝关节置换术组为68%（p = 0.003）。
尽管特定临床参数反映出术后第一个月内计算机辅助微创全膝关节置换术功能恢复率早期有所提高，但该技术相对于传统全膝关节置换术的主要优势在于术后放射学对线改善，且短期并发症未增加。
