Kim Young-Hoo, Kim Jun-Shik, Hong Ki-Sook, Kim Youn-Jin, Kim Jong-Hak
The Joint Replacement Center of Korea, Ewha Womans University DongDaMun Hospital, 70, ChogRo 6-Ga, ChongRo-Gu, Seoul, South Korea.
J Bone Joint Surg Am. 2008 Jan;90(1):123-8. doi: 10.2106/JBJS.G.00176.
Total knee arthroplasty performed with computer-assisted navigation without breaching of the femoral medullary canal may decrease the prevalence of fat and/or bone-marrow-cell embolization. We performed this study to determine whether the use of navigation for primary total knee arthroplasty resulted in a different prevalence of fat and/or bone-marrow-cell embolization.
We enrolled 160 patients (210 knees) who were scheduled to undergo primary total knee arthroplasty with navigation and 160 patients (210 knees) who were scheduled to undergo primary total knee arthroplasty without navigation. Arterial and right atrial blood samples were obtained before insertion of a femoral alignment rod or cutting of the distal part of the femur (baseline); at one, three, five, and ten minutes after insertion of an alignment rod or cutting of the distal part of the femur; before insertion of a tibial component broach (baseline); at one, three, five, and ten minutes after insertion of a tibial component broach; and at twenty-four and forty-eight hours after the operation. We determined the presence of fat emboli and bone-marrow-cell emboli in histologic preparations of the blood samples.
The prevalence of fat embolization was 49% (102 of 210 knees) in the total knee arthroplasty group managed with navigation and 52% (109 of 210 knees) in the total knee arthroplasty group managed without navigation (p = 0.2674). The prevalence of bone-marrow-cell embolization was 17% (thirty-six of 210 knees) in the group managed with navigation and 15% (thirty-one of 210 knees) in the group managed without navigation (p = 0.2591)
The prevalence of fat and/or bone-marrow-cell embolization was not significantly different between the patients who underwent total knee arthroplasty with navigation and those who underwent it without navigation.
采用计算机辅助导航进行全膝关节置换术且不侵犯股骨髓腔，可能会降低脂肪和/或骨髓细胞栓塞的发生率。我们开展这项研究以确定在初次全膝关节置换术中使用导航是否会导致脂肪和/或骨髓细胞栓塞的发生率有所不同。
我们纳入了160例计划接受导航辅助初次全膝关节置换术的患者（210膝）以及160例计划接受非导航辅助初次全膝关节置换术的患者（210膝）。在插入股骨定位杆或切除股骨远端之前（基线）；插入定位杆或切除股骨远端后1分钟、3分钟、5分钟和10分钟；插入胫骨假体拉刀之前（基线）；插入胫骨假体拉刀后1分钟、3分钟、5分钟和10分钟；以及术后24小时和48小时采集动脉血和右心房血样本。我们在血样本的组织学制剂中检测脂肪栓子和骨髓细胞栓子的存在情况。
在采用导航辅助的全膝关节置换术组中，脂肪栓塞的发生率为49%（210膝中的102膝），在未采用导航辅助的全膝关节置换术组中为52%（210膝中的109膝）（p = 0.2674）。在采用导航辅助的组中，骨髓细胞栓塞的发生率为17%（210膝中的36膝），在未采用导航辅助的组中为15%（210膝中的31膝）（p = 0.2591）。
接受导航辅助全膝关节置换术的患者与未接受导航辅助全膝关节置换术的患者相比，脂肪和/或骨髓细胞栓塞的发生率无显著差异。
