在计算机导航全膝关节置换术中，平均不同的对线轴可改善股骨旋转对线。
Averaging different alignment axes improves femoral rotational alignment in computer-navigated total knee arthroplasty.
作者信息
Siston Robert A, Cromie Melinda J, Gold Garry E, Goodman Stuart B, Delp Scott L, Maloney William J, Giori Nicholas J
机构信息
Department of Mechanical Engineering, Ohio State University, Columbus, OH 43210, USA.
出版信息
J Bone Joint Surg Am. 2008 Oct;90(10):2098-104. doi: 10.2106/JBJS.G.00996.
BACKGROUND
Computer navigation systems generally establish the rotational alignment axis of the femoral component on the basis of user-defined anatomic landmarks. However, navigation systems can also record knee kinematics and average alignment axes established with multiple techniques. We hypothesized that establishing femoral rotational alignment with the use of kinematic techniques is more accurate and precise (repeatable) than the use of anatomic techniques and that establishing femoral rotational alignment by averaging the results of different alignment techniques is more accurate and precise than the use of a single technique.
METHODS
Twelve orthopaedic surgeons used three anatomic and two kinematic alignment techniques to establish femoral rotational alignment axes in a series of nine cadaver knees. The axes derived with the individual anatomic and kinematic techniques as well as the axes derived with six combination techniques--i.e., those involving averaging of the alignments established with two of the individual techniques--were compared against a reference axis established with computed tomography images of each femur.
RESULTS
The kinematic methods were not more accurate (did not have smaller mean errors) or more precise (repeatable) than the anatomic techniques. The combination techniques were accurate (five of the six had a mean error of <5 degrees ) and significantly more precise than all but one of the single methods. The percentage of measurements with <5 degrees of error as compared with the reference epicondylar axis was 37% for the individual anatomic techniques, 30% for the individual kinematic techniques, and 58% for the combination techniques.
CONCLUSIONS
Averaging the results of kinematic and anatomic techniques, which is possible with computer navigation systems, appears to improve the accuracy of rotational alignment of the femoral component. The number of rotational alignment outliers was reduced when combination techniques were used; however, they are still a problem and continued improvement in methods to accurately establish rotation of the femoral component in total knee arthroplasty is needed.
背景
计算机导航系统通常根据用户定义的解剖标志来确定股骨组件的旋转对线轴。然而，导航系统也可以记录膝关节运动学以及通过多种技术建立的平均对线轴。我们假设，与使用解剖技术相比，使用运动学技术建立股骨旋转对线更准确、更精确（可重复），并且通过平均不同对线技术的结果来建立股骨旋转对线比使用单一技术更准确、更精确。
方法
12名骨科医生使用三种解剖和两种运动学对线技术，在一系列9个尸体膝关节中确定股骨旋转对线轴。将通过个体解剖和运动学技术得出的轴，以及通过六种组合技术得出的轴（即涉及对两种个体技术所建立的对线进行平均的技术）与通过每个股骨的计算机断层扫描图像建立的参考轴进行比较。
结果
运动学方法并不比解剖技术更准确（平均误差更小）或更精确（可重复）。组合技术是准确的（六种中有五种平均误差<5度），并且除一种单一方法外，比所有其他单一方法都显著更精确。与参考上髁轴相比，误差<5度的测量百分比在个体解剖技术中为37%，在个体运动学技术中为30%，在组合技术中为58%。
结论
计算机导航系统可以实现运动学和解剖学技术结果的平均化，这似乎提高了股骨组件旋转对线的准确性。使用组合技术时，旋转对线异常值的数量减少；然而，它们仍然是一个问题，需要继续改进在全膝关节置换术中准确确定股骨组件旋转的方法。
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