Rothman Institute of Orthopedics, 925 Chestnut Street, Philadelphia, PA 19107, USA.
J Bone Joint Surg Am. 2010 Jan;92(1):92-7. doi: 10.2106/JBJS.H.00497.
A substantial number of patients experience postoperative cognitive changes following total joint arthroplasty. The change in mental status may be the result of fat and bone-marrow-debris embolization. We hypothesized that the use of computer-assisted total knee arthroplasty, which does not involve the use of intramedullary alignment rods, would produce less fat and bone-marrow-debris embolization and, hence, fewer changes in mental status.
Forty-seven patients who underwent total knee arthroplasty with use of a computer-assisted navigation system and forty-eight patients who underwent conventional total knee arthroplasty without the assistance of computer navigation were followed prospectively. The validated Folstein Mini-Mental State Examination (MMSE) was used to assess the mental status of the patients. The test was administered preoperatively, serially postoperatively while the patient was in the hospital, and at six months. Medication and oxygen requirements were recorded.
On the basis of the numbers studied, no significant differences in postoperative pain-medication or oxygen requirements were found between the group treated with computer-assisted navigation (the navigation group) and the group treated with conventional total knee arthroplasty (the control group). The mean postoperative MMSE score was 88.9 points in the navigation group and 89.3 points in the control group (p = 0.844). Twenty-five patients in the navigation group and thirty-six patients in the control group completed the test at six months. The mean score at that time was 95.3 points in the navigation group and 96.3 points in the control group (p = 0.514).
Further research is needed to determine if fat and bone-marrow-debris embolization is truly decreased by the use of computer-assisted total knee arthroplasty and if such a reduction has any clinical relevance.
大量患者在全膝关节置换术后会出现认知功能改变。精神状态的改变可能是脂肪和骨髓碎片栓塞的结果。我们假设使用不涉及髓内定位杆的计算机辅助全膝关节置换术会产生较少的脂肪和骨髓碎片栓塞，从而导致精神状态的变化较少。
前瞻性随访了 47 例使用计算机辅助导航系统行全膝关节置换术的患者和 48 例未行计算机导航辅助的常规全膝关节置换术患者。采用经过验证的福氏简易精神状态检查量表（MMSE）评估患者的精神状态。该测试在术前、术后住院期间连续进行，并在术后 6 个月进行。记录药物和氧气需求。
根据研究数量，计算机辅助导航治疗组（导航组）和常规全膝关节置换治疗组（对照组）之间在术后疼痛药物或氧气需求方面没有显著差异。导航组术后 MMSE 平均得分为 88.9 分，对照组为 89.3 分（p=0.844）。导航组有 25 例患者和对照组有 36 例患者完成了 6 个月的测试。此时，导航组的平均得分为 95.3 分，对照组为 96.3 分（p=0.514）。
需要进一步研究以确定计算机辅助全膝关节置换术是否确实减少了脂肪和骨髓碎片栓塞，如果这种减少具有临床意义。
