Turajane Thana, Larbpaiboonpong Viroj, Kongtharvonskul Jatupon, Maungsiri Samart
Department of Orthopedic Surgery, Police General Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2009 Dec;92 Suppl 6:S51-8.
Mini-incision subvastus approach is soft tissue preservation of the knee. Advantages of the mini-incision subvastus approach included reduced blood loss, reduced pain, self rehabilitation and faster recovery. However, the improved visualization, component alignment, and more blood preservation have been debatable to achieve the better outcome and preventing early failure of the Total Knee Arthroplasty (TKA). The computer navigation has been introduced to improve alignment and blood loss. The purpose of this study was to evaluate the short term outcomes of the combination of computer assisted mini-incision subvastus approach for Total Knee Arthroplasty (CMS-TKA).
A prospective case series of the initial 80 patients who underwent computer assisted mini-incision subvastus approach for CMS-TKA from January 2007 to October 2008 was carried out. The patients' conditions were classified into 2 groups, the simple OA knee (varus deformity was less than 15 degree, BMI was less than 20%, no associated deformities) and the complex deformity (varus deformity was more than 15 degrees, BMI more was than 20%, associated with flexion contractor). There were 59 patients in group 1 and 21 patients in group 2. Of the 80 knees, 38 were on the left and 42 on the right.
The results of CMS-TKA [the mean (range)] in group 1: group 2 were respectively shown as the incision length [10.88 (8-13): 11.92 (10-14], the operation time [118 (111.88-125.12): 131 (119.29-143.71) minutes, lateral releases (0 in both groups), postoperative range of motion in flexion [94.5 (90-100): 95.25 (90-105) degree] and extension [1.75 (0-5): 1.5 (0-5) degree] Blood loss in 24 hours [489.09 (414.7-563.48): 520 (503.46-636.54) ml] and blood transfusion [1 (0-1) unit? in both groups], Tibiofemoral angle preoperative [Varus = 4 (varus 0-10): Varus = 17.14 (varus 15.7-18.5) degree, Tibiofemoral angle postoperative [Valgus = 1.38 (Valgus 0-4): Valgus = 2.85 (valgus 2.1-3.5) degree], Tibiofemoral angle outlier (85% both groups), and Knee society score preoperative and postoperative [64.6 (59.8-69.4) and 93.7 (90.8-96.65)]: 69 (63.6-74.39) 92.36 (88.22-96.5)]. The complications found in both groups were similar. No deep vein thrombosis, no fracture at both femur and tibia, no vascular injury, and no pin tract pain or infection was found in both groups.
The computer assisted CMS-TKA) is one of the appropriate procedures for all varus deformity, no limitation with the associated bone loss, flexion contractor, BMI, except the fixed valgus deformity. To ensure the clinical outcomes, multiple key steps were considered as the appropriate techniques for this approach which included the accurate registration, precision bone cut and ligament balances, and the good cement techniques.
小切口股直肌下入路可保护膝关节软组织。小切口股直肌下入路的优点包括减少失血、减轻疼痛、自我康复以及恢复更快。然而，在全膝关节置换术（TKA）中，为实现更好的手术效果并预防早期失败，改善可视化、假体对线以及更多的血液保存一直存在争议。计算机导航技术已被引入以改善对线和减少失血。本研究的目的是评估计算机辅助小切口股直肌下入路全膝关节置换术（CMS-TKA）的短期疗效。
对2007年1月至2008年10月接受计算机辅助小切口股直肌下入路CMS-TKA的80例患者进行前瞻性病例系列研究。将患者情况分为两组，单纯性骨关节炎膝关节（内翻畸形小于15度，体重指数小于20%，无相关畸形）和复杂畸形（内翻畸形大于15度，体重指数大于20%，伴有屈曲挛缩）。第1组有59例患者，第2组有21例患者。80个膝关节中，38个在左侧，42个在右侧。
第1组和第2组CMS-TKA的结果（平均值[范围]）分别如下：切口长度[10.88（8 - 13）：11.92（10 - 14）]，手术时间[118（111.88 - 125.12）：131（119.29 - 143.71）分钟]，外侧松解（两组均为0），术后屈曲活动范围[94.5（90 - 100）：95.25（90 - 105）度]和伸直[1.75（0 - 5）：1.5（0 - 5）度]，24小时失血量[489.09（414.7 - 563.48）：520（503.46 - 636.54）毫升]和输血[1（0 - 1）单位]，两组均如此，术前胫股角[内翻 = 4（内翻0 - 10）：内翻 = 17.14（内翻15.7 - 18.5）度]，术后胫股角[外翻 = 1.38（外翻0 - 4）：外翻 = 2.85（外翻2.1 - 3.5）度]，胫股角异常值（两组均为85%），以及术前和术后膝关节协会评分[64.6（59.8 - 69.4）和93.7（90.8 - 96.65）]：69（63.6 - 74.39）92.36（88.22 - 96.5）。两组发现的并发症相似,两组均未发现深静脉血栓形成、股骨和胫骨骨折、血管损伤、针道疼痛或感染。
计算机辅助CMS-TKA是治疗所有内翻畸形的合适手术方法之一，除固定性外翻畸形外，对相关骨质丢失、屈曲挛缩、体重指数无限制。为确保临床疗效，多个关键步骤被认为是该手术方法的合适技术，包括准确注册、精确截骨和韧带平衡以及良好的骨水泥技术。
