术中透视可提高传统 TKA 的手术精度。
Intraoperative fluoroscopy improves surgical precision in conventional TKA.
机构信息
Polyclinique de la Thiérache, Service d'Orthopédie, Rue du Dr Edmond Koral, 59212, Wignehies, France,
出版信息
Knee Surg Sports Traumatol Arthrosc. 2014 Jul;22(7):1619-25. doi: 10.1007/s00167-012-2350-6. Epub 2012 Dec 22.
PURPOSE
The purpose of this study was to assess whether intraoperative fluoroscopy assists in the restoration of the coronal limb alignment target in conventional total knee arthroplasty (TKA).
METHODS
One hundred and six patients undergoing conventional cemented TKA were randomly assigned to be operated on with or without intraoperative fluoroscopy. The image intensifier, together with customized manual instrumentation, was used for separately measuring the frontal alignment of the femoral and tibial resection surfaces. The surgeon adjusted the resection surfaces when a mechanical axis deviation error angle of ≥ 0.5° was observed on the fluoroscopic image. Coronal alignment was measured on standing long-leg digital radiographs.
RESULTS
Patients operated with fluoroscopy assistance had (1) a lower risk of malalignment at the threshold of >3° (risk ratio, 0.7; 95 % CI, 0.13-1.2), (2) a mean fluoroscopic time of 3 s, and (3) a longer operative time (69 vs. 60 min, p < 0.001). The American Knee Society Score was not different between the two groups at 1-year follow-up.
CONCLUSION
This new surgical intervention appears to offer an effective means for improving the precision of TKA alignment in the coronal plane.
目的
本研究旨在评估术中透视是否有助于恢复传统全膝关节置换术（TKA）中的冠状肢对线目标。
方法
106 例行常规骨水泥 TKA 的患者被随机分为术中透视组和非透视组。术中透视组使用影像增强器和定制的手动器械分别测量股骨和胫骨截骨面的额状面对线。当透视图像上观察到机械轴偏差误差角度≥0.5°时，外科医生会调整截骨面。冠状面对线在站立位全长下肢数字 X 线片上测量。
结果
接受透视辅助手术的患者（1）具有较低的>3°失准风险（风险比，0.7；95%可信区间，0.13-1.2），（2）透视时间平均为 3 秒，（3）手术时间较长（69 分钟 vs. 60 分钟，p<0.001）。两组患者在 1 年随访时的美国膝关节协会评分无差异。
结论
这种新的手术干预似乎为提高 TKA 冠状面对线的精确性提供了一种有效手段。
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