Department of Orthopaedic Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore,
Knee Surg Sports Traumatol Arthrosc. 2014 Mar;22(3):630-5. doi: 10.1007/s00167-013-2638-1. Epub 2013 Aug 31.
The aim of this study was to investigate the post-operative radiological outcomes of patient-specific instrumentation (PSI) surgery versus conventional total knee arthroplasty (TKA).
Sixty patients scheduled for a primary TKA were prospectively divided into PSI or conventional technique. Coronal and sagittal radiographic long limb films were taken post-operatively. The accepted values for normal alignment were 180° ± 3° for hip-knee-ankle angle; 90° ± 3° for coronal femoral component angle or coronal tibia component angle; 0° to 3° flexion for sagittal femoral component angle and 0° to 7° posterior slope for sagittal tibia component angle.
For hip-knee-ankle angle, there were 21 % more outliers in the PSI group compared to the conventional group (p = 0.045). Most of these outliers had valgus deformity in the PSI group and varus deformity in the conventional group (p = 0.045). For implant placement, there was no difference in the proportion of outliers between the two groups. There was also no difference in the duration of surgery.
This study showed that PSI surgery is associated with a larger proportion of outliers for lower limb alignment. PSI surgery as an alternative to conventional TKA is not advisable.
II.
本研究旨在探讨个体化截骨手术（PSI）与传统全膝关节置换术（TKA）术后影像学结果。
前瞻性将 60 例拟行初次 TKA 的患者分为 PSI 或传统技术组。术后拍摄冠状位和矢状位下肢全长 X 线片。接受的正常对线标准为：髋膝踝角为 180°±3°；冠状面股骨组件角或胫骨组件角为 90°±3°；矢状面股骨组件角为 0°至 3°屈曲，胫骨组件角为 0°至 7°后倾。
在 PSI 组中，髋膝踝角的离群值比传统组多 21%（p=0.045）。这些离群值大多在 PSI 组中表现为外翻畸形，而在传统组中表现为内翻畸形（p=0.045）。在植入物放置方面，两组的离群值比例无差异。手术时间也无差异。
本研究表明，PSI 手术与下肢对线的离群值比例更大。PSI 手术作为 TKA 的替代方法不可取。
II 级。
