Durham Administrative Medical Center, Durham, NC, USA.
J Am Acad Orthop Surg. 2013 Sep;21(9):513-8. doi: 10.5435/JAAOS-21-09-513.
The use of patient-specific instruments for total knee arthroplasty shifts computer navigation for bone landmark registration and implant positioning from the intraoperative to the preoperative setting. Each system requires preoperative MRI or CT, with specifications determined by the instrument manufacturer. The marketed advantages of patient-specific instruments include greater accuracy in coronal alignment with fewer outliers, no need for instrumentation of the intramedullary canal, reduced surgical time, lower hospital costs, and improved clinical outcomes. The few published results of these instruments suggest minimal gains obtained in hospital logistics variables and minimal evidence of improvement in either alignment or patient outcomes. Disadvantages of patient-specific instruments include increased costs for imaging and instrument fabrication as well as increased preoperative time required for surgical planning and reviewing the instrument plans, and the learning curve for the surgeon to work with the engineers and use these instruments intraoperatively. It is also necessary to have a set of standard instruments available in case the patient-specific instruments do not work properly. Additional data are required before deciding whether these instruments should be recommended.
使用患者特异性器械进行全膝关节置换术将计算机导航的骨骼标志点注册和植入物定位从术中转移到术前。每个系统都需要术前 MRI 或 CT，其规格由器械制造商确定。患者特异性器械的市场优势包括在冠状面的准确性更高，离群值更少，无需髓内管器械化，手术时间缩短，医院成本降低，临床结果改善。这些器械的少数已发表结果表明，在医院后勤变量方面仅获得了最小的收益，并且在对齐或患者结果方面几乎没有改善的证据。患者特异性器械的缺点包括影像学和器械制造的成本增加，以及术前用于手术计划和审查器械计划的时间增加，以及外科医生与工程师合作并在术中使用这些器械的学习曲线。如果患者特异性器械不能正常工作，还需要有一套标准器械。在决定是否推荐这些器械之前，还需要更多的数据。
