Sydney Orthopaedic Research Institute, Suite 13, Level 1, 445 Victoria Avenue, Chatswood, NSW, 2067, Australia,
Knee Surg Sports Traumatol Arthrosc. 2014 Mar;22(3):660-5. doi: 10.1007/s00167-013-2670-1. Epub 2013 Sep 17.
The introduction of patient-specific instruments (PSI) for guiding bone cuts could increase the incidence of malalignment in primary total knee arthroplasty. The purpose of this study was to assess the agreement between one type of patient-specific instrumentation (Zimmer PSI) and the pre-operative plan with respect to bone cuts and component alignment during TKR using imageless computer navigation.
A consecutive series of 30 femoral and tibial guides were assessed in-theatre by the same surgeon using computer navigation. Following surgical exposure, the PSI cutting guides were placed on the joint surface and alignment assessed using the navigation tracker. The difference between in-theatre data and the pre-operative plan was recorded and analysed.
The error between in-theatre measurements and pre-operative plan for the femoral and tibial components exceeded 3° for 3 and 17% of the sample, respectively, while the error for total coronal alignment exceeded 3° for 27% of the sample.
The present results indicate that alignment with Zimmer PSI cutting blocks, assessed by imageless navigation, does not match the pre-operative plan in a proportion of cases. To prevent unnecessary increases in the incidence of malalignment in primary TKR, it is recommended that these devices should not be used without objective verification of alignment, either in real-time or with post-operative imaging. Further work is required to identify the source of discrepancies and validate these devices prior to routine use.
II.
引导骨切的个体化截骨器械（PSI）的引入可能会增加初次全膝关节置换术（TKR）中对线不良的发生率。本研究旨在评估无图像计算机导航下使用一种特定于患者的器械（Zimmer PSI）与术前计划在 TKR 中骨切和组件对线的一致性。
同一位外科医生在手术室中连续评估了 30 个股骨和胫骨引导器，使用计算机导航。在手术暴露后，将 PSI 切割引导器放置在关节表面上，并使用导航跟踪器评估对准情况。记录和分析手术室数据与术前计划之间的差异。
术中测量与术前计划的股骨和胫骨组件之间的误差分别超过 3°的比例为 3%和 17%，而总冠状位对准的误差超过 3°的比例为 27%。
目前的结果表明，使用无图像导航评估的 Zimmer PSI 切割块的对准情况，在一定比例的病例中与术前计划不匹配。为了防止初次 TKR 中对线不良发生率的不必要增加，建议在没有对线的客观验证的情况下，不应常规使用这些器械，无论是实时还是术后影像学。需要进一步工作来确定差异的来源，并在常规使用之前验证这些设备。
II 级。
