Asada Shigeki, Mori Shigeshi, Matsushita Tetsunao, Nakagawa Koichi, Tsukamoto Ichiroh, Akagi Masao
Department of Orthopaedic Surgery, Kinki University Faculty of Medicine, Japan.
Department of Orthopaedic Surgery, Kinki University Faculty of Medicine, Japan.
Knee. 2014 Dec;21(6):1238-43. doi: 10.1016/j.knee.2014.08.015. Epub 2014 Sep 6.
The patient-specific guide for total knee arthroplasty (TKA) is created from the data provided by magnetic resonance imaging (MRI) or computed tomography (CT) scans. It remains unknown which imaging technology is suitable for the patient-specific guide. The purpose of this study was to compare the accuracy of implant positioning and operative times between the two types of patient-specific guides for TKA.
Forty arthritic knees were divided into two treatment groups using MRI-based (PS-MRI group) or CT-based (PS-CT group) patient-specific guides in this prospective, comparative study. The guide in the PS-MRI group had a cutting slot, whereas that in the PS-CT group only had a pin locator. The operative times were compared between the two groups. The angular error and number of outliers (deviations >3°) of the implant position using pre- and postoperative CT were investigated in both groups.
The mean operative time was significantly shorter in the PS-MRI group (109.2 ± 16.5 min) than in the PS-CT group (129.5 ± 19.4 min) (p<0.001). There were no significant differences in the accuracy of the implant position regarding the coronal, sagittal, and axial planes between the groups (p>0.05).
To reduce the operative time, guides with additional functions, such as cutting and positioning, should be used. Both CT- and MRI-based-guides would result in the same accuracy in three planes but high inaccuracy in the sagittal plane. The use of patient-specific guide based on MRI might not be cost-effective.
level 2.
全膝关节置换术（TKA）的患者特异性导板是根据磁共振成像（MRI）或计算机断层扫描（CT）提供的数据制作的。目前尚不清楚哪种成像技术适用于患者特异性导板。本研究的目的是比较两种类型的TKA患者特异性导板在植入物定位准确性和手术时间方面的差异。
在这项前瞻性比较研究中，40个患有关节炎的膝关节被分为两组，分别使用基于MRI的（PS-MRI组）或基于CT的（PS-CT组）患者特异性导板。PS-MRI组的导板有一个切割槽，而PS-CT组的导板只有一个销定位器。比较两组的手术时间。使用术前和术后CT研究两组植入物位置的角度误差和异常值数量（偏差>3°）。
PS-MRI组的平均手术时间（109.2±16.5分钟）明显短于PS-CT组（129.5±19.4分钟）（p<0.001）。两组之间在冠状面、矢状面和轴面上植入物位置的准确性没有显著差异（p>0.05）。
为了减少手术时间，应使用具有切割和定位等附加功能的导板。基于CT和MRI的导板在三个平面上的准确性相同，但在矢状面上的准确性较低。使用基于MRI的患者特异性导板可能不具有成本效益。
2级。
