Lee Chien-Yin, Lin Shih-Jie, Kuo Liang-Tseng, Peng Kuo-Ti, Huang Kuo-Chin, Huang Tsan-Wen, Lee Mel S, Hsu Robert Wen-Wei, Shen Wun-Jer
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 6, West Section, Chia-Pu Road, Pu-Tz City, Chia-Yi Hsien, 613, Taiwan.
Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, 333, Taiwan.
J Orthop Surg Res. 2014 Dec 3;9:122. doi: 10.1186/s13018-014-0122-3.
Mechanical alignment guides are designed to compensate for variations in the valgus alignment angle; however, these guides may not be adequate when a patient has coronal alignment with marked bowing deformity. Previous study demonstrates better radiographic results, but the clinical benefits are a matter of speculation. The aim of this study was to investigate whether radiographic benefits of computer-assisted surgery total knee arthroplasty (CAS-TKA) would translate to clinical outcomes.
Patients with osteoarthritis and coronal alignment with marked bowing deformity who underwent total knee arthroplasty (TKA) at our institution between January 2005 and June 2012 were entered into this retrospective study. Patients were divided into three groups: patients with coronal alignment with marked bowing deformity treated with CAS-TKA; with coronal alignment with marked bowing deformity treated with conventional TKA; and without marked coronal bowing deformity treated with conventional TKA. The computer-assisted navigation and the conventional technique were then compared by radiographic parameters. The International Knee Society (IKS) scores and patellar score were obtained for all patients preoperatively and at the last follow-up visit.
One hundred and thirty-seven patients (198 knees) met the inclusion criteria. For patients with osteoarthritic knees with marked femoral bowing deformity, the reconstructed mechanical axis (MA) was significantly closer to normal in the CAS-TKA group (P = 0.002) than in the conventional group. Significant differences in the reconstructed MA after conventional TKA were noted between patients without bowing and those with bowing (P = 0.003). Using the patellar score and IKS score, at a mean follow-up of 52.2 months, the differences did not achieve statistical significance among the three groups.
CAS-TKA was an effective alternative for obtaining proper alignment in patients with coronal alignment with marked bowing deformity. However, there was no statistically significant difference in clinical function between patients treated with CAS-TKA and conventional TKA. Long-term follow-up will be needed to determine if the improvement in radiographic results translates to better clinical outcomes.
机械对线导向装置旨在补偿外翻对线角度的变化；然而，当患者存在伴有明显弓形畸形的冠状面畸形时，这些导向装置可能并不适用。先前的研究显示出更好的影像学结果，但临床益处仍存在争议。本研究的目的是调查计算机辅助手术全膝关节置换术（CAS-TKA）的影像学益处是否能转化为临床疗效。
对2005年1月至2012年6月期间在我院接受全膝关节置换术（TKA）的骨关节炎且伴有明显弓形畸形的冠状面畸形患者进行了这项回顾性研究。患者被分为三组：接受CAS-TKA治疗的伴有明显弓形畸形的冠状面畸形患者；接受传统TKA治疗的伴有明显弓形畸形的冠状面畸形患者；接受传统TKA治疗的无明显冠状面弓形畸形患者。然后通过影像学参数比较计算机辅助导航和传统技术。在术前和最后一次随访时获取所有患者的国际膝关节协会（IKS）评分和髌骨评分。
137例患者（198膝）符合纳入标准。对于患有明显股骨弓形畸形的骨关节炎膝关节患者，CAS-TKA组重建的机械轴（MA）比传统组显著更接近正常（P = 0.002）。在无弓形畸形和有弓形畸形的患者之间，传统TKA术后重建的MA存在显著差异（P = 0.003）。使用髌骨评分和IKS评分，平均随访52.2个月时，三组之间的差异未达到统计学意义。
CAS-TKA是在伴有明显弓形畸形的冠状面畸形患者中获得正确对线的有效替代方法。然而，CAS-TKA治疗的患者与传统TKA治疗的患者在临床功能上没有统计学显著差异。需要长期随访以确定影像学结果的改善是否能转化为更好的临床疗效。
