Ferrara Ferdinando, Cipriani Antonio, Magarelli Nicola, Rapisarda Santi, De Santis Vincenzo, Burrofato Aaron, Leone Antonio, Bonomo Lorenzo
Orthopedics. 2015 Apr;38(4):e271-80. doi: 10.3928/01477447-20150402-54.
The number of total knee arthroplasty (TKA) procedures continuously increases, with good to excellent results. In the last few years, new surgical techniques have been developed to improve prosthesis positioning. In this context, patient-specific instrumentation is included. The goal of this study was to compare the perioperative parameters and the spatial positioning of prosthetic components in TKA procedures performed with patient-specific instrumentation vs traditional TKA. In this prospective comparative randomized study, 15 patients underwent TKA with 3-dimensional magnetic resonance imaging (MRI) preoperative planning (patient-specific instrumentation group) and 15 patients underwent traditional TKA (non-patient-specific instrumentation group). All patients underwent postoperative computed tomography (CT) examination. In the patient-specific instrumentation group, preoperative data planning regarding femoral and tibial bone resection was correlated with intraoperative measurements. Surgical time, length of hospitalization, and intraoperative and postoperative bleeding were compared between the 2 groups. Positioning of implants on postoperative CT was assessed for both groups. Data planned with 3-dimensional MRI regarding the depth of bone cuts showed good to excellent correlation with intraoperative measurements. The patient-specific instrumentation group showed better perioperative outcomes and good correlation between the spatial positioning of prosthetic components planned preoperatively and that seen on postoperative CT. Less variability was found in the patient-specific instrumentation group than in the non-patient-specific instrumentation group in spatial orientation of prosthetic components. Preoperative planning with 3-dimensional MRI in TKA has a better perioperative outcome compared with the traditional method. Use of patient-specific instrumentation can also improve the spatial positioning of both prosthetic components.
全膝关节置换术（TKA）的手术数量持续增加，效果良好至极佳。在过去几年中，已开发出新的手术技术以改善假体定位。在此背景下，引入了患者特异性器械。本研究的目的是比较使用患者特异性器械与传统TKA进行TKA手术时的围手术期参数和假体组件的空间定位。在这项前瞻性比较随机研究中，15例患者接受了基于三维磁共振成像（MRI）术前规划的TKA（患者特异性器械组），15例患者接受了传统TKA（非患者特异性器械组）。所有患者均接受了术后计算机断层扫描（CT）检查。在患者特异性器械组中，股骨和胫骨骨切除的术前数据规划与术中测量结果相关。比较了两组之间的手术时间、住院时间以及术中及术后出血情况。评估了两组术后CT上植入物的定位。三维MRI规划的骨切口深度数据与术中测量结果显示出良好至极佳的相关性。患者特异性器械组显示出更好的围手术期结果，并且术前规划的假体组件空间定位与术后CT所见之间具有良好的相关性。在假体组件的空间定位方面，患者特异性器械组的变异性低于非患者特异性器械组。与传统方法相比，TKA中使用三维MRI进行术前规划具有更好的围手术期结果。使用患者特异性器械还可以改善两个假体组件的空间定位。
