Kuo Shu-Jui, Wang Feng-Sheng, Wang Ching-Jen, Ko Jih-Yang, Chen Sung-Hsiung, Siu Ka-Kit
Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.
Department of Medical Research, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan.
PLoS One. 2015 May 8;10(5):e0126663. doi: 10.1371/journal.pone.0126663. eCollection 2015.
Total knee arthroplasty (TKA) inevitably perturbs the femoral medullary canal, which increases blood loss or morbidities associated with marrow embolization postoperatively. Computer navigation TKA reportedly minimizes medullary disturbance to alleviate perioperative blood loss. We performed a prospective comparative study, enrolling 87 patients with osteoarthritic knees from March 2011 to December 2011 in our hospital. The patients were separated into two groups, according to the surgeon they visited. Fifty-four patients underwent computer navigation TKAs and 33 had conventional TKAs. Levels of cell adhesion molecules (CAMs), including intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and platelet endothelial cellular adhesion molecule-1 (PECAM-1) in sera and hemovac drainage were measured by ELISA before and 24 hours after the surgery. We showed that patients receiving computer navigation TKAs had less blood loss and lower CAMs in serum and hemovac drainage after the operation. Less postoperative elevation of serum ICAM-1 (p=0.022) and PECAM-1 (p=0.003) from the preoperative baseline after the surgery was also noted. This study provides molecular evidence for the differential extent in vascular injury between conventional and navigation TKAs and sheds light on the possible benefits of computer navigation TKAs.
ClinicalTrials.gov NCT02206321.
全膝关节置换术（TKA）不可避免地会扰乱股骨髓腔，这会增加术后失血或与骨髓栓塞相关的发病率。据报道，计算机导航全膝关节置换术可将髓腔干扰降至最低，以减轻围手术期失血。我们进行了一项前瞻性对照研究，于2011年3月至2011年12月在我院纳入了87例膝骨关节炎患者。根据患者就诊的外科医生将其分为两组。54例患者接受了计算机导航全膝关节置换术，33例接受了传统全膝关节置换术。通过酶联免疫吸附测定法（ELISA）在手术前和手术后24小时测量血清和负压引流管中细胞黏附分子（CAMs）的水平，包括细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）和血小板内皮细胞黏附分子-1（PECAM-1）。我们发现，接受计算机导航全膝关节置换术的患者术后失血更少，血清和负压引流管中的CAMs水平更低。术后血清ICAM-1（p = 0.022）和PECAM-1（p = 0.003）较术前基线的升高幅度也更小。本研究为传统全膝关节置换术和导航全膝关节置换术在血管损伤程度上的差异提供了分子证据，并揭示了计算机导航全膝关节置换术可能的益处。
ClinicalTrials.gov NCT02206321。
