Schotanus M G M, van Haaren E H, Hendrickx R P M, Jansen E J P, Kort N P
Medical Researcher at Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands.
Orthopedic Surgeon at Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
Eur J Orthop Surg Traumatol. 2015 Dec;25(8):1313-20. doi: 10.1007/s00590-015-1677-3. Epub 2015 Aug 12.
Published clinical trials who studied the accuracy of patient-specific guides (PSG) for total knee arthroplasty exclude patients with articular deformity of the knee joint. We prospectively analysed a series of 30 patients with post-traumatic osteoarthritis of the knee joint with use of PSG. At 1 year post-operative, the achieved biomechanical (HKA) axis and varus/valgus of the femur and tibia components were measured on anterior-posterior (AP) long-standing weight-bearing radiographs. Flexion/extension of the femoral and AP slope of the tibia component was measured on standard lateral radiographs. Percentages >3° deviation of the pre-operative planned HKA axis and individual implant components were considered as outliers. Approved and used implant size, median blood loss (ml) and operation time (min) were obtained from the operation records. Pre- and 1-year post-operative patient-reported outcome measures (PROMs) were performed. Eighty-three per cent of the patients had a HKA axis restored <3° of the pre-operative planned alignment. Varus/valgus outliers were 0.0 and 6.7 % for the femoral and tibial components, respectively. Percentages of outliers of flexion/extension were 36.7 % for the femoral component and 10.0 % for the AP slope of the tibial component. Median blood loss was 300 ml (50-700), while operation time was 67 min (44-144). In 20 % of all cases, the approved implant size was changed into one size smaller. One-year post-operative PROMs improved significantly. We conclude that the accuracy of CT-based PSG is not impaired in patients with post-traumatic osteoarthritis and this modality can restore biomechanical limb alignment.
已发表的研究全膝关节置换术患者特异性导板（PSG）准确性的临床试验排除了膝关节存在关节畸形的患者。我们前瞻性地分析了一系列30例创伤后膝关节骨关节炎患者使用PSG的情况。术后1年，在前后位（AP）长期负重X线片上测量获得的生物力学（HKA）轴线以及股骨和胫骨组件的内翻/外翻情况。在标准侧位X线片上测量股骨的屈伸情况以及胫骨组件的AP倾斜度。术前计划的HKA轴线和各个植入组件偏差>3°的百分比被视为异常值。从手术记录中获取批准使用的植入物尺寸、中位失血量（ml）和手术时间（min）。进行术前和术后1年的患者报告结局指标（PROMs）评估。83%的患者HKA轴线恢复到术前计划对线的<3°。股骨和胫骨组件的内翻/外翻异常值分别为0.0%和6.7%。股骨组件屈伸异常值的百分比为36.7%，胫骨组件AP倾斜度异常值的百分比为10.0%。中位失血量为300 ml（50 - 700），而手术时间为67 min（44 - 144）。在所有病例的20%中，批准使用的植入物尺寸改为小一号。术后1年的PROMs有显著改善。我们得出结论，基于CT的PSG在创伤后骨关节炎患者中的准确性并未受损，并且这种方式可以恢复肢体的生物力学对线。
