de Thomasson E, Gouzy S, Cloerec F, Geais L
Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
Société Amplitude, 11, cours Jacques-Offenbach, 26000 Valence, France.
Orthop Traumatol Surg Res. 2016 May;102(3):375-8. doi: 10.1016/j.otsr.2016.01.014. Epub 2016 Mar 8.
Computer-assisted surgery improves the positioning of hip prostheses but requires use of transosseous pins requiring a complementary approach exposing the patient to rare but at times serious complications. The use of sensor arrays attached to the skin could advantageously replace pins provided that comparable results are obtained, but their validity has not yet been assessed. We conducted a prospective in vitro study to: measure the possible error of a cutaneous versus transosseous fixation to determine the hip rotation center (HRC) position and determine the inter- and intraobserver reproducibility of the cutaneous versus the transosseous fixation.
Use of cutaneous sensor arrays while recording the HRC is sufficiently reliable for its calculation algorithm to provide measurement accuracy within 5mm.
A rigid array attached with either a silicone strap or an adhesive were compared to a transosseous array. Four series of 96 HRC measurements were collected by four operators on two cadavers, half with an array attached with a strap and half with an adhesive. The results were compared to those obtained by a sensor attached with transosseous pins.
On condition that the hip-knee is mobilized in extension, a sensor array attached with an adhesive gives results with comparable accuracy (standard deviation [SD]: 2.89mm [1.9-4.8]) to the results obtained with a transosseous fixation (SD: 1.2mm [0.9-1.6]), with no significant inter- or intraobserver variation (0.97<ICC<0.99). If the knee was flexed, accuracy was within more than 1cm, or twice the predetermined limit. Only the adhesive array gave measurements systematically within the limits established with the data spread (8.7%) close to that obtained with a pin (6%).
An adhesive array seems to be a reliable alternative to transosseous pins to evaluate HRC and provides a three-dimensional landmark, indispensable to total hip arthroplasty navigation. These preliminary results confirm our hypothesis but should be validated in vivo.
Level III, comparative prospective in vitro study.
计算机辅助手术可改善髋关节假体的定位，但需要使用经皮骨针，这需要采用辅助方法，使患者面临罕见但有时严重的并发症。如果能获得可比的结果，使用附着在皮肤上的传感器阵列可有利地替代骨针，但其有效性尚未得到评估。我们进行了一项前瞻性体外研究，以：测量皮肤固定与经皮骨固定确定髋关节旋转中心（HRC）位置时的可能误差，并确定皮肤固定与经皮骨固定在观察者间和观察者内的可重复性。
在记录HRC时使用皮肤传感器阵列足够可靠，其计算算法可提供5毫米内的测量精度。
将用硅胶带或粘合剂附着的刚性阵列与经皮骨阵列进行比较。四名操作员在两具尸体上收集了四组共96次HRC测量数据，其中一半尸体附着有带子的阵列，另一半附着有粘合剂的阵列。将结果与经皮骨针附着的传感器获得的结果进行比较。
在髋关节-膝关节伸展状态下活动时，用粘合剂附着的传感器阵列给出的结果与经皮骨固定获得的结果具有可比的精度（标准差[SD]：2.89毫米[1.9 - 4.8]），观察者间或观察者内无显著差异（0.97 < ICC < 0.99）。如果膝关节屈曲，精度超过1厘米，即预定极限的两倍。只有粘合剂阵列给出的测量结果系统地在根据数据分布确定的极限范围内（8.7%），接近用骨针获得的结果（6%）。
粘合剂阵列似乎是经皮骨针评估HRC的可靠替代方法，并提供了一个三维标志，这对全髋关节置换术导航必不可少。这些初步结果证实了我们的假设，但应在体内进行验证。
III级，比较性前瞻性体外研究。
