Chan W Cw, Pinder E, Loeffler M
Department of Trauma and Orthopaedics, Colchester Hospital University NHS Foundation Trust, Colchester, United Kingdom.
J Orthop Surg (Hong Kong). 2016 Aug;24(2):175-8. doi: 10.1177/1602400211.
To compare patient-specific instrumentation (PSI) with conventional instrumentation in total knee arthroplasty (TKA) in terms of component alignment, operating time, and the learning curve required in a non-teaching hospital.
Records of 33 men and 29 women aged 50 to 88 (mean, 71) years who underwent TKA for osteoarthritis using PSI (n=31) or conventional instrumentation (n=31) by a single surgeon were reviewed. The choice of instrumentation was made by the patient; the surgeon did not express any preference and had not used PSI before. All patients used the same cemented, cruciate-retaining system.
The PSI and conventional instrumentation groups were comparable in terms of age, body mass index (BMI), American Society of Anesthesiologists grade, pre- and post-operative haemoglobin level, and the need for blood transfusion. Compared with conventional instrumentation, PSI resulted in a smaller coronal femoral component angle (7.7º vs. 6.4º, p=0.003) and posterior tibial slope angle (6.4º vs. 3.2º, p=0.0001), and smaller variance of the respective angles (p=0.006 and p=0.003). In patients with a BMI ≥30, PSI still resulted in a smaller posterior tibial slope angle (5.8º vs. 3.1º, p=0.015) and variance of the angle (p=0.02). The mean tourniquet time was shorter in the PSI group in all patients (p=0.013) and in patients with BMI ≥30 kg/m2 (p=0.0008), and its variance was also smaller in the PSI group (p=0.0004). There was no learning curve required.
PSI was simple to use, with no learning curve required. It can be used in non-teaching hospitals and in patients with a high BMI and in cases where the use of an intramedullary alignment guide would be problematic due to previous femoral trauma.
在一家非教学医院中，比较全膝关节置换术（TKA）中患者特异性器械（PSI）与传统器械在假体对线、手术时间和所需学习曲线方面的差异。
回顾了33名男性和29名女性（年龄50至88岁，平均71岁）的记录，这些患者因骨关节炎接受了TKA手术，其中31例使用PSI，31例使用传统器械，均由同一位外科医生进行操作。器械的选择由患者决定；外科医生未表达任何偏好且之前未使用过PSI。所有患者均使用相同的骨水泥固定、保留交叉韧带的系统。
PSI组和传统器械组在年龄、体重指数（BMI）、美国麻醉医师协会分级、术前和术后血红蛋白水平以及输血需求方面具有可比性。与传统器械相比，PSI导致股骨冠状面假体角度更小（7.7°对6.4°，p = 0.003）和胫骨后倾角度更小（6.4°对3.2°，p = 0.0001），且各角度的方差更小（p = 0.006和p = 0.003）。在BMI≥30的患者中，PSI仍导致胫骨后倾角度更小（5.8°对3.1°，p = 0.015）和角度方差更小（p = 0.02）。所有患者中，PSI组的平均止血带时间更短（p = 0.013），BMI≥30 kg/m2的患者也是如此（p = 0.0008），且PSI组的方差也更小（p = 0.0004）。无需学习曲线。
PSI使用简单，无需学习曲线。它可用于非教学医院、BMI较高的患者以及因既往股骨创伤而使用髓内对线导向器存在问题的病例。
