Kamara Eli, Berliner Zachary P, Hepinstall Matthew S, Cooper H John
Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York.
Department of Orthopaedic Surgery, Columbia University, New York, New York.
J Arthroplasty. 2017 Sep;32(9):2842-2846. doi: 10.1016/j.arth.2017.03.073. Epub 2017 Apr 20.
There has been a great increase in the use of navigation technology in joint arthroplasty. In most types of navigation-assisted surgery, several temporary navigation pins are placed in the patient. Goals of this study are (1) to identify complications and (2) risk factors associated with placement of these pins.
This is a retrospective cohort study of all navigation-assisted hip and knee arthroplasty performed a single institution over a 3-year period. Records were reviewed and outcome measures were tabulated in a database. Complications included in the database were pin site infection, deep prosthetic joint infection, neurologic injury, vascular injury, and fracture through a pin site.
A total of 3136 pin sites in 839 patients were included in the study. Five pin site complications were reported with a complication rate of 0.16% per pin site and 0.60% per patient. The complications-per-procedure were slightly higher for unicondylar knee arthroplasty (0.64%) compared with patellofemoral arthroplasty (0%) and total hip arthroplasty (0.46%), but not statistically significant. There were three infections, one neuropraxia, and one suture abscess. No periprosthetic fractures through a pin site were reported. All complications were resolved with nonoperative treatment. The infections required oral antibiotics, and were associated with transcortical drilling in two cases and juxtacortical drilling in the third.
Pins required for navigation-assisted arthroplasty have a low complication rate. Transcortical or juxtacortical drilling may be a risk factor for pin site infection; future studies should be directed at quantifying this effect.
关节置换术中导航技术的应用有了大幅增加。在大多数类型的导航辅助手术中，会在患者体内放置多个临时导航针。本研究的目的是：（1）确定并发症；（2）确定与这些针放置相关的危险因素。
这是一项对某单一机构在3年期间内进行的所有导航辅助髋关节和膝关节置换术的回顾性队列研究。查阅记录并将结果指标列入数据库。数据库中包括的并发症有针道感染、深部假体关节感染、神经损伤、血管损伤以及针道处骨折。
本研究共纳入839例患者的3136个针道。报告了5例针道并发症，每个针道的并发症发生率为0.16%，每位患者的并发症发生率为0.60%。单髁膝关节置换术的每例手术并发症发生率（0.64%）略高于髌股关节置换术（0%）和全髋关节置换术（0.46%），但差异无统计学意义。有3例感染、1例神经失用和1例缝线脓肿。未报告针道处假体周围骨折。所有并发症均通过非手术治疗得到解决。感染患者需要口服抗生素，其中2例与经皮质钻孔有关，第3例与皮质旁钻孔有关。
导航辅助关节置换术所需的针并发症发生率较低。经皮质或皮质旁钻孔可能是针道感染的一个危险因素；未来的研究应致力于量化这种影响。
