Clement N D, Makaram N, Bell J, Tiemessen C H, Mehdi S A, Livingston S J
Department of Orthopaedics and Trauma, Borders General Hospital, Huntlyburn, Melrose TD6 9BS, UK.
Department of Orthopaedics and Trauma, Borders General Hospital, Huntlyburn, Melrose TD6 9BS, UK.
Knee. 2017 Dec;24(6):1442-1447. doi: 10.1016/j.knee.2017.08.004. Epub 2017 Sep 29.
The aim of this study was to compare the medium term functional outcome and patient satisfaction of gap balanced (GB) with measured resection (MR) total knee arthroplasty (TKA) using computer navigation.
A cohort of 144 consecutive computer navigated TKA were retrospectively identified from an arthroplasty database. Functional assessment using the Oxford Knee Score (OKS) and patient satisfaction were obtained from 113 patients at a mean follow-up of 5.4 (range four to seven) years. There were 44 patients in the GB group and 69 patients in the MR group.
The mean OKS for the GB group was 36.9 (SD 9.2) and for the MR was 33.6 (SD 9.8), with a difference of 3.3 (95% CI 0.3 to 6.3) points, which was statistically significant (p=0.01). Linear regression analysis confirmed the independent effect of surgical technique when adjusting for confounding factors and surgeon, with the GB group achieving a greater post-operative OKS (R=0.39, 3.0 points, 95% CI 1.2 to 4.8, p=0.001). There was a greater rate of patient satisfaction in the GB group (88.6%, n=39/44) compared to the MR group (81.1%, n=56/69), but this was not statistically significant (odds ratio 1.8, 95% CI 0.6 to 5.5, p=0.31).
Computer navigated Columbus® TKA using a GB technique results in a statistically significantly greater functional outcome but no significant difference in patient satisfaction in the medium term compared to patients undergoing a MR technique.
本研究旨在比较使用计算机导航的间隙平衡（GB）全膝关节置换术（TKA）与测量切除（MR）全膝关节置换术的中期功能结局和患者满意度。
从一个关节置换数据库中回顾性识别出144例连续接受计算机导航TKA的患者队列。在平均随访5.4年（范围4至7年）时，从113例患者中获得了使用牛津膝关节评分（OKS）进行的功能评估和患者满意度。GB组有44例患者，MR组有69例患者。
GB组的平均OKS为36.9（标准差9.2），MR组为33.6（标准差9.8），差值为3.3（95%可信区间0.3至6.3）分，具有统计学显著性（p = 0.01）。线性回归分析在调整混杂因素和外科医生后证实了手术技术的独立作用，GB组术后OKS更高（R = 0.39，3.0分，95%可信区间1.2至4.8，p = 0.001）。GB组患者满意度（88.6%，n = 39/44）高于MR组（81.1%，n = 56/69），但差异无统计学显著性（优势比1.8，95%可信区间0.6至5.5，p = 0.31）。
与接受MR技术的患者相比，使用GB技术的计算机导航Columbus® TKA在中期功能结局上有统计学显著改善，但在患者满意度上无显著差异。
