De Santis V, Burrofato A, D’Apolito R, De Ieso C, Magarelli N, Maccauro G, Ziranu A
Orthopaedics and Traumatology Institute, Catholic University of Sacred Heart. Rome, Italy
Department of Radiological Sciences, Catholic University of Sacred Heart, Rome, Italy
J Biol Regul Homeost Agents. 2017;31(4 suppl 1):51-60.
In the last years new surgical techniques are developing to improve prosthesis positioning, increasing clinical and functional results and reducing invasiveness. In this scenario patient-specific instrumentations have been introduced in order to enhance surgical accuracy and ease of implantation. The purpose of this study was to assess the compliance of the pre-operative planning data with bone resections measured intraoperatively and to evaluate prosthesis positioning in patients undergoing total knee arthroplasty (TKA) using an MRI-based pin-guides instrumentation. Thirty consecutive patients (20 women and 10 men) undergoing 30 total knee replacements (20 right- and 10 left-sided knees) were included in this study. The same cemented cruciate ligament sacrificing prosthesis (NexGen LPS, Zimmer, Warsaw, Indiana, USA) was implanted in all patients by a single surgeon using Patient-Specific Instruments (PSI, Zimmer, Warsaw, Indiana, USA). Femoral and tibial bone resections were measured using a manual caliper intra-operatively and compared with the corresponding pre-operative values. Each patient underwent A CT examination following surgery in order to investigate individual component positioning. None of the cases was converted from PSI technique to conventional TKA and adequate femoral and tibial bone cuts were performed without the need for intraoperative adjustments. Two outliers were detected among the intra-operative bone cuts measurements. In all patients the size of femoral and tibial prosthetic components, hypothesized at preoperative planning, was confirmed intra-operatively. Two outliers were detected among post-operative CT measurements as for components positioning. PSI system can assist in obtaining good component positioning with reduction of outliers. Despite the small number of patients, our data demonstrate the validity of this patient-specific pin-guides system in TKA and may support repeatable improvements in surgical accuracy. Level of evidence: IV.
在过去几年中，新的外科技术不断发展，以改善假体定位，提高临床和功能效果，并减少侵入性。在这种情况下，引入了患者特异性器械，以提高手术准确性和植入的便利性。本研究的目的是评估术前规划数据与术中测量的骨切除情况的一致性，并使用基于MRI的针引导器械评估全膝关节置换术（TKA）患者的假体定位。本研究纳入了连续30例患者（20名女性和10名男性），他们接受了30次全膝关节置换手术（20例右侧膝关节和10例左侧膝关节）。所有患者均由一名外科医生使用患者特异性器械（PSI，Zimmer，美国印第安纳州华沙）植入相同的骨水泥固定型保留交叉韧带假体（NexGen LPS，Zimmer，美国印第安纳州华沙）。术中使用手动卡尺测量股骨和胫骨骨切除情况，并与相应的术前值进行比较。每位患者术后均接受CT检查，以调查各个组件的定位情况。没有一例从PSI技术转换为传统TKA，并且在无需术中调整的情况下进行了足够的股骨和胫骨截骨。在术中骨切除测量中检测到两个异常值。在所有患者中，术前规划时假设的股骨和胫骨假体组件尺寸在术中得到了确认。在术后CT测量的组件定位方面也检测到两个异常值。PSI系统可以帮助获得良好的组件定位并减少异常值。尽管患者数量较少，但我们的数据证明了这种患者特异性针引导系统在TKA中的有效性，并可能支持手术准确性的可重复提高。证据级别：IV。
