基于加速度计的便携式导航是否比传统全髋关节置换术更能准确、精确地定位杯具而不发生假体撞击？一项随机对照研究。
Does accelerometer-based portable navigation provide more accurate and precise cup orientation without prosthetic impingement than conventional total hip arthroplasty? A randomized controlled study.
机构信息
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
出版信息
Int J Comput Assist Radiol Surg. 2022 Jun;17(6):1007-1015. doi: 10.1007/s11548-022-02592-5. Epub 2022 Mar 26.
PURPOSE
This prospective randomized controlled study examined whether accelerometer-based navigation resulted in more accurate or precise cup orientation than a conventional mechanical guide. We used a simulation to evaluate how cup orientation affected potential hip range of motion (RoM) and freedom from prosthetic impingement.
METHODS
Sixty hips were randomly allocated 1:1 to accelerometer-based portable navigation or conventional guidance. Procedures were performed through a standard posterolateral approach and combined anteversion technique. Cup inclination, cup anteversion, and stem anteversion were measured using computed tomography (CT). Using CT-based simulation, we evaluated impingement-free potential RoM and the proportion of hips with potential RoM required for daily activities.
RESULTS
Absolute cup inclination and anteversion error averaged 4.3° ± 3.2° and 4.4° ± 2.9° for the navigation cohort and 5.6° ± 3.7° and 5.7° ± 4.2° for the conventional cohort, with no significant differences. Navigation resulted in significantly less variation in anteversion error than the conventional guide (p = .0049). Flexion, internal rotation (IR) at 90° of flexion, extension, and external rotation (ER) averaged 123° ± 12°, 46° ± 13°, 50° ± 10°, and 73° ± 23°, respectively, in the navigation cohort and 127° ± 10°, 52° ± 14°, 45° ± 10°, and 63° ± 12°, respectively, in the conventional cohort (p = .15, .15, .03, and .03, respectively). Flexion > 110°, IR > 30° at 90° of flexion, extension > 30°, and ER > 30° were achieved by 93%, 90%, 100%, and 100% of hips, respectively, in the navigation cohort and 97%, 93%, 97%, and 100% of hips, respectively, in the conventional cohort, with no significant differences.
CONCLUSIONS
Cup anteversion with the navigation system was more precise, but not more accurate, than with the conventional guide. The navigation cohort exhibited greater potential extension and ER than the conventional cohort, but no significant difference in impingement within the potential RoM required for daily activities.
TRIAL REGISTRATION NUMBER
- Date of registration: November 14, 2017.
目的
本前瞻性随机对照研究旨在探讨基于加速度计的导航是否比传统机械导向更能精确地定位杯体。我们使用模拟来评估杯体位置如何影响潜在髋关节活动范围（ROM）和避免假体撞击。
方法
将 60 髋随机分配 1:1 至基于加速度计的便携式导航或传统引导组。手术均通过标准的后外侧入路和联合前倾角技术进行。使用计算机断层扫描（CT）测量杯倾斜度、杯前倾角和柄前倾角。通过基于 CT 的模拟，我们评估了无撞击的潜在 ROM 以及需要日常活动的潜在 ROM 的髋关节比例。
结果
导航组平均杯倾斜度和前倾角误差分别为 4.3°±3.2°和 4.4°±2.9°，传统组分别为 5.6°±3.7°和 5.7°±4.2°，差异无统计学意义。导航组的前倾角误差变化明显小于传统导向器（p=0.0049）。导航组的屈曲、90°屈曲时内旋（IR）、伸展和外旋（ER）平均分别为 123°±12°、46°±13°、50°±10°和 73°±23°，而传统组分别为 127°±10°、52°±14°、45°±10°和 63°±12°（p=0.15、0.15、0.03 和 0.03）。导航组 93%、90%、100%和 100%的髋关节屈曲>110°、IR>30°在 90°屈曲时、伸展>30°和 ER>30°，而传统组分别为 97%、93%、97%和 100%，差异无统计学意义。
结论
与传统导向器相比，导航系统的杯体前倾角更精确，但准确性没有提高。导航组的潜在伸展和 ER 大于传统组，但在日常活动所需的潜在 ROM 范围内，撞击无显著差异。
试验注册号
29036。注册日期：2017 年 11 月 14 日。
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