Sugimura Natsuki, Ozaki Kazuki, Aso Koji, Ikeuchi Masahiko
Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-Cho Kohasu, Nankoku, Kochi, 783-8505, Japan.
Eur J Orthop Surg Traumatol. 2024 Feb;34(2):967-972. doi: 10.1007/s00590-023-03741-5. Epub 2023 Oct 3.
Precise determination of the tibial mechanical axis in total knee arthroplasty (TKA) requires intraoperative identification of the talus center. We present the ultrasonography-integrated tibial extramedullary guide (USG) that enables real-time visualization of the talus. This study assesses the precision of USG compared to computer-assisted surgery (CAS) and validates the efficacy of USG.
We evaluated 58 patients (62 knees) who underwent primary TKA retrospectively, categorizing them into USG and CAS groups (31 each). We statistically analyzed demographic data, the preoperative alignment of the tibial plateau to the mechanical axis, the postoperative alignment of the tibial component to planned alignment on 3D-CT, pain visual analog scale, and WOMAC scores. Additionally, the frequency of postoperative outlier from planned alignment over 2° was statistically compared.
No significant differences were observed in the preoperative data between the groups. The accuracy (mean deviation from the planned alignment) in both groups was not statistically different. However, in terms of the precision of coronal alignment, the USG group exhibited lower variance than the CAS group in the F-test (F value = 2.76, p = 0.023). Moreover, there were no postoperative deviations beyond 2 degrees in the USG group, in contrast to a 20% outlier frequency in the CAS group (p = 0.024). Concerning the precision of sagittal alignment (variance and deviations over 2°), no statistical differences were identified.
The USG demonstrated higher precision in the tibial coronal plane than CAS in coronal alignment. Direct identification of the individual talus may enhance precision.
在全膝关节置换术（TKA）中精确确定胫骨机械轴需要在术中识别距骨中心。我们介绍了一种集成超声的胫骨髓外导向器（USG），它能够实时可视化距骨。本研究评估了USG与计算机辅助手术（CAS）相比的精度，并验证了USG的有效性。
我们回顾性评估了58例接受初次TKA的患者（62个膝关节），将他们分为USG组和CAS组（每组31例）。我们对人口统计学数据、胫骨平台与机械轴的术前对线、术后胫骨组件与三维CT上计划对线的对线情况、疼痛视觉模拟量表和WOMAC评分进行了统计分析。此外，还对术后偏离计划对线超过2°的异常值频率进行了统计学比较。
两组术前数据无显著差异。两组的准确性（与计划对线的平均偏差）在统计学上无差异。然而，在冠状面对线的精度方面，USG组在F检验中的方差低于CAS组（F值 = 2.76，p = 0.023）。此外，USG组术后没有超过2度的偏差，而CAS组的异常值频率为20%（p = 0.024）。关于矢状面对线的精度（方差和超过2°的偏差），未发现统计学差异。
在胫骨冠状面，USG在冠状面对线方面显示出比CAS更高的精度。直接识别个体距骨可能会提高精度。
