Li Yuan-Yuan, He Ming-Jiang, Shan Peng-Cheng, Hu Pei-Yan, Jing Lin, Yan Qi, Tang Hai, Wang Xin-Yue, Liu Si-Ye, Zhang Hong-Mei
The First Department of Osteoarthropathy, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing 100102, China.
Zhongguo Gu Shang. 2024 Sep 25;37(9):878-85. doi: 10.12200/j.issn.1003-0034.20240342.
To explore clinical accuracy of remote sensing navigation alignment (RSNA) system in total knee arthroplasty (TKA) and its influence on postoperative clinical efficacy.
From May 2021 to May 2022, 60 knee osteoarthritis (KOA) patients with Kellgren-Lawrence (K-L) grade Ⅲ to Ⅳ treated by unilateral primary TKA were selected and divided into RSNA group and traditional operation group according to treatment methods, and 30 patients in each group. There were 6 males and 24 females in RSNA group, aged from 55 to 86 years old with an average of (68.06±8.23) years old;body mass index (BMI) ranged from 22.15 to 34.58 kg·m with an average of (28.20±3.01) kg·m;the courses of disease ranged from 2 to 60 months with an average of (18.80±14.80) months;13 patients with grade Ⅲ and 17 patients with grade Ⅳ according to K-L grading. In traditional operation group, there were 8 males and 22 females, aged from 57 to 85 years old with an average of (67.26±6.32) years old;BMI ranged from 23.94 to 34.55 kg·m with an average of (27.49±2.32) kg·m;the courses of disease ranged from 3 to 60 months with an average of (21.30±16.44) months;14 patients with grade Ⅲ and 16 patients with grade Ⅳ according to K-L grading. Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and Knee Society score(KSS) were used to evaluate functional recovery of patients. Hip-knee-ankle angle (HKAA), distal femoral valgus angle (FVA) and distal fermoral flexion angle (DFFA) were measured before operation. HKAA and HKAA deviation angle were measured at 1 week after operation, and defective rate of lower limb force line, femur prosthesis valgus angle (FPVA) and femoral prosthesis flexion angle (FPFA), respectively, were calculated.
There were no serious complications such as vascular and nerve injury during operation, and wound healed at stage Ⅰ. Both groups were followed up for 6 months. There were no significant difference in WOMAC index, KSS, HKAA, FVA and DFFA between two groups before operation (>0.05). The force line defect rate, HKAA, HKAA deviation angle, FPVA deviation angle and FPFA of RSNA group were 6.7%, (178.74±1.56) °, (1.25±1.56) °, (1.84±0.16) ° and (4.85±2.46) °, respectively;while in traditional operation group were 20%, (176.73±3.46) °, (3.27±3.46) °, (2.44±0.26) °, (6.60±1.86) °;the difference between two groups were statistically significant (<0.05). There were no significant difference in WOMAC index and KSS between two groups at 3 and 6 months after operation (>0.05).
RSNA system could reduce defective rate of lower limb force line, FPVA deviation angle and FPFA after TKA, which is more accurate and easy to operate than traditional intramedullary localization surgery while ensuring postoperative efficacy.
探讨遥感导航定位（RSNA）系统在全膝关节置换术（TKA）中的临床准确性及其对术后临床疗效的影响。
选取2021年5月至2022年5月行单侧初次TKA治疗的60例Kellgren-Lawrence（K-L）Ⅲ～Ⅳ级膝关节骨关节炎（KOA）患者，根据治疗方法分为RSNA组和传统手术组，每组30例。RSNA组男6例，女24例，年龄55～86岁，平均（68.06±8.23）岁；体重指数（BMI）为22.15～34.58 kg·m，平均（28.20±3.01）kg·m；病程2～60个月，平均（18.80±14.80）个月；K-L分级Ⅲ级13例，Ⅳ级17例。传统手术组男8例，女22例，年龄57～85岁，平均（67.26±6.32）岁；BMI为23.94～34.55 kg·m，平均（27.49±2.32）kg·m；病程3～60个月，平均（21.30±16.44）个月；K-L分级Ⅲ级14例，Ⅳ级16例。采用西安大略和麦克马斯特大学（WOMAC）骨关节炎指数及膝关节协会评分（KSS）评估患者功能恢复情况。术前测量髋-膝-踝角（HKAA）、股骨远端外翻角（FVA）和股骨远端屈曲角（DFFA）。术后1周测量HKAA及HKAA偏差角，分别计算下肢力线不良率、股骨假体外翻角（FPVA）和股骨假体屈曲角（FPFA）。
术中无血管、神经损伤等严重并发症，伤口均Ⅰ期愈合。两组均随访6个月。术前两组WOMAC指数、KSS、HKAA、FVA及DFFA比较，差异无统计学意义（>0.05）。RSNA组力线不良率、HKAA、HKAA偏差角、FPVA偏差角及FPFA分别为6.7%、（178.74±1.56）°、（1.25±1.56）°、（1.84±0.16）°、（4.85±2.46）°；传统手术组分别为20%、（176.73±3.46）°、（3.27±3.46）°、（2.44±0.26）°、（6.60±1.86）°；两组比较，差异有统计学意义（<0.05）。术后3、6个月两组WOMAC指数和KSS比较，差异无统计学意义（>0.05）。
RSNA系统可降低TKA术后下肢力线不良率、FPVA偏差角及FPFA，在保证术后疗效的同时，比传统髓内定位手术更精确、操作更简便。
