便携式导航与计算机导航辅助在全膝关节置换力线对准和手术时间的比较

doi:10.19723/j.issn.1671-167X.2021.04.018

摘要/Abstract

摘要：

目的: 探讨便携式导航(portable accelerometer-based navigation device,PAD)与计算机导航辅助(computer assisted surgery,CAS)在全膝关节置换术(total knee arthroplasty, TKA)中力线对准和手术时间的差异。方法: 选择2017年12月—2019年12月于北京大学第三医院使用iASSIST便携式导航设备以及OrthoPilot计算机导航辅助系统进行TKA的患者病例资料进行回顾性分析,比较两组患者术前一般资料、术前下肢力线对准参数、手术时间以及术后下肢力线对准参数的差异。结果: 共纳入82例患者,其中PAD组40例,CAS组42例。两组患者的性别、年龄、体重指数(body mass index, BMI)、手术侧别、术前髋膝踝(hip-knee-ankle,HKA)角、术前HKA角偏差值之间,差异均无统计学意义(P>0.05)。PAD组术后HKA角(180.8°±2.2° vs. 181.8°±1.6°, t=-2.458, P=0.016)和术后冠状面股骨组件角(coronal femoral-component angle,CFA)(90.6°±1.8° vs. 91.6°±1.6°, t=-2.749,P=0.007)小于CAS组,但两组冠状面胫骨组件角(coronal tibia-component angle,CTA)的差异无统计学意义(90.0°±1.3° vs. 89.6°±1.4°,t=1.335,P=0.186);术后HKA角(10.0% vs. 11.9%,χ²=0.076,P=0.783)、CFA(12.5% vs.14.3%, χ² =0.056, P=0.813)和CTA(2.5% vs. 0%, χ²=1.063, P=0.303)偏移超过3°的偏移率差异也无统计学意义;两组的HKA角(2.1° vs. 2.0°,t=0.055,P=0.956)、CFA(1.4° vs.1.8°,t=-1.365,P=0.176)和CTA(1.0° vs.1.1°,t=-0.828,P=0.410)的准确度差异无统计学意义;两组的HKA角(1.1° vs.1.3°, F=1.251, P=0.267)、CFA(1.3° vs.1.4°, F=0.817, P=0.369)和CTA(0.8° vs. 0.9°, F=0.937, P=0.336)的精确度差异也无统计学意义。在手术时间方面, PAD组与CAS组的差异无统计学意义[(83.4±25.6) min vs. (86.5±17.7) min,t=-0.641,P=0.524)]。结论: PAD与CAS在TKA中下肢力线对准的准确度和精确度相当,手术时间差异无统计学意义,这提示PAD在TKA中可能具有广泛的应用前景。

关键词: 便携式导航, 计算机导航辅助, 全膝关节置换术

Abstract:

Objective: To explore the differences of alignment and operative time between portable accelerometer-based navigation device (PAD) and computer assisted surgery (CAS) in total knee arthroplasty (TKA). Methods: Data of patients using iASSIST (a kind of PAD) and OrthoPilot (a kind of CAS) for TKA in Peking University Third Hospital from December 2017 to December 2019 were retrospectively collected. The differences of preoperative general data, preoperative alignment, operative time and postoperative alignment were studied between the two groups. Results: A total of 82 patients were enrolled in our study, including 40 patients in the PAD group and 42 patients in the CAS group. Gender, age, body mass index (BMI), surgical side, preoperative hip-knee-ankle (HKA) angle and preoperative HKA angle deviation didn’t show statistically significant difference between the PAD group and the CAS group (P>0.05). Postoperative HKA angle (180.8°±2.2° vs.181.8±1.6°, t=-2.458, P=0.016) and postoperative coronal femoral-component angle (CFA, 90.6°±1.8° vs. 91.6°±1.6°, t =-2.749, P=0.007) of the PAD group were smaller than those of the CAS group, but there was no significant difference in coronal tibia-component angle (CTA, 90.0°±1.3° vs.89.6°±1.4°, t=1.335, P=0.186) between the two groups. There was no significant difference in the rate of outliers (varus or valgus>3°) for postoperative HKA angle (10.0% vs.11.9%,χ² =0.076,P=0.783), CFA (12.5% vs. 14.3%, χ²=0.056, P=0.813) and CTA (2.5% vs. 0%, χ²=1.063, P=0.303). There was no significant difference in the accuracy of postoperative HKA angle (2.1° vs. 2.0°, t=0.055, P=0.956), CFA (1.4° vs. 1.8°, t=-1.365, P=0.176) and CTA (1.0° vs. 1.1°, t=-0.828, P=0.410) between the two groups. The precision of postoperative HKA angle (1.1° vs. 1.3°, F=1.251, P=0.267), CFA (1.3° vs. 1.4°, F=0.817, P=0.369) and CTA (0.8° vs. 0.9°, F=0.937, P=0.336) were also not significantly different. We also didn’t find statistically significant difference in operative time between the two groups [(83.4±25.6) min vs. (86.5±17.7) min, t=-0.641,P=0.524]. Conclusion: PAD and CAS had similar accuracy and precision in alignment in TKA, and there was no significant difference in operative time, which indicates that PAD has a broad application prospect in TKA.

Key words: Portable accelerometer-based navigation device, Computer assisted surgery, Total knee arthroplasty

中图分类号:

R687.4

王鑫光,耿霄,李杨,吴天晨,李子剑,田华. 便携式导航与计算机导航辅助在全膝关节置换力线对准和手术时间的比较[J]. 北京大学学报（医学版）, 2021, 53(4): 728-733.

WANG Xin-guang,GENG Xiao,LI Yang,WU Tian-chen,LI Zi-jian,TIAN Hua. Comparison of alignment and operative time between portable accelerometer-based navigation device and computer assisted surgery in total knee arthroplasty[J]. Journal of Peking University (Health Sciences), 2021, 53(4): 728-733.

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参考文献 16

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Group	Gender, male :female	Age/years, $\bar{x}±s$	BMI / (kg/m²), $\bar{x}±s$	Side, left :right	Preoperative HKA angle/(°), $\bar{x}±s$	Preoperative HKA angle deviation/(°), $\bar{x}±s$
PAD	5 :35	66.3±6.1	26.6±3.9	18 :22	187.9±11.5	12.5±5.9
CAS	6 :36	67.2±7.0	27.7±2.8	17 :25	189.7±6.6	11.2±3.6
Statistic value	χ² =0.056	t=-0.614	t=-1.517	χ²=0.171	t=0.876	t=1.330
P	0.813	0.541	0.133	0.679	0.384	0.187

Group	Postoperative HKA angle/(°), $\bar{x}±s$	Postoperative HKA angle deviation/(°), $\bar{x}±s$	Outliers of postoperative HKA angle	Postoperative CFA /(°), $\bar{x}±s$	Postoperative CFA deviation/(°), $\bar{x}±s$	Outliers of postoperative CFA	Postoperative CTA /(°), $\bar{x}±s$	Postoperative CTA deviation/(°), $\bar{x}±s$	Outliers of postoperative CTA
PAD	180.8±2.2	2.1±1.1	10.0%(4/40)	90.6±1.8	1.4±1.3	12.5%(5/40)	90.0±1.3	1.0±0.8	2.5%(1/40)
CAS	181.8±1.6	2.0±1.3	11.9%(5/42)	91.6±1.6	1.8±1.4	14.3%(6/42)	89.6±1.4	1.1±0.9	0 (0/42)
Statistic value	t=-2.458	t=0.055/ F=1.251	χ² =0.076	t=-2.749	t=-1.365/ F=0.817	χ² =0.056	t=1.335	t=-0.828/ F=0.937	χ² =1.063
P	P=0.016	P=0.956/ P=0.267	P=0.783	P=0.007	P=0.176/ P=0.369	P=0.813	P=0.186	P=0.410/ P=0.336	P=0.303