Computer-Assisted Navigation in Total Knee Replacement: Results of an Initial Experience in Thirty-five Patients

S. Stulberg, P. Loan, V. Sarin
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引用次数: 369

Abstract

The success of total knee replacement surgery depends on several factors, including proper patient selection, appropriate implant design, correct surgical technique, and effective perioperative care. The outcome of total knee replacement surgery is particularly sensitive to variations in surgical technique 1-9. Incorrect positioning or orientation of the implant and improper alignment of the limb can lead to accelerated implant wear and loosening as well as suboptimal functional performance. A number of studies have suggested that alignment errors of >3° are associated with more rapid failure and less satisfactory functional results after total knee arthroplasty 1,10-20. Recent studies have also emphasized that the most common cause for revision total knee replacement is error in surgical technique. Mechanical alignment guides have improved the accuracy with which implants can be inserted. Although mechanical alignment systems are continually being refined, errors in implant and limb alignment continue to occur. It has been estimated that errors in tibial and femoral alignment of >3° occur in at least 10% of total knee arthroplasties, even when performed by experienced surgeons using mechanical alignment systems of modern design. Mechanical alignment systems have fundamental problems that limit their ultimate accuracy. The accuracy of preoperative planning is limited by the errors inherent in standard radiographs. It is difficult to determine accurately, with standard instrumentation, the correct location of crucial alignment landmarks (e.g., the center of the femoral head, the center of the ankle). Moreover, mechanical alignment and sizing devices presume a standardized bone geometry that may not apply to a specific patient. Even the most elaborate mechanical instrumentation systems rely on visual inspection to confirm the accuracy of limb and implant alignment and stability at the conclusion of the total knee replacement procedure. Computer-based alignment systems have been developed to address the …
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全膝关节置换术中的计算机辅助导航:35例患者的初步经验
全膝关节置换术的成功取决于几个因素,包括正确的患者选择、合适的植入物设计、正确的手术技术和有效的围手术期护理。全膝关节置换术的结果对手术技术的变化特别敏感。假体的不正确的定位或方向以及肢体的不正确对齐可导致假体加速磨损和松动,以及不理想的功能表现。许多研究表明,全膝关节置换术后,对准误差>3°与更快的失效和更不令人满意的功能结果有关1,10-20。最近的研究也强调翻修全膝关节置换术最常见的原因是手术技术错误。机械对准导轨提高了植入物插入的精度。虽然机械对准系统正在不断改进,但假体和肢体对准的错误仍在发生。据估计,即使由经验丰富的外科医生使用现代设计的机械对齐系统进行手术,至少10%的全膝关节置换术患者胫骨和股骨对齐错误大于3°。机械对准系统有限制其最终精度的基本问题。术前计划的准确性受到标准x线片固有误差的限制。使用标准仪器很难准确确定关键对齐标志的正确位置(例如股骨头中心、踝关节中心)。此外,机械对齐和大小装置假定一个标准化的骨几何,可能不适用于特定的病人。即使是最精密的机械仪器系统,在全膝关节置换术结束时,也要依靠目视检查来确认肢体和假体对齐的准确性和稳定性。基于计算机的校准系统已经开发出来,以解决…
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