目的:探讨遥感导航定位(remote sensing navigation alignment，RSNA)系统在全膝关节置换术(total knee arthroplasty，TKA)中的精准性及其对术后临床疗效的影响。方法:自2021年5月至2022年5月选取60例初次行单侧TKA的Kellgren-Lawrence(K-L)分级为Ⅲ-Ⅳ级的膝骨关节炎(knee osteoarthritis，KO A)患者，按照治疗方法分为RSNA组和传统手术组，每组30例。RSNA组男6例，女24例;年龄55～86(68。06±8。23)岁;身体质量指数(body mass index，BMI)22。15～34。58(28。20±3。01)kg·m-2;病程 2～60(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(67。26±6。32)岁;BMI 为 23。94～34。55(27。49±2。32)kg·m-2;病程 3～60(21。30±16。44)个月;K-L分级Ⅲ级14例，Ⅳ级16例。分别于术前与术后3、6个月采用Western Ontario and McMaster大学骨关节炎指数(Western Ontario and McMaster Universities Osteiarthritis Index，WOMAC)和美国膝关节协会评分(Knee Society score，KSS)评价患者功能恢复情况。术前测量下肢髋膝踝角(hip-knee-ankle angle，HKAA)、股骨远端外翻角(femoral valgus angle，FVA)和股骨远端屈曲角(distal fermoral flexion angle，DFFA)。术后1周测量HKAA、HKAA偏移角并计算下肢力线不良率、股骨假体外翻角(femur prosthesis valgus angle，FPV A)和股骨假体屈曲角(femoral prosthesis flexion angle，FP-FA)。结果:两组手术均顺利进行，术中无血管、神经损伤等严重并发症，术后伤口 Ⅰ期愈合。两组均获得6个月随访。两组术前 WOMAC、KSS、HKAA、FVA及DFFA比较，差异均无统计学意义(P＞0。05);术后1周RSNA组力线不良率、HKAA、HKAA 偏移角、FPVA 偏移角、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。0％、(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(P＜0。05)。两组术后3、6个月WOMAC、KSS比较，差异无统计学意义(P＞0。05)。结论:RSNA系统可以降低TKA术后下肢力线不良率、FPVA偏移角和FPFA，在保证术后疗效的同时较传统髓内定位手术更精准，操作更简便。
Application of remote sensing navigation system in total knee arthroplasty
Objective To explore clinical accuracy of remote sensing navigation alignment(RSNA)system in total knee arthroplasty(TKA)and its influence on postoperative clinical efficacy.Methods From May 2021 to May 2022,60 knee os-teoarthritis(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-2 with an average of(28.20±3.01)kg·m-2;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 Ⅳaccording 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-2 with an average of(27.49±2.32)kg·m-2;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 pa-tients 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(FP-VA)and femoral prosthesis flexion angle(FPFA),respectively,were calculated.Results 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(P＞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 sig-nificant(P＜0.05).There were no significant difference in WOMAC index and KSS between two groups at 3 and 6 months after operation(P＞0.05).Conclusion 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.
Total knee arthroplastyRemote sensing navigation alignmentProsthesis alignmentFiducial markers
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