徒手与导航定位辅助重建儿童和青少年前十字韧带断裂的早期疗效比较
Comparison of early efficacy of manual technique and navigation positioning system-assisted reconstruction of anterior cruciate ligament in children and adolescents
梁求真 1郑江 1赵赞栋 1康鑫 1刘沛东 1张咪 1廖超凡 1王月 1张亮1
作者信息
- 1. 西安交通大学附属红会医院运动医学中心,西安 710054
- 折叠
摘要
目的 比较徒手与导航定位辅助重建儿童和青少年前十字韧带(anteriorcruciate ligament,ACL)断裂的早期疗效.方法 回顾性分析2019年1月至2022年10月西安交通大学附属红会医院运动医学诊疗中心采用初次ACL全骨骺内重建治疗ACL断裂的患者28例,根据置入导针方式分为徒手组(依靠手术者的经验徒手置入导针)和导航辅助组(采用机器人导航定位系统辅助置入导针).徒手组14例,男9例、女5例,年龄(13.59±1.59)岁;导航辅助组14例,男10例、女4例,年龄(13.27±1.66)岁.比较两组的手术时间、术中透视次数、导针置入次数、胫骨及股骨骨隧道关节内口中心点位与理想点位的距离、骨骺积惹率、国际膝关节文献委员会(International Knee Documentation Committee,IKDC)主观评分、Lysholm评分、KT-2000韧带松弛度、下肢力线情况.结果 徒手组术后随访时间为(19.9±6.3)个月,导航辅助组为(18.8±4.9)个月(t=0.546,P=0.589).徒手组手术时间为(123.0±12.6)min,较导航辅助组的(96.4±12.9)min延长(t=5.502,P＜0.001);徒手组术中透视次数为(11.8±3.1)次,高于导航辅助组的(3.7±0.8)次(t=9.434,P＜0.001);导航辅助组股骨及胫骨导针置入次数均为1次,而徒手组股骨侧导针置入次数为(5.7±1.2)次、胫骨侧为(4.6±1.8)次.导航辅助组股骨关节内口中心点位与理想点位的距离为(0.87±0.20)mm,优于徒手组的(1.92±0.64)mm(t=5.816,P＜0.001);胫骨关节内口中心点位与理想点位之间的距离为(1.15±0.34)mm,优于徒手组的(1.94±0.55)mm(t=4.582,P＜0.001).术后即刻MRI示导航辅助组骨骺积惹率为0(0/14);而徒手组为21％(3/14),其中单纯累及胫骨骺板2例、股骨骺板1例.术后3个月,导航辅助组的IKDC主观评分及 Lysholm 评分分别 为(90.57±8.46)分和(86.29±5.09)分,均高于徒手组的(83.50±6.19)分和(80.93±5.93)分(P＜0.05).末次随访时的IKDC主观评分、Lysholm评分及KT-2000韧带松弛度两组差异均无统计学意义(P＞0.05);两组均未见生长发育异常,下肢力线正常.结论 机器人导航定位系统辅助重建儿童和青少年ACL断裂较徒手操作法制备的骨隧道点位更精确、手术时间更短、术中透视次数更少、术后康复更快,且对骨骺的保护更好.
Abstract
Objective To investigate the initial effectiveness of manual techniques versus navigation positioning system-assisted reconstruction for anterior cruciate ligament(ACL)injuries in children and adolescent populations.Methods A retro-spective analysis was conducted on 28 patients with ACL rupture who underwent primary total epiphyseal ACL reconstruction in the Sports Medicine Treatment Center of Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2019 to October 2022.Patients were categorized into two groups based on the method of guide needle insertion:the manual group(guide needle in-sertion relying on the operator's expertise)and the robot-assisted group(guide needle insertion assisted by the Tianji robot naviga-tion and positioning system).The manual group comprised 14 cases(9 males,5 females)with an average age of 13.59±1.59 years,while the robot-assisted group included 14 patients(10 males,4 females)with an average age of 13.27±1.66 years.The operation time,intraoperative fluoroscopy times,guide needle placement times,the distance between the central point of the internal articu-lar opening of the tibial and femoral bone tunnel and the ideal point,the rate of epiphyseal inflammation,and the International Knee Documentation Committee(IKDC)subjective score,Lysholm score,KT-2000 ligament relaxation,lower limb force line were compared between the two groups.Results The follow-up duration was 19.9±6.3 months for the manual group and 18.8±4.9 months for the robot group(t=0.546,P=0.589).The manual group's operation duration was 123.0±12.6 min,significantly longer than the robot group's 96.4±12.9 min(t=5.502,P＜0.001).Intraoperative fluoroscopy was performed 11.8±3.1 times in the manual group,markedly more than the robot group's 3.7±0.8 times(t=9.434,P＜0.001).The robot group required only one guide needle placement for both femur and tibia,while the manual group had 5.7±1.2 placements on the femur side and 4.6±1.8 on the tibia side.The distance between the femoral joint's central point and the ideal point was 0.87±0.20 mm in the robot group,superior to the manual group's 1.92±0.64 mm(t=5.81 6,P＜0.001).Similarly,the distance between the central point and the ideal point was 1.15±0.34 mm for the robot group,better than the manual group's 1.94±0.55 mm(t=4.582,P＜0.001).No cases of epiphyseal irrita-tion were observed in the robot group,while 21％(3/14)of the manual group experienced tibial or femoral epiphyseal plate involve-ment.At 3 months post-surgery,the robot group exhibited higher IKDC subjective scores(90.57±8.46)and Lysholm scores(86.29± 5.09)compared to the manual group(83.50±6.19 and 80.93±5.93),respectively(P＜0.05).However,at the final follow-up,there were no significant differences in IKDC subjective scores,Lysholm scores,or KT-2000 ligament relaxation between the two groups(P＞0.05).Both groups showed normal lower limb force alignment and no abnormal growth or development.Conclusion Tianji ro-bot navigation and positioning system-assisted ACL reconstruction in children and adolescents offer advantages such as precise po-sitioning,shorter operation times,reduced intraoperative fluoroscopy,faster recovery,and enhanced epiphyseal protection com-pared to manual methods.
关键词
儿童/青少年/前交叉韧带损伤/前交叉韧带重建/手术导航系统Key words
Child/Adolescent/Anterior cruciate ligament injuries/Anterior cruciate ligament reconstruction/Surgical navigation systems引用本文复制引用
基金项目
陕西省重点研发计划资助项目(2023-YBSF-141)
陕西省自然科学基础研究计划资助项目(2022JQ-865)
出版年
2024
NETL
NSTL
万方数据