中国组织工程研究

中国组织工程研究 ›› 2014, Vol. 18 ›› Issue (53): 8553-8559.doi: 10.3969/j.issn.2095-4344.2014.53.005

• 人工假体 artificial prosthesis • 上一篇    下一篇

应用自制组配式截骨工具行微创全膝关节置换：延长切口长度的影响因素

李帅华，徐栋梁，何沛恒，黄  帅，瓦庆德，左建伟，张  娟   

  1. 中山大学附属第一医院关节外科，广东省广州市  510080
  • 修回日期:2014-11-25 出版日期:2014-12-24 发布日期:2014-12-24
  • 通讯作者: 徐栋梁，博士生导师，教授，主任医师，中山大学附属第一医院关节外科，广东省广州市 510080
  • 作者简介:李帅华，男，1982年生，江西省丰城市人，汉族，中山大学附属第一医院在读博士，主治医师，主要从事骨关节外科研究。
  • 基金资助:

    中山大学临床医学研究“5010”计划项目(2010005)

Self-made assembly osteotomy instrument for minimally invasive total knee arthroplasty: influential factors for extending incision length

Li Shuai-hua, Xu Dong-liang, He Pei-heng, Huang Shuai, Wa Qing-de, Zuo Jian-wei, Zhang Juan   

  1. Department of Joint Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
  • Revised:2014-11-25 Online:2014-12-24 Published:2014-12-24
  • Contact: Xu Dong-liang, Doctoral supervisor, Professor, Chief physician, Department of Joint Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
  • About author:Li Shuai-hua, Studying for doctorate, Attending physician, Department of Joint Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
  • Supported by:

    Sun Yat-sen University Clinical Medical Research “5010” Project, No. 2010005

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摘要：

背景：常用的微创人工全膝关节置换手术器械操作难度较大，截骨和假体安装的准确性欠佳。
目的：评估自制组配式截骨器械在微创全膝关节置换过程中的使用价值。
方法：2012年6月至2014年3月采用自行研发设计的微创器械对45例(49膝)患者行8-10 cm QS切口微创全膝关节置换。并根据完成截骨后，拉钩暴露术野，安装假体需延长的切口长度，将49例膝分成切口延长< 1.0 cm组(16例)和切口延长1.0-2.0 cm组(33例)，比较两组中影响切口长度延长各因素(体质量指数、下肢长度、髌腱长度、髌骨厚度、髌骨纵径、髌骨横径以及假体型号)的差异及切口愈合情况。
结果与结论：所有患者手术切口均Ⅰ期甲级愈合，无感染、下肢深静脉血栓及血管、神经损伤等并发症。自行研发设计的微创器械皆能完成截骨，但需延长切口完成假体安装，最终切口长度(10.3±1.2) cm (9-12) cm。切口延长< 1.0 cm组和切口延长1.0-2.0 cm组中，体质量指数、髌腱长度、髌骨厚度、髌骨纵径、髌骨横径以及假体型号的差异均有显著性意义(P < 0.05)，这些因素的增大均会影响切口延长的长度；但两组下肢长度差异无显著性意义(P > 0.05)。提示自制组配式截骨器械，操作简单，能较好的完成微创人工全膝关节置换术中截骨，并且降低了微创手术风险，减少了置换后并发症，但受患者体质量指数、髌腱长度、髌骨厚度、纵径和横径以及所使用假体型号的影响，需延长切口长度以完成假体安装。


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


全文链接：

关键词: 植入物, 人工假体, 截骨器械, 微创, 组配式, 全膝关节置换, 切口长度, 切口延长, 体质量指数, 临床应用, 影响因素

Abstract:

BACKGROUND: Commonly used minimally invasive total knee arthroplasty instruments are difficult to be operated. Accuracy of osteotomy and prosthesis installation was poor.
OBJECTIVE: To evaluate the use value of self-made assembly osteotomy instrument in minimally invasive total knee arthroplasty.
METHODS: From June 2012 to March 2014, self-made minimally invasive instrument was used to perform  8-10 cm QS minimally invasive total knee arthroplasty in 45 patients (49 knees). After osteotomy, the operative field was exposed by retractors. Prosthesis placement needed to extend the length of incision. 49 knees were assigned to < 1.0 cm extension group (n=16) and 1.0-2.0 cm extension group (n=33). The differences in factors (body mass index, lower limb length, the length of the patellar tendon, patellar thickness, longitudinal and transverse diameter, and prosthesis model) affecting extension of incision length and the healing of the incision were compared between the two groups.
RESULTS AND CONCLUSION: Operative incision of all patients was healed in stage I. No complications such as infection, deep vein thrombosis, vascular and nerve damage. Our designed minimally invasive instrument could be used in osteotomy, but the incision should be extended for prosthesis placement. The final length of the incision was (10.3±1.2) cm (9-12 cm). Significant differences in body mass index, the length of the patellar tendon, patellar thickness, longitudinal and transverse diameter, and prosthesis model were detected between < 1.0 cm extension group and 1.0-2.0 cm extension group (P < 0.05). The increase in above factors can impact the length of the incision. However, no significant difference was detectable in the lower limb length between the two groups (P > 0.05). These data indicate that self-made minimally invasive instrument is simple to be operated, can be perfectly used in osteotomy of minimally invasive total knee arthroplasty, reduces the risk of minimally invasive operation, and diminishes postoperative complications, but this instrument is influenced by patients’ body mass index, the length of the patellar tendon, patellar thickness, longitudinal and transverse diameter, and prosthesis model. The length of the incision should be extended for prosthesis placement.


中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


全文链接：

Key words: arthroplasty, replacement, knee, surgical procedures, minimally invasive, prosthesis implantation

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