Intraoperatīvās zāģējuma kļūdas analīze, izmantojot datornavigācijas sistēmu totālas ceļa locītavas endoprotezēšanas operācijās
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Pilnīga ceļa locītavas endoprotezēšana tiek veikta 70 no 100 000 iedzīvotājiem Latvijā (OECD Health Statistics 2016, Eurostat Database) un ir ar tendenci augt Eiropā kopumā. Precīza kājas ass atjaunošana ir viens no galvenajiem faktoriem, lai iegūtu labu ilgtermiņa rezultātu pēc pilnīgas ceļa locītavas endoprotezēšanas operācijas.
Datornavigācijas sistēmas pielietošana ļauj izmērīt kaula griezuma kļūdu intraoperatīvi, tādējādi iegūstot vērtīgu informāciju par kaula griezuma precīzumu un ļauj ārstam veikt labojumus operācijas laikā. Pat ja viss pirms griezuma ir nomērīts pareizi, tāpat iespējama griezuma kļūda, kas atkarīga no daudziem faktoriem – viens no tiem ir ka kaulviela deformācijas pusē var būt cietāka un līdz ar to būt neprecīza griezuma cēlonis.
Šī pētījuma mērķis bija novērtēt intraoperatīvo zāģējumu kā iespējamu neprecizitātes cēloni pilnīgas ceļa locītavas endoprotezēšanas operācijās. Visiem pacientiem bija ceļa locītavas osteoartrīts un tika veikta ceļa locītavas endoprotezēšanas operācija ar datornavigāciju. Pacientu informācija tika iegūta no Rīgas 2. slimnīcas arhīviem, visās operācijās tika izmantota Aesculap OrthroPilot 5.0 navigācijas sistēma.
Kopumā, pētījumā bija 39 pacienti, no kuriem 77% bija sievietes. Vidējais pacientu vecums bija 68 gadi operācijas laikā. Pacientiem pirms operācijas tika novērta ievērojama ceļa locītavas deformācija.
Biežākā pieļautā osteotomijas kļūda bija femur nozāģēts vairāk extensijas pozīcijā, kas notika 51,3% pacientu. Femur vairāk fleksijas pozīcijā nozāģēts bija tikai 2 pacientiem. Otra biežākā osteotomijas kļūda – tibia nogriezta vairāk ekstenzijas pozīcijā, kas bija 11 pacientiem. Tibia nogriezta vairāk fleksijas pozīcijā bija tikai divās operācijās. Kopumā varus tipa griezuma kļūda bija sastopama aptuveni divreiz biežāk nekā valgus veida osteotomijas kļūda un tā tika pieļauta 5 pacientiem tibia griezumā un 6 pacientiem femur griezumā.
Galvenais šī pētījuma trūkums bija tas, ka datornavigācija varēja parādīt kļūdas tikai ar viena grāda precizitāti, tādēļ padziļināta statistiskā analīze nebija iespējama. 95% pacientu bija veida osteotomijas griezuma kļūda operācijā. Neprecīza osteotomija var ietekmēt protēzes izturību un saīsināt kalpošanas ilgumu, kā arī rezultēties sliktākos funkcionālajos rezultātos. Datornavigācijas lietošana ir vērtīga šādu neprecizitāšu atpazīšanā un novēršanā.
Knee replacement is a surgical procedure to replace the weight-bearing surfaces of the knee joint in order to relieve the pain and disability of osteoarthritis. Since the 2000s, the number of knee replacements has increased rapidly in most OECD countries. The use of computer navigation in total knee arthroplasty allows the surgeon to measure intraoperative cutting errors. Accurate reconstruction of leg alignment is crucial in total knee arthroplasty (or TKA in short). The aim of this study was to evaluate the alignment of tibial and femoral cutting surfaces using a computer navigation system to determine the accuracy of bone resection. All patients were diagnosed with osteoarthritis of the knee (M-17, SSK-10) and TKA was performed on all of the patients. Patient information was gathered from Riga 2nd Hospital records and existing joint deformation as well as bone cutting error measurements were gathered intraoperatively. All of the patients were operated on using a Aesculap (ESKULAP) OrthoPilot 5.0 navigation system. 39 patients were analysed. 77% patients were female. Overall, only 2 patients had no cutting errors detected in any plane after both femoral and tibial resection. Mean age of patients was 68 years at the time of operation. The results show that patients already had considerable amount of deformation in the knee joint before the operation. In the pre-bone cutting stage, the surgeon can select and plan how he would like the tibia and femur to be cut. After the resection is made, the surgeon can check if the cut was exactly like planned or not. The results were that second most frequent error overall was tibia being cut in an extended position occurring in 11 patients. Only in two operations tibiae was cut in a more flexed position, a more Varus cut occurred in 5 patients, a more Valgus cut occurred in 2 patients. The most common bone cutting error overall was in femoral osteotomy – a more extended position occurred in 51,3% patients out of whom 13 patients had a cutting error of 1 degree while 7 patients had an error of 2 degrees and a more flexed position occurred in 5,1% patients. A more Varus cut occurred in 6 patients, a more Valgus cut occurred in 4 patients A drawback in this study was the least count or the smallest and accurate value in the measured quantity that can be resolved on the instrument's scale. The computer navigation could only show changes one degree at the time, so a more in depth statistical analysis was difficult to do. Vast majority of patients had some kind of deviation between the planned osteotomy and the result. It is important to have optimal implant alignment because otherwise unstable loading conditions, wear and component loosening may occur. Therefore, it is important to have correct alignment and for bone to be recut if necessary. Orthopedic navigation system is useful during TKA for verification of the cutting surface and avoidance of malalignment.
Knee replacement is a surgical procedure to replace the weight-bearing surfaces of the knee joint in order to relieve the pain and disability of osteoarthritis. Since the 2000s, the number of knee replacements has increased rapidly in most OECD countries. The use of computer navigation in total knee arthroplasty allows the surgeon to measure intraoperative cutting errors. Accurate reconstruction of leg alignment is crucial in total knee arthroplasty (or TKA in short). The aim of this study was to evaluate the alignment of tibial and femoral cutting surfaces using a computer navigation system to determine the accuracy of bone resection. All patients were diagnosed with osteoarthritis of the knee (M-17, SSK-10) and TKA was performed on all of the patients. Patient information was gathered from Riga 2nd Hospital records and existing joint deformation as well as bone cutting error measurements were gathered intraoperatively. All of the patients were operated on using a Aesculap (ESKULAP) OrthoPilot 5.0 navigation system. 39 patients were analysed. 77% patients were female. Overall, only 2 patients had no cutting errors detected in any plane after both femoral and tibial resection. Mean age of patients was 68 years at the time of operation. The results show that patients already had considerable amount of deformation in the knee joint before the operation. In the pre-bone cutting stage, the surgeon can select and plan how he would like the tibia and femur to be cut. After the resection is made, the surgeon can check if the cut was exactly like planned or not. The results were that second most frequent error overall was tibia being cut in an extended position occurring in 11 patients. Only in two operations tibiae was cut in a more flexed position, a more Varus cut occurred in 5 patients, a more Valgus cut occurred in 2 patients. The most common bone cutting error overall was in femoral osteotomy – a more extended position occurred in 51,3% patients out of whom 13 patients had a cutting error of 1 degree while 7 patients had an error of 2 degrees and a more flexed position occurred in 5,1% patients. A more Varus cut occurred in 6 patients, a more Valgus cut occurred in 4 patients A drawback in this study was the least count or the smallest and accurate value in the measured quantity that can be resolved on the instrument's scale. The computer navigation could only show changes one degree at the time, so a more in depth statistical analysis was difficult to do. Vast majority of patients had some kind of deviation between the planned osteotomy and the result. It is important to have optimal implant alignment because otherwise unstable loading conditions, wear and component loosening may occur. Therefore, it is important to have correct alignment and for bone to be recut if necessary. Orthopedic navigation system is useful during TKA for verification of the cutting surface and avoidance of malalignment.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Ceļa endoprotezēšana, Datornavigācija, Osteotomija, Griezuma kļūda., Total knee arthroplasty, navigation system, osteotomy, malalignment.