医学影像信息系统辅助全膝置换前计划中的作用

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摘要：背景：医学影像信息系统在临床应用中逐步取代醋酸酯模板在胶片上进行测量的传统术前计划模式，可以准确地获得全膝关节置换手术操作过程中所需要的各项参数。 目的：探讨医学影

背景：医学影像信息系统在临床应用中逐步取代醋酸酯模板在胶片上进行测量的传统术前计划模式，可以准确地获得全膝关节置换手术操作过程中所需要的各项参数。

目的：探讨医学影像信息系统在全膝关节置换术前计划与术后评估中的应用价值。

方法：选择2016年3月至2018年3月南京医科大学附属无锡人民医院收治的重度膝关节骨关节炎患者，随机分 2组，试验组(n=32)术前通过医学影像信息系统进行截骨规划，然后植入人工膝关节假体；对照组(n=32)术中依据X射线片进行截骨，然后植入人工膝关节假体，术中测试两组髌骨活动轨迹。术后复查膝关节正侧位和下肢全长 X射线片，通过数字影像系统测量胫骨假体后倾角度和膝关节内(外)翻角度，评估下肢力线恢复情况；术后1，3，12个月进行患侧膝关节HSS评分，评估关节功能恢复情况。试验获得南京医科大学附属无锡人民医院伦理委员会批准。

结果与结论：①试验组下肢力线满意率、髌骨活动轨迹优良率高于对照组(100%，91%；100%，94%，P<0.05)，两组后倾截骨满意率比较差异无显著性意义(P>0.05)；②试验组术后1，3个月的膝关节HSS评分高于对照组[(80.)，(74.)分，P<0.05；(89.)，(82.)分，P<0.05]，两组术后12个月的评分比较差异无显著性意义(P>0.05)；③术后未发生与植入假体相关并发症及不良反应；④结果表明，通过医学影像信息系统可对全膝关节置换患者制定个性化截骨方案，提高截骨精确性，更好地矫正下肢力线，获得优良的髌骨活动轨迹，取得较好的手术早期疗效，1年内的随访结果较满意，远期疗效还有待进一步观察。

BACKGROUND:In clinical application,Picture Archiving and Communication System gradually replaces the traditional preoperative planning mode of acetate template measurement on film,which can accurately obtain the parameters needed in the operation of total knee arthroplasty.

OBJECTIVE:To evaluate the usage of Picture Archiving and Communication System in planning and assessment pre- and post-operatively in total knee arthroplasty.

METHODS:Severe knee osteoarthritis patients who undertook total knee arthroplasty in Wuxi People’s Hospital affiliated to Nanjing Medical University from March 2016 to March 2018 were included in the patients were randomly divided into two the trial group(n=32),osteotomy was performed by Picture Archiving and Communication System,and then patients were implanted with knee the control group (n=32),the osteotomy was performed according to the X-ray film,and then the artificial knee joint prosthesis was trajectory of the tibia was tested during the and lateral X-ray films of the knee and the whole length films of the lower limbs were reexamined plateau inclination angle and valgus or varus angle were measured through Picture Archiving and Communication of lower limb alignment was for special surgery knee score on the affected side was analyzed to evaluate the recovery of joint function at postoperative 1,3 and 12 study was approved by the Ethics Committee of Wuxi People’s Hospital affiliated to Nanjing Medical University.

RESULTS AND CONCLUSION:(1) The satisfaction rate of lower limb alignment and the excellent and good rate of patellar movement trajectory were higher in the trial group than in the control group (100%,91%;100%,94%,P<0.05).There was no significant difference between the two groups in the satisfaction rate of osteotomy (P>0.05).(2) Hospital for special surgery knee score was higher in the trial group than in the control group at postoperative 1 and 3 months [(80.),(74.),P<0.05;(89.),(82.),P<0.05].There was no significant difference in the score at postoperative 12 months (P>0.05).(3) No complications or adverse reactions related to implant occurred after operation.(4) Results indicated that personal osteotomy data can be obtained through Picture Archiving and Communication System in the total knee arthroplasty so as to improve the accuracy of osteotomy,better correct the lower limb alignment,obtain excellent patellar trajectory,and obtain better early curative effect of follow-up results within 1 year were long-term effect remains to be further observed.

0 引言 Introduction

全膝关节置换是治疗重度膝关节骨关节炎的标准手术，但是25%的患者对术后结果不满意[1]。多种因素影响全膝关节置换的手术疗效，包括假体大小的选择、下肢力线的重建、胫骨和股骨假体旋转摆位、屈伸间隙平衡等[2-6]，良好的术前计划可有效降低上述因素的误差，提高手术疗效。随着医疗数字化进程，医学影像信息系统在临床应用越来越普遍[7]，其精准的测量功能逐步取代醋酸酯模板在胶片上进行测量的传统术前计划模式[8]，可以准确地获得全膝关节置换手术操作过程中所需要的各项参数。作者采用医学影像信息系统对一组病例进行术前计划和测量，术后通过该影像系统对手术结果进行评估，与常规手术组进行比较，探讨其临床应用价值。

文章来源：《数字化用户》 网址: http://www.szhyhbjb.cn/qikandaodu/2020/0817/570.html

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