Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Computer-Assisted Navigation in Total Knee Arthroplasty

내비게이션 장치를 이용한 슬관절 전치환술

  • Jeong, Hwa-Jae (Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Park, Yong-Beom (Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Lee, Han-Jun (Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine)
  • 정화재 (성균관대학교 의과대학 강북삼성병원 정형외과학교실) ;
  • 박용범 (중앙대학교 의과대학 중앙대학교병원 정형외과학교실) ;
  • 이한준 (중앙대학교 의과대학 중앙대학교병원 정형외과학교실)
  • Received : 2017.10.30
  • Accepted : 2018.01.23
  • Published : 2018.12.30
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Abstract

Total knee arthroplasty has become a standard procedure for advanced knee arthritis to relieve pain and improve function. Computer-assisted navigation systems have been used in total knee arthroplasty to improve the mechanical axis of the limb as well as the alignment and position of the components. A computer-assisted navigation system has the advantage of real-time feedback during surgery, such as mediolateral balance in extension and flexion gap, alignment of the lower limb, and components. On the other hand, the computer-assisted navigation system requires an additional stab wound for tracker fixation, which can increase the likelihood of superficial wound infection and stress fractures and increase the operation time and cost of surgery. The clinical efficacy of computer-assisted navigation in total knee arthroplasty is also controversial. Compared to the conventional technique, computer navigation improves the accuracy of the postoperative mechanical axis within outliers of $3^{\circ}$ varus or $3^{\circ}$ valgus. This paper reviews the surgical technique, pitfalls, clinical and radiological outcomes, useful clinical cases, and future perspectives in computer-assisted navigation total knee arthroplasty.

슬관절의 골관절염 환자에서 슬관절 전치환술은 통증 경감 및 기능 회복에 도움이 되는 치료법으로 많이 시행되고 있다. 최근 수술 술기 및 과학 기술의 발달로 인하여 내비게이션 장치를 이용하여 슬관절 전치환술 후 하지 정렬과 치환물의 위치 및 정렬을 호전시키려는 노력이 지속적으로 이루어지고 있다. 이러한 내비게이션 장치를 이용할 경우 수술 중에 신전, 굴곡 시 내외측 간격, 하지 및 치환물의 정렬에 대하여 실시간 추적이 가능하다는 장점이 있다. 하지만 고식적인 방법에 비해 추적기 사용에 따른 추가적 절개로 인한 감염 및 골절 등의 합병증 발생 가능성이 있고 수술 시간이 길어지는 단점 및 비용 부담 등이 지적되어 왔다. 지금까지 많은 연구들이 진행되어 왔으나 임상적 효용성에 대해서는 아직까지 논란이 있다. 하지만 많은 연구들에서 관상면 상에서 역학적 축 내, 외반 $3^{\circ}$이내의 정렬 빈도를 높여주는 것으로 보고되고 있다. 이번 종설에서는 내비게이션 장치를 이용한 슬관절 전치환술의 수술 방법 및 수술 시 주의사항, 최근 연구들의 임상적 결과 및 방사선적 결과, 내비게이션 장치의 유용성과 최근 동향에 대하여 기술하고자 한다.

Keywords

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