| 张卓,孔祥朋,杨敏之,等.机器人辅助人工全髋关节置换的短期疗效分析.骨科,2020,11(4): 269-273. |
| 机器人辅助人工全髋关节置换的短期疗效分析 |
| Short-term outcome of robot-assisted total hip arthroplasty |
| 投稿时间：2020-05-22 |
| DOI：10.3969/j.issn.1674-8573.2020.04.001 |
| 中文关键词: 关节成形术，置换，髋 机器人辅助手术 精确性 并发症 |
| 英文关键词: Arthroplasty, replacement, hip Robotic assisted surgery Accuracy Complication |
| 基金项目:解放军总医院转化医学项目（2018TM-13） |
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| 中文摘要: |
| 目的 探讨机器人辅助人工全髋关节置换术（total hip arthroplasty, THA）的短期疗效。方法 回顾性分析2018年8月至2019年3月于我科采用MAKO机器人系统辅助植入臼杯行THA手术治疗的79例（100髋）病人的临床资料，纳入机器人辅助组，并选择同一手术医师施行的80例（100髋）徒手THA病人纳入对照组，均采用标准髋关节后外侧入路。收集比较两组病人的围手术期相关信息，如手术时间、住院时间、髋臼杯位置、术后下肢长度差异（limb length discrepancy, LLD）、围手术期并发症及髋关节Harris评分（hip Harris score, HHS）。结果 病人术后均得到3个月以上随访，两组均未发生髋关节脱位、无菌性松动、假体周围感染或翻修。机器人辅助组的手术时间为（95.92±15.64） min，明显长于对照组的（83.12±18.22） min，两组比较，差异有统计学意义（t=3.309，P=0.001）。两组的术后HHS均较术前显著改善，但组间比较，差异无统计学意义（P＞0.05）。机器人辅助组的前倾角、外展角、LLD和偏心距差异分别为19.05°±5.03°、41.14°±3.66°、（2.87±3.75） mm、（3.34±1.79） mm，对照组分别为16.91°±5.48°、40.35°±6.57°、（4.23±3.12） mm、（3.98±2.04） mm；两组的前倾角和LLD比较，差异均有统计学意义（P均＜0.05），但两组间的外展角和偏心距差异比较，差异无统计学意义（P＞0.05）。机器人辅助组的手术假体位于Lewinnek安全区内的比例更高（91% vs. 82%），但两组间比较，差异无统计学意义（χ2=3.468，P=0.063）。结论 机器人辅助THA能够优化髋臼杯假体植入的精确性，不增加手术的并发症，但其远期效果仍需进一步研究证实。 |
| 英文摘要: |
| Objective To evaluate the short-term outcome of robot-assisted total hip arthroplasty (THA) retrospectively. Methods From August 2018 to March 2019, 79 patients (100 hips) who were treated with MAKO robot-assisted THA were retrospectively studied and served as robot-assisted group, and 80 patients (100 hips) with manual THA in the same period performed by the same surgeon were included to the control group. Posterolateral approach was used. Perioperative information was recorded and analyzed, as well as time of surgery, length of hospital stays, cup position, lower limb length discrepancy (LLD), perioperative complications and hip Harris score (HHS). Results Patients were followed up for more than 3 months, no hip dislocation, aseptic loosening, periprosthetic infection or revision occurred in two groups. The operation time in the robotic assisted group was (95.92±15.64) min, which was significantly longer than that in the control group ［(83.12±18.22) min, t=3.309, P=0.001］. The postoperative HHS in the two groups was significantly improved as compared with that before the operation (P＜0.05 for all), but there was no statistically significant difference between the two groups (P＞0.05). The anteversion angle, abduction angle, LLD and eccentricity difference in the robot-assisted group were 19.05°±5.03°, 41.14°±3.66°, (2.87±3.75) mm, (3.34±1.79) mm, and those in the control group were 16.91°±5.48°, 40.35°±6.57°, (4.23±3.12) mm, (3.98±2.04) mm, respectively. There was statistically significant difference between the two groups in anteversion angle and LLD (all P＜0.05), but there was no significant difference in abduction angle and eccentricity difference between the two groups (P＞0.05). The percentage of surgical prostheses within the safety zone of Lewinnek in the robot-assisted group was higher (91% vs. 82%), but there was no statistically significant difference between the two groups (χ2=3.468, P=0.063). Conclusion Better accuracy could be achieved with robot-assisted THA, without increasing perioperative complications. Further studies should focus on mid- to long-term outcomes on the procedure. |
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