| 杨阳,杨勇,刘常宇,等.机器人辅助与传统截骨行全膝关节置换术的早期临床疗效对比.骨科,2023,14(6): 523-529. |
| 机器人辅助与传统截骨行全膝关节置换术的早期临床疗效对比 |
| A Comparative Study of the Early Clinical Efficacy of Robot-Assisted Total Knee Arthroplasty vs. Conventional Total Knee Arthroplasty |
| 投稿时间：2023-04-21 |
| DOI：10.3969/j.issn.1674-8573.2023.06.007 |
| 中文关键词: 机器人手术 关节成形术，置换，膝 假体安装 骨关节炎, 膝 治疗结果 对比研究 |
| 英文关键词: Robotic surgical procedures Arthroplasty, replacement, knee Prosthesis fitting Osteoarthritis, knee Treatment outcome Comparative study |
| 基金项目:国家自然科学基金（81974350、82202673）；材料复合新技术国家重点实验室（武汉理工大学）开放基金（2022-KF-29） |
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| 中文摘要: |
| 目的 对比国产和华瑞博（HURWA）机器人导航辅助全膝关节置换术（robotic-assisted total knee arthroplasty，RATKA）与传统全膝关节置换术（TKA）治疗膝关节骨性关节炎（KOA）的早期临床疗效。方法 回顾性分析我科2021年3月至2022年1月收治的46例行TKA治疗终末期KOA的病人。其中RATKA组23例，男10例，女13例，年龄为（67.54±12.32）岁；传统TKA组23例，男8例，女15例，年龄为（70.34±9.74）岁。记录围手术期的髋-膝-踝角（HKA）偏移、股骨机械轴远端外侧角（mLDFA）、胫骨机械轴近端内侧角（mMPTA）、膝关节线汇聚角（JLCA），作为评估力线对位及假体放置的影像学指标。采用术前与术后1天血红蛋白（HB）差值、术中出血量、术后引流量评估出血情况。随访并记录手术时间、膝前正中切口长度、术前及术后3个月膝关节活动度，术前、术后1个月、术后1年的美国膝关节协会评分（KSS）及疼痛视觉模拟量表（VAS）评分，以评估短期临床疗效。结果 手术均顺利完成，术后均未出现严重并发症。两组病人力线及假体对位指标均较术前明显改善，且在正常范围，RATKA组HKA偏移及术后JLCA优于传统TKA组，差异有统计学意义（P＜0.05），但两组术后mLDFA、mMPTA比较，差异无统计学意义（P＞0.05）。RATKA组术中出血量及术后引流量略小于传统TKA组，但差异无统计学意义（P＞0.05）；RATKA组的手术时间、膝前正中切口长度均长于传统TKA组，术后1天与术前的HB差值低于传统TKA组，差异有统计学意义（P＜0.05）。两组病人术后3个月活动度、术后1个月及1年的KSS评分和VAS评分均较术前有明显改善，且RATKA组和传统TKA组术后3个月的活动度比较，差异有统计学意义（P＜0.05），但两组KSS评分、VAS评分比较，差异无统计学意义（P＞0.05）。结论 国产HURWA机器人辅助行TKA相较传统TKA具有对线及假体放置更精准、出血少、关节活动度恢复更佳的优势，传统TKA在手术时间及切口长度方面优于RATKA。RATKA短期疗效值得肯定，远期预后有待进一步论证。 |
| 英文摘要: |
| Objective To compare the early clinical outcomes of domestic HURWA robotic-assisted total knee arthroplasty (RATKA) with conventional total knee arthroplasty (TKA) in the treatment of knee osteoarthritis (KOA). Methods A total of 46 patients with end-stage KOA who were admitted to our department for TKA from March 2021 to January 2022 were included in this study. There were 23 patients in the RATKA group, including 10 males and 13 females, aged (67.54±12.32) years, and 23 patients in the conventional TKA group, including 8 males and 15 females, aged (70.34±9.74) years. The hip-knee-ankle angle (HKA) offset, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and joint line convergence angle (JLCA) were recorded during the perioperative period, as imaging indicators to assess force line alignment and prosthesis placement. The difference in hemoglobin (HB) between the day after surgery and the day before surgery, intraoperative bleeding and postoperative drainage were used as indicators to assess bleeding. The duration of surgery, the length of the anterior median knee incision, the range of motion (ROM) before and 3 months after surgery, the knee society score (KSS) and the visual analogue scale (VAS) before, 1 month and 1 year after surgery were followed up and recorded to assess short-term clinical outcomes. Results The surgery was completed successfully and there were no serious postoperative complications. Compared with those before surgery, the force line and prosthesis alignment indexes in both groups were significantly improved and within the normal range. The HKA offset and postoperative JLCA in the RATKA group were superior to those in the conventional TKA group, with statistically significant differences (P＜0.05). However, there was no statistically significant difference in postoperative mLDFA and mMPTA between the two groups (P＞0.05). The intraoperative bleeding and postoperative drainage were slightly smaller in the RATKA group than in the conventional TKA group, but the differences were not statistically significant (P＞0.05). The duration of surgery and the length of the anterior median knee incision were longer in the RATKA group than in the conventional TKA group, and the difference in HB between the postoperative day and the preoperative day was lower in the RATKA group, the differences were statistically significant (P＜0.05). The ROM at 3 months, KSS scores and VAS scores at 1 month and 1 year postoperation were significantly improved as compared with the preoperative scores. There was a statistically significant difference between the RATKA and conventional TKA groups in the ROM at 3 months postoperatively (P＜0.05), but there was no statistically significant difference in the KSS scores and VAS scores (P＞0.05). Conclusion The domestic robotic navigation-assisted TKA, known as “HURWA”, offers advantages over conventional TKA in terms of more precise alignment and placement of the prosthesis, less bleeding and faster recovery of joint mobility. Conventional TKA is superior to RATKA in terms of operating time and incision length. The short-term efficacy of RATKA is positive, but the long-term prognosis needs to be further investigated. |
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