机器人辅助髓芯减压术治疗股骨头坏死的效果

Effect of robot-assisted core decompression and bone grafting fornecrosis of femoral head

目的观察国产骨科手术机器人应用于髓芯减压植骨术治疗早期股骨头缺血性坏死的临床效果。方法回顾性分析2020年6月至2021年5月于西安交通大学第二附属医院骨关节外科行髓芯减压植骨术治疗早期股骨头缺血性坏死的病例共36例,国际骨循环研究会(ARCO)分期均为Ⅱ期,其中机器人辅助手术组15例,传统手术组21例,记录手术时间、导针尝试穿刺次数和透线次数,比较术前、术后3、6个月的Harris髋关节评分和视觉模拟评分(VAS)。统计学分析采用两独立样本t检验和重复测量方差分析。结果所有患者均成功随访,机器人组患者的手术时间(57.3±18.9)min较传统手术组(71.6±18.2)min明显缩短(t=2.292,P<0.05),机器人组患者的导针尝试穿刺次数、总透线次数和置入导针透线次数均较传统组明显减少(t=6.818、4.871、4.546,均为P<0.05),而两组在术后3个月和术后6个月的Harris评分和VAS评分差异无统计学意义(F=0.080、0.069,均为P>0.05)。结论应用国产机器人辅助下髓芯减压植骨术治疗早期股骨头坏死是安全有效的,可以节省手术时间并减少医患放射线暴露。

Objective To observe the effect of the domestic orthopedic robot-assisted core decompression and bone grafting surgery for early necrosis of the femoral head.Methods A retrospective analysis was performed on 36 cases underwent core decompression and bone grafting for early necrosis of the femoral head treated at Department of Bone and Joint Surgery,the Second Affiliated Hospital of Xi′an Jiaotong University from June 2020 to May 2021.15 cases underwent robot-assisted surgery,and 21 cases underwent conventional surgery.All the patients were in Association research circulation osseous(ARCO)stageⅡ.The operating times,the number of guidewire attempts and total number of intraoperative radiation exposure were recorded.The preoperative and postoperative Harris scores and VAS scores in three and six months were compared.The repeated measurements analysis of variances and t test of two independent samples were used for statistical analysis.Results All the patients were successfully followed up,and the operation time of the robot-assisted group(57.3±18.9)min was significantly shorter than that of the traditional group(71.6±18.2)min(t=2.292,P<0.05);compared with the traditional group,the number of guidewire attempts,the total number of intraoperative radiation exposure,and the number of radiation exposure during insertion of guidewire were significantly reduced in the robot-assisted group(t=6.818,4.871,4.546,all P<0.05),and there were no significant differences between the two groups in Harris score and VAS score at three and six months postoperatively(F=0.080,0.069,both P>0.05).Conclusion It is safe and effective to use the domestic robot-assisted core decompression and bone grafting for the treatment of early femoral head necrosis,which can save the operation time and reduce the radiation exposure.