一种新型计算机辅助全膝关节置换手术系统:华佗(WATO)

WATO:a new computer- assisted orthopaedic surgery system

目的评估计算机辅助骨科手术(CAOS)系统——华佗(WATO)系统的操作精度,并进行临床应用前的检测,为系统改进和临床使用提供实验依据。方法本研究包括假骨切割和尸体膝关节切割两部分,实验组使用WATO系统作为术前规划和股骨、胫骨的定位工具,根据定位过程中确定的参考力线,驱动机器人做精确的截骨;对照组由高年资关节外科医生使用常规手术工具进行截骨。截骨结束后比较测量力线和规划的理想下肢力线的偏角,并进行统计学分析。结果实验组使用WATO系统切割了200根假骨,平均偏角为0.98°±1.17°(0°～5.3°),对照组使用标准全膝关节置换工具切割了30根假骨,平均偏角为2.09°±1.96°(0.1°～7.1°)。两者平均偏角比较差异有统计学意义(P<0.01)。实验组使用WATO系统进行5具尸体膝关节的截骨,平均偏角为1.44°±0.52°(0.9°～2.3°),对照组使用标准全膝关节置换工具进行5具尸体膝关节的截骨,平均偏角为4.38°±2.72°(1.1°～7.9°)。两者平均偏角比较差异有统计学意义(P<0.05)。结论WATO系统与传统全膝关节置换术相比具有良好的准确性和稳定性,有望在将来的临床使用中辅助关节外科医生实现更好的术后力线重建。

Objective To evaluate the accuracy of a new computer - assisted orthopaedic surgery （CAOS） system-- WATO system in order to provide evidences for the system improvement and clinical application. Methods Bone resec- tion was performed on phantoms and cadaver knees in two groups. WATO system was used in experimental group to assist preoperative planning as well as bone positioning, and robot performed bone cutting according to designed alignment. Rou- tine surgical tools were used in control group by an experienced joint surgeon to perform bone resection. The deviations from ideal prosthesis alignment design in the intraoperative positioning procedure were determined after bone resection. Results Two hundred phantoms were resected in experiment group with the help of WATO, and the average deviation from ideal prosthesis alignment was 0. 98±1.17 degree （range from 0 -5.3 degree）. Thirty phantoms were resected in control group with routine TKA tools, and the average deviation from ideal prosthesis alignment was 2. 09±1.96 degree （ range from 0. 1 -7. 1 degree）, which showed significant difference from experimental group （P 〈 0. 01 ）. Five cadaver knees were resected in experiment group with the help of WATO, and the average deviation from ideal prosthesis alignment was 1.44 ＋ 0. 52 degree （range from 0. 9 - 2. 3 degree）. Five cadaver knees were resected in control group with routine TKA tools, and the average deviation from ideal prosthesis alignment was 4. 38±2. 72 degree （range from 1.1 -7.9 degree）, which showed significant difference from experimental group （ P 〈 0. 05 ）. Conclusion Extensive experiments can be conducted on phantoms and cadaver bones to verify the accuracy and stability of WATO system. WATO system shows its superiority in TKR, and has a broad application prospect in the future.