手术机器人系统在关节置换术中的应用研究进展

Research progress in the use of surgical robotic systems in arthroplasty

机器人系统应用于关节置换手术已有20余年的历史。涉及的关节置换手术覆盖全髋关节置换、全膝关节置换及单髁关节置换等。根据工作模式可将手术机器人系统分为被动型、半自动型、自动型，根据平台兼容性可以分为开放式与封闭式。系统均包括导航模块，但导航所使用的3D重建模式不同：仅需术中重建或需术前影像学检查辅助。现阶段通过美国FDA认证的关节置换手术机器人系统共有四个型号，包括Robodoc全自动手术机器人系统、Rio半自动手术机器人系统、iBlock自动辅助切割模块及Navio半自动手持切割系统。相对于常规手术，机器人辅助关节置换手术可以做到更精准的磨削、切割、钻孔操作，提高关节塑形精度，实现更准确的对线，植入假体的角度误差与术前规划更接近；在术后功能改善和患者满意度方面具有一定的优势，学习曲线也没有过度延长。但受到技术发展水平的制约，现有手术机器人系统仍存在手术时间延长、术野暴露要求高、出血量增多等缺陷。在费效比方面尚缺少基于中国国情的相关研究。未来关节置换手术机器人需要克服现阶段安全性和可靠性等方面的缺陷，进一步提高自动化程度，向更多手术环节拓展。也可向小型化发展。

With the application of robotic-assisted arthroplasty in the clinical setting during the last two decades, passive, semiautonomous, and autonomous surgical robotic systems have been developed and utilized in a wide range of surgical procedures. Such procedures include total hip arthroplasty, total knee arthroplasty, and unicompartmental knee arthroplasty. These robotic platforms can be divided into open platforms and closed systems. A navigation component is indispensable for all kinds of surgical robotic systems used in arthroplasty. Navigation components need two disparate approaches to realize three-dimensional reconstruction. Some robotic systems require preoperative imaging examination for navigation, while others only need iutraoperarive anatomic landmark identification. The following four types of FDA-approved surgical robotic systems are currently available for arthroplasty, the Robodoc autonomous system, the Rio haptic system, the iBlock cutting guide, and the Navio handheld system. Robotic-assisted arthroplasty reportedly facilitates more accurate milling, cutting, and drilling, allowing component alignment and bone morphing to be performed with higher precision and closer to preoperative planning. These advantages result in better postoperative function restoration and patient satisfaction. The learning curve is also acceptable for these systems. Nonetheless, robotic systems are still somewhat disappointing, because they are typically associated with prolonged surgical procedures and require adequate surgical field exposure. Moreover, the cost-effectiveness ratio of this technology in China is required for further investiga- tion. Future designs of robotic arthroplasty systems should aim to overcome the current shortcomings in terms of security and reliability, facilitating further automation of more surgical procedures and reduction in the size of the systems.