MAKO机器人辅助后外侧入路全髋关节置换的学习曲线及临床早期效果

Learning curve and early clinical results of total hip arthroplasty with MAKO robot assisted posterolateral approach

背景:随着全髋关节置换技术的不断成熟,对手术的精准程度要求越来越高,以期望患者得到更良好的置换结果:MAKO机器人辅助下的关节置换技术使手术的精准程度实现了可能,但该项技术有一定的学习曲线,早期的置换结果及并发症应是关注重点。目的:分析MAKO机器人辅助下后外侧入路人工髋关节置换的学习曲线及临床早期效果。方法:回顾性分析2017年3月至2018年3月中南大学湘雅医学院附属海口医院西院(海口骨科与糖尿病医院)采用MAKO机器人辅助下后外侧入路行人工髋关节置换26例患者的病例资料,其中男12例,女14例。关注学习曲线早期的髋关节置换中易发生的问题及早期临床结果。结果与结论:手术时间56-155 min,平均(87.0±16.1)min:显性出血220-850 mL,平均(336±246)mL。髋臼外展角(41.3±2.7)°,髋臼前倾角(16.4±3.4)°,下肢长度差值为(1.0±2.0)mm,股骨偏心距差值为(1.6±0.6)mm.术中股骨距骨折1例,无感染、坐骨神经损伤及伤口相关并发症。置换后弃拐行走时间3-6周,平均(3.8±2.1)周。置换后3个月Harris评分(92.1±4.7)分。提示MAKO机器人辅助下后外侧入路全髋关节置换学习曲线的病例短期内显示疼痛改善,功能康复快,临床结果良好,手术时间随着熟练度而缩短,假体位置均在安全范围内,失血量亦在可接受范围。

BACKGROUND:With the maturity of total hip arthroplasty,the need for operative accuracy is highly increasing to get better operative results.The joint replacement technique assisted by MAKO robot makes the precision of the operation possible.However,this technology has a certain learning curve,and early replacement results and complications should be the major concern.OBJECTIVE:To analyze the learning curve and early clinical results of total hip arthroplasty through the posterolateral approach assisted by the MAKO robot.METHODS:From March 2017 to March 2018,26 patients undergoing hip arthroplasty via posterolateral approach assisted by MAKO robots in West Hospital(Haikou Orthopedics and Diabetes Hospital),Haikou Hospital,Xiangya School of Medicine,Central South University,including 12 males and 14 females,were retrospectively analyzed.The problems and early clinical outcomes of hip replacement in the early learning curve were focused on.RESULTS AND CONCLUSION:The operation time was 56-155 minutes,mean(87.0±16.1) minutes.The dominant bleeding was 220-850 mL,mean(336±246) mL.The acetabular abduction angle was(41.3±2.7)°.The acetabular anteversion angle was(16.4±3.4)°.The difference in lower limb length was(1.0±2.0) mm,and the femoral offset error value was(1.6±0.6) mm.Intraoperative femoral fractures occurred in one case.No infection,sciatic nerve injury or wound-related complications occurred.The weight bearing time was 3-6 weeks,mean(3.8±2.1) weeks.Harris score was(92.1±4.7) 3 months after surgery.It is indicated that the MAKO robot-assisted total hip arthroplasty via posterolateral approach showed that patient’s postoperative pain improved;the function recovered quickly;the clinical results were good;the operation time decreased with the proficiency;the prosthesis position was within the safe range;and the blood loss was within the acceptable range.