Mako机器人辅助后外侧入路全髋关节置换术

MAKO robot-assisted total hip arthroplasty through posterior lateral approach

[目的]介绍MAKO机器人辅助后外侧入路全髋关节置换术(THA)的手术技术与临床结果。[方法]2017年3月~2018年3月,17例患者在MAKO机器人辅助下行THA。术前行腰椎、骨盆和同侧膝关节CT扫描,建立一个三维模型,输入MAKO机器人手臂辅助全髋关节系统,确定假体组件的大小和位置。术中对骨性标志登记,在机械臂辅助下进行截骨,安装假体。[结果] 17例患者均顺利完成手术,术中无血管、神经损伤等严重并发症。术中出现1例(5.88%)股骨距轻度劈裂骨折,术后无脱位等并发症。随访12个月以上,末次随访时,VAS评分为(1.26±0.71)分,Harris评分(91.17±3.82)分。术后影像检查显示假体位置良好,外展角为(41.33±3.84)°,前倾角为(16.42±1.46)°,17例患者术后双下肢长度差异均在10 mm以内。[结论] MAKO机械人辅助后外侧入路THA假体置入更精准,有利于保持髋关节的生物力学环境。

[Objective] To introduce surgical technique and primary clinical outcomes of MAKO robot-assisted total hip arthroplasty(THA). [Methods] From March 2017 to March 2018, a total of 17 patients underwent MAKO robot-assisted THA.Before operation, CT scanning involving lumbar spine, pelvis and ipsilateral knee was conducted to form a three-dimensional model. Subsequently, the data was input into the MAKO robot system to determine the size and position of the components. During operation, the bony marks of the patient were registered in the system, and then osteotomies were performed under assistances of the robotic arms. Finally, the acetabular and femoral components were installed based on systemic data. [Results] All the17 patients had THA conducted smoothly without serious complication, such as neurovascular injuries, except slight cleavage fracture on the calcar femorale noted in 1 patient(4.5%). No dislocation happened in anyone of them during early stage after operation. All the patients were followed up for more than 12 months. At the latest follow up, the VAS score was of(1.26±0.71),while the Harris score of(91.17±3.82). The postoperative radiographs revealed that proper positions of the acetabular and femoral components was achieved in all the patients, with acetabular abduction angle of(41.33±3.84)°, acetabular anteversion angle of(16.42±1.46)°, and the lower leg discrepancy less than 10 mm. [Conclusion] The MAKO robot-assisted THA through posterolateral approach does improve the accuracy of prosthetic placement, which is benefit for maintaining the biomechanical environment of the hip.