机器人辅助下钻孔减压治疗股骨头坏死与传统手术的对比

Comparison of robot-assisted drilling decompression and traditional surgery for treatment of aseptic necrosis of femoral head

背景:为了延缓早期股骨头坏死的进一步加重,股骨头钻孔减压是一种较好的治疗方法,但传统股骨头钻孔减压手术创伤大。目的:对比机器人辅助下钻孔减压治疗股骨头无菌性坏死与传统手术疗效的差异。方法:纳入40例行股骨头无菌性坏死钻孔减压患者进行回顾性对比分析,根据治疗方案分为2组。机器人组在机器人辅助下对18例(26个股骨头)进行股骨头钻孔减压治疗,其中FicatⅠ期13例(18个股骨头),FicatⅡ期5例(8个股骨头);传统手术组共22例患者(29个股骨头),其中FicatⅠ期15例(19个股骨头),FicatⅡ期7例(10个股骨头)。对比2组患者的手术切口、术中透视次数、术中出血量、术中穿刺次数及手术时间,术前及术后1,3,6个月根据Harris评分评估髋关节功能。结果与结论:①所有患者均随访6个月以上;②机器人组术中切口长度、术中出血量、透视次数、术中穿刺次数、手术时间均优于传统组,差异有显著性意义(P<0.05);③2组患者术后1,3,6个月Harris评分相比差异均无显著性意义(P>0.05);④提示与传统术式相比,机器人辅助下钻孔减压治疗股骨头无菌性坏死的疗效方面并未见明显优势,但其手术切口小,术中透视次数少,创伤小,操作更加安全微创。

BACKGROUND:To delay the further aggravation of early femoral head necrosis,drilling decompression of the femoral head is a better treatment method.However,traditional trepanation and decompression of the femoral head is traumatic.OBJECTIVE:To compare the difference in the effect between robot-assisted drilling decompression and traditional surgery for aseptic necrosis of femoral head.METHODS:Forty patients with aseptic necrosis of the femoral head were included for retrospective comparative analysis.According to the treatment plan,they were divided into two groups.Eighteen cases(26 femoral heads)in the robot group were treated with drilling decompression assisted by robots.Among them,13 cases(18 femoral heads)were in Ficat stage I and 5 cases(8 femoral heads)were in Ficat stage II.The traditional surgery group consisted of 22 patients(29 femoral heads).Among them,15 patients(19 femoral heads)were in Ficat stage I and 7 patients(10 femoral heads)in Ficat stage II.Incision,times of intraoperative fluoroscopy,intraoperative blood loss,times of intraoperative puncture and operation time were compared between the two groups.Harris score was used before and 1,3,and 6 months after operation to evaluate the hip effect.RESULTS AND CONCLUSION:(1)All cases were followed up for 6 months.(2)Incision,times of intraoperative fluoroscopy,intraoperative blood loss,times of intraoperative puncture and operation time were better in the robot group than in the traditional surgery group(P<0.05).(3)Harris score was not significantly different 1,3 and 6 months after surgery in the two groups(P>0.05).(4)Compared with the traditional surgery,robot-assisted drilling decompression has no obvious advantage in the treatment of aseptic necrosis of the femoral head.However,its operation incision is small;the number of intraoperative fluoroscopy is small;the trauma is small;and the operation is safer and minimally invasive.