后外侧入路人工全髋关节置换术中MAKO机器人手臂辅助与传统人工方法的比较研究

A comparative study of MAKO robotic arm assisted total hip arthroplasty and traditional total hip arthroplasty through posterolateral approach

目的初步探讨后外侧入路MAKO机器人手臂辅助人工全髋关节置换术(total hip arthroplasty,THA)的疗效。方法回顾分析2017年3月—2019年3月收治且符合选择标准的70例THA患者临床资料。根据治疗方式不同分为两组,其中35例行MAKO机器人手臂辅助后外侧入路THA(MAKO组),35例行传统后外侧入路THA(THA组)。两组患者性别、年龄、体质量指数、病程、病因、术前日常生活能力量表(ADL)指数、美国麻醉医师协会(ASA)分级、行走能力、合并症、血红蛋白等一般资料比较差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者手术时间、术中出血量、住院时间,术后6个月髋臼前倾角、外展角及双下肢长度差,术中输血、术后立即负重及术后切口引流时间>2 d患者构成比及并发症发生情况。根据术后6个月X线片判断复位质量。术后3、6个月采用遗忘关节评分、Harris评分,可自主行走及ADL指数较术前增加患者构成比评价患者功能恢复情况。结果两组患者均获随访,随访时间6~18个月,平均8个月。两组手术时间、术中出血量、住院时间,术后6个月髋臼前倾角、外展角及双下肢长度差比较差异均无统计学意义(P>0.05)。术中输血、术后立即负重及切口引流时间>2 d患者构成比比较差异均无统计学意义(P>0.05);术后6个月X线片示两组复位质量比较差异亦无统计学意义(Z=4.191,P=0.123)。术后MAKO组7例(20.0%)发生并发症,THA组10例(28.6%),两组并发症发生率比较差异无统计学意义(χ^2=2.121,P=0.224)。MAKO组2例(5.7%)、THA组4例(11.4%)于6个月内行翻修处理,两组再手术率比较差异无统计学意义(χ^2=0.729,P=0.673)。术后3、6个月可自主行走及ADL指数较术前增加患者构成比两组间比较差异均无统计学意义(P>0.05)。两组Harris评分均较术前显著改善(P<0.05);两组间Harris评分及遗忘关节评分比较差异均无统计学意义(P>0.05)。结论与传统THA相比,MAKO机器人手臂辅助THA手术时间更长、术中出血更多,但具有定位准确、操作简便等优点,二者术后短期功能恢复无明显差异。

Objective To investigate the efficacy of total hip arthroplasty(THA)assisted by the MAKO robotic arm via posterolateral approach.Methods The clinical data of 70 patients treated with THA via posterolateral approach between March 2017 and March 2019 who met the selection criteria were retrospectively analyzed.According to different treatment methods,the patients were divided into two groups,35 were treated with MAKO robotic arm assisted THA(MAKO group)and 35 with traditional THA(THA group).There was no significant difference in gender,age,body mass index,disease duration,etiology,perioperative time,preoperative activity of daily living(ADL)scale index,American Society of Anesthesiologists(ASA)classification,walking ability,comorbidities,hemoglobin,and other general data between the two groups(P>0.05).The operation time,intraoperative blood loss,hospital stay,postoperative acetabular abduction and anteversion angles,postoperative length difference of bilateral lower limbs,and proportions of intraoperative blood transfusion,immediate postoperative loading,wound drainage time more than 2 days,and complications were recorded and compared between the two groups.According to the X-ray films at 6 months after operation,the reduction quality was judged.The forgotten joint score,Harris score,and proportions of independent walking and ADL index increased were used to evaluate the function recovery of patients.Results Patients in both groups were followed up 6-18 months,with an average of 8 months.There was no significant difference(P>0.05)between the two groups in operation time,intraoperative blood loss,hospital stay,acetabular abduction and anteversion angles,and length difference of both lower limbs at 6 months after operation.There was no significant difference in the proportions of intraoperative blood transfusion,immediate postoperative loading,and wound drainage time more than2 days between the two group(P>0.05).X-ray reexamination at 6 months after operation showed that there was no significant difference in the reduction quality between the two groups(Z=4.191,P=0.123).Postoperative complications occurred in 7 patients(20.0%)in the MAKO group and 10 patients(28.6%)in the THA group,showing no significant difference in the incidence of complications between the two groups(χ^2=2.121,P=0.224).Two patients(5.7%)in the MAKO group and 4 patients(11.4%)in the THA group underwent revision within 6 months,showing no significant difference in the revision rate between the two groups(χ^2=0.729,P=0.673).At 3 and 6 months after operation,the proportions of independent walking and ADL index increased showed no significant difference between the two groups(P>0.05).Harris scores in both groups improved significantly when compared with preoperative scores(P<0.05);there was no significant difference in the forgotten joint scores and Harris scores between the two groups(P>0.05).Conclusion Compared with traditional THA,MAKO robotic arm assisted THA has longer operation time and more intraoperative blood loss,but it has the advantages of accurate positioning and simple operation,and there is no significant difference in short-term postoperative function recovery.