Mako机器人辅助全髋关节置换术后患者早期下床活动情况的研究

Study on early out of bed mobility in patients after Mako robotic-assisted total hip arthroplasty

目的研究Mako机器人辅助全髋关节置换术后患者的早期下床活动情况。方法前瞻性纳入2020年4月-7月在重庆医科大学附属第一医院骨科拟行初次单侧全髋关节置换术的住院患者为研究对象,用随机数字表法分为试验组(采用机器人辅助全髋关节置换)和对照组(采用传统全髋关节置换),两组患者术后均施以相同的护理措施及下床活动训练指导,比较两组患者的术后活动性疼痛情况(采用视觉模拟评分法)、术后24 h内愿意下床活动的患者比例、首次下床活动时间、首次下床活动持续时间、首次下床活动步行距离≥5 m的患者比例和术后前3 d下床活动水平。结果共纳入38例患者,试验组17例,对照组21例。两组患者的基线情况差异无统计学意义(P>0.05)。试验组与对照组术后6、24 h视觉模拟评分组间差异有统计学意义(P<0.05)。手术当天口服围手术期能量制剂2 h后试验组愿意早期下床活动的患者比例高于对照组,差异有统计学意义(100.0%vs.57.1%,P<0.05)。试验组患者的首次下床活动时间[(4.39±0.17)vs.(8.74±4.70)h]、下床活动持续时间[(10.89±3.60)vs.(8.37±3.31)h]、完成下床活动步行距离≥5 m的患者比例(94.1%vs.61.9%)均优于对照组,差异有统计学意义(P<0.05)。试验组与对照组术后前3 d内下床活动平均水平及术后第1、2天下床活动水平组间差异有统计学意义(P<0.05)。住院期间两组患者均未发生跌倒、关节假体脱位、假体周围骨折和下肢深静脉血栓形成。结论借助Mako骨科机器人辅助系统的精准手术方式有助于促进患者术后早期下床活动,可为未来如何改善传统全髋关节置换术后患者的康复护理提供参考。

Objective To study the early out-of-bed activities of patients after Mako robotic-assisted total hip arthroplasty.Methods We prospectively included inpatients planned to undergo primary unilateral total hip arthroplasty in the Department of Orthopaedics of the First Affiliated Hospital of Chongqing Medical University from April to July 2020.Using a randomized numerical table,the patients were divided into trial group to undergo roboticassisted total hip arthroplasty and control group to undergo traditional total hip arthroplasty,and both groups received the same nursing measures and instructions for training to get out of bed after surgery.Postoperative active pain(assessed with Visual Analogue Scale),the proportion of patients willing to get out of bed within 24 h after surgery,the time and duration for the first out of bed activity,the proportion of patients with a walking distance≥5 m for first activity,and the level of activity in the first 3 d after surgery between the two groups were compared.Results A total of 38 patients were included in this study,with 17 patients in the trial group and 21 patients in the control group.There was no statistical significance in the baseline demographics between the two groups(P>0.05).There were statistically significant differences in postoperative 6-hour and 24-hour Visual Analogue Scale scores between the two groups(P<0.05).Two hours after oral administration of perioperative energy preparations on the day of surgery,the proportion of patients who were willing to get out of bed early in the trial group was higher than that in the control group(100.0%vs.57.1%,P<0.05).The first time to get out of bed[(4.39±0.17)vs.(8.74±4.70)h],the duration of getting out of bed[(10.89±3.60)vs.(8.37±3.31)h],and the proportion of patients with a walking distance≥5 m for first activity(94.1%vs.61.9%)were better than those of the control group(P<0.05).There were statistically significant differences between the trial group and the control group in the average level in the first 3 days after surgery,postoperative first-day level,and postoperative second-day level of getting out of bed(P<0.05).There were no falls,dislocation of the prosthesis,fractures around the prosthesis,or deep vein thrombosis in the two groups of patients during their hospitalization.Conclusion The precise surgery method with the help of Mako orthopedic robot-assisted system can help promote patients to get out of bed early after surgery,and can provide a reference for how to improve the rehabilitation of patients after traditional total hip replacement in the future.