Mako机器人辅助后外侧入路人工全髋关节置换术近期疗效

Short-term effectiveness of Mako robot-assisted total hip arthroplasty via posterolateral approach

目的探讨Mako机器人辅助后外侧入路人工全髋关节置换术(total hip arthroplasty,THA)的早期临床疗效。方法回顾分析2020年5月—2021年3月采用Mako机器人辅助后外侧入路THA治疗的64例(74髋)患者(机器人组)临床资料,并与同期采用传统后外侧入路THA治疗的52例(55髋)患者(对照组)进行比较。两组患者性别、年龄、侧别、身体质量指数、疾病种类及术前Harris评分等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中出血量及并发症发生情况;术后测量髋臼外展角、髋臼前倾角及双下肢长度差;末次随访时,采用疼痛视觉模拟评分(VAS)、Harris评分及遗忘关节评分(FJS-12)评价髋关节疼痛及功能改善情况。结果机器人组3例患者(包括1例术中探查发现髋臼骨折者)因髂前上棘处安置的骨盆数据阵列松动,导致数据错误,无法进行髋臼注册,从而改行常规THA;两组其余患者均顺利完成手术。机器人组手术时间及术中出血量均明显多于对照组(P<0.05)。两组患者均获随访,随访时间1~10个月,平均4.6个月。机器人组1例强直性脊柱炎患者术后2 d发现髋臼假体松动,行手术翻修处理,10例发现下肢肌间静脉血栓形成;对照组1例术后发生左髋关节脱位,5例发现下肢肌间静脉血栓形成;两组均未发生坐骨神经损伤、切口渗液、假体周围感染等并发症。机器人组与对照组并发症发生率比较(17.2%vs.11.5%),差异无统计学意义(χ^(2)=0.732,P=0.392)。末次随访时,机器人组髋臼前倾角及FJS-12评分大于对照组,双下肢长度差小于对照组,差异均有统计学意义(P<0.05);两组髋臼外展角及VAS评分比较差异无统计学意义(P>0.05)。两组Harris评分均较术前显著改善(P<0.05),但两组手术前后差值比较差异无统计学意义(t=1.632,P=0.119)。结论 Mako机器人辅助THA较传统手术能够提升髋臼杯植入的准确性和安全性,减少双下肢长度差,具有一定学习曲线,其远期效果需进一步研究证实。

Objective To explore the short-term effectiveness of Mako robot-assisted total hip arthroplasty(THA) via posterolateral approach. Methods The clinical data of 64 patients(74 hips) treated with Mako robot-assisted THA via posterolateral approach(robot group) between May 2020 and March 2021 were retrospectively analyzed and compared with the clinical data of 52 patients(55 hips) treated with traditional THA via posterolateral approach(control group) in the same period. There was no significant difference in general data such as gender, age, side, body mass index,disease type, and preoperative Harris score between the two groups(P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the two groups. Acetabular inclination angle, acetabular anteversion angle, and lower limbs discrepancy were measured after operation. At last follow-up, the improvement of hip pain and function was evaluated by visual analogue scale(VAS) score, Harris score, and forgetting joint score(FJS-12).Results In the robot group, 3 patients(including 1 patient with acetabular fracture during operation) were converted to routine THA because the pelvic data array placed at the anterior superior iliac spine was loose, resulting in data error and unable to register the acetabulum;the other patients in the two groups completed the operation successfully.The operation time and intraoperative blood loss in the robot group were significantly higher than those in the control group(P<0.05). All patients were followed up 1-10 months, with an average of 4.6 months. In the robot group, 1 patient with ankylosing spondylitis had acetabular prosthesis loosening at 2 days after operation, underwent surgical revision, and10 patients had lower limb intermuscular vein thrombosis;in the control group, 1 patient had left hip dislocation and5 patients had lower extremity intermuscular vein thrombosis;there was no complication such as sciatic nerve injury,incision exudation, and periprosthetic infection in both groups. There was no significant difference in the incidence of complications between the robot group and the control group(17.2% vs.11.5%)(χ^(2)=0.732, P=0.392). At last follow-up, the acetabular anteversion angle and FJS-12 score in the robot group were was significantly greater than those in the control group, and the lower limbs discrepancy was significantly less than that in the control group(P<0.05);there was no significant difference in acetabular inclination angle and VAS score between the two groups(P>0.05). The Harris scores of the two groups were significantly improved when compared with those before operation(P<0.05), but there was no significant difference in the difference of pre-and post-operative score between the two groups(t=1.632, P=0.119).Conclusion Compared with traditional surgery, Mako robot-assisted THA can optimize the accuracy and safety of acetabular cup implantation, reduce the length difference of the lower limbs, and has a certain learning curve. Its longterm effectiveness needs further research to confirm.