机器人辅助人工全髋关节置换术中及术后测量髋臼角度比较研究

Comparative study of intra-and post-operative inclination and anteversion angles of acetabular cup in robot-assisted total hip arthroplasty

目的比较机器人辅助人工全髋关节置换术(total hip arthroplasty,THA)术中测量与术后基于X线片及CT影像学资料测量的髋臼杯外展角及前倾角差异。方法回顾分析2020年5月—12月接受机器人辅助THA的54例(54髋)患者临床资料。其中男26例(26髋),女28例(28髋);年龄39~71岁,平均58.4岁。身体质量指数19.2~29.3 kg/m2,平均25.2 kg/m2。患者均为初次THA,包括股骨头坏死31例、髋关节骨关节炎12例、股骨颈骨折8例、髋关节发育不良3例。记录机器人主机系统中术中髋臼杯外展角与前倾角;术后2~7 d行髋关节X线片及CT平扫检查,测量髋臼杯外展角与前倾角。按照Lewinnek等的"髋臼安全区"概念,比较术中及术后髋臼杯位于安全区的比例。结果手术时间为57.8~89.2 min,平均68.3 min;术中出血量125.0~450.0 mL,平均204.8 mL。患者住院期间均未发生髋关节脱位、感染等不良事件。术中测量髋臼杯外展角为(40.8±0.6)°,术后为(41.2±2.8)°,差异无统计学意义(t=1.026,P=0.307);术中测量髋臼杯前倾角为(17.6±1.4)°,显著小于术后(23.4±3.8)°,差异有统计学意义(t=10.520,P=0.000)。按照Lewinnek等的"髋臼安全区"概念,术中54髋(100%)均在安全区范围内,术后16髋在安全区范围外,38髋在安全区范围以内,安全区内比例为70.4%,差异有统计学意义(χ^(2)=18.783,P=0.000)。结论机器人辅助THA可精确获得术中髋臼杯角度,术中侧卧位下的髋臼杯安置前倾角与术后仰卧位时测量的髋臼杯前倾角偏差较大,需要进一步研究术中髋臼杯安置位置。

Objective To compare the difference in the inclination and anteversion angles of the acetabular cup measured by intraoperative robot-assisted total hip arthroplasty(THA) and postoperative X-ray films and CT imaging.Methods The clinical data of 54 patients(54 hips) who underwent robot-assisted THA between May 2020 and December2020 were retrospectively analyzed. Among them, there were 26 males(26 hips) and 28 females(28 hips), with an average age of 58.4 years(range, 39-71 years). The body mass index was 19.2-29.3 kg/m2, with an average of 25.2 kg/m2. All the patients had their first THA, including 31 cases of osteonecrosis of the femoral head, 12 cases of hip arthritis, 8 cases of femoral neck fracture, and 3 cases of developmental dysplasia of the hip. The anteversion and inclination angles of the acetabular cup were obtained through the surgical data in the robot host system. All patients underwent X-ray and CT scan examination within 2-7 days after operation to obtain the postoperative anteversion and inclination angles of the acetabular cup. According to the concept of "Lewinnek safe zone", the proportion of acetabular in the safe zone intraand post-operation were compared. Results The operation time was 57.8-89.2 minutes, with an average of 68.3 minutes;the intraoperative blood loss was 125.0-450.0 mL, with an average of 204.8 mL. No adverse events such as dislocation of hip joint and infection occurred during hospitalization. The anteversion angle of acetabular cup was(40.8±0.6)° during operation and(41.2±2.8)° after operation, with no significant difference(t=1.026, P=0.307). The anteversion angle of acetabular cup measured during operation was(17.6±1.4)°, which was significantly smaller than that measured after operation(23.4±3.8)°(t=10.520, P=0.000). According to "Lewinnek safe zone", 54 hips(100%) were in the safety zone during operation, and 16 hips were out of the safety zone, 38 hips were in the safty zone after operation, the ratio of the hips in the safty zone was 70.4%, showing a significant difference(χ^(2)=18.783, P=0.000). Conclusion Robot-assisted THA can obtain accurate placement of the acetabular cup, but there is a large deviation between the anteversion angle of the acetabular cup in the lateral position during operation and the supine position after operation. Further study is needed to define the intraoperative placement position of the acetabular cup.