机器人辅助与传统方法行全髋关节置换术后偏心距和旋转中心差异比较

Comparison of hip offset and rotation center reconstruction between robot-assisted and manual total hip arthroplasty

目的比较机器人辅助与传统手工方法行全髋关节置换术(THA)术后偏心距和旋转中心的差异。方法选取2020年5至9月在重庆医科大学附属第一医院分别采用机器人辅助和手工方法行THA的患者为研究对象,其中机器人辅助THA(rTHA)患者27例(28髋),手工THA(mTHA)患者29例(31髋)。rTHA组男16例,女11例,年龄(59±13)岁;mTHA组男18例,女11例,年龄(63±14)岁。分别记录两组患者的性别、年龄、体质指数、诊断、功能评分等数据。rTHA组采用Mako机器人通过术前设计、术中定位和实时导航辅助完成THA,mTHA组通过模板进行术前设计,常规完成THA。记录两组患者手术时间和术后功能评分;分别测量两组术前和术后股骨偏心距、髋臼偏心距和总偏心距的长度;测量髋关节旋转中心在水平方向和垂直方向的移动情况;分析术中反馈总偏心距变化与术后测量偏心距变化的相关性。结果rTHA组手术时间长于mTHA组[(80±10)min比(58±18)min,P<0.001]。术后6个月随访rTHA组Harris评分为(94.9±2.8)分,略高于mTHA组的(93.1±2.8)分(P=0.017);rTHA组西安大略湖和麦克马斯特大学骨关节炎评分(WOMAC)为(7.0±3.8)分,与mTHA组[(7.1±2.4)分]相当(P=0.840)。rTHA组术前和术后总偏心距差异在5 mm以内者占71.4%(20/28),mTHA组为45.2%(14/31);rTHA组术前和术后总偏心距差异在5~10 mm者占28.6%(8/28),mTHA组为29.0%(9/31);rTHA组术前和术后总偏心距差异>10 mm者为0,mTHA组为25.8%(8/31),差异均有统计学意义(均P<0.05)。rTHA术中反馈总偏心距的变化与术后测量总偏心距的变化具有相关性(r=0.77,P<0.001)。两组旋转中心改变均主要集中在外上象限,rTHA组旋转中心的变化主要集中在10 mm的范围内,而mTHA组旋转中心变化更为分散。结论机器人辅助较传统手工THA可更精确地恢复偏心距和旋转中心,机器人术中反馈的偏心距可以作为参考。

Objective To compare the differences of hip offset and rotation center reconstruction between robot-assisted and manual total hip arthroplasty(THA).Methods Patients underwent robot-assisted and manual THA from May to September of 2020 in the First Affiliated Hospital of Chongqing Medical University were enrolled in this study.The patients included 27 patients(28 hips)in robot-assisted THA(rTHA)group and 29 patients(31 hips)in manual THA(mTHA)group.In rTHA group,there were 16 males and 11 females,with a mean age of(59±13)years.In mTHA group,there were 18 males and 11 females,with a mean age of(63±14)years.Basic information,including gender,age,body mass index(BMI),diagnosis and functional scoring etc,were recorded.In rTHA group,Mako robot system was used for preoperative planning,intraoperative real-time location and navigation.In mTHA group,traditional preoperative template design and surgical procedure were carried out.Operation time and functional scoring were compared postoperatively.Femoral offset,acetabular offset,global offset,rotation center changes in vertical and horizontal directions were measured on pelvis X-ray and analyzed.The correlation between intraoperative feedback of global offset change in robot system and postoperative measured global offset were analyzed.Results Operation time in rTHA group was(80±10)min,which was statistically longer than that in mTHA group((58±18)min,P<0.001).With 6 months′follow-up,the Harris scoring in rTHA group was 94.9±2.8,which was statistically higher than that in mTHA group(93.1±2.8,P=0.017),however there was no statistic difference in WOMAC scoring between rTHA and mTHA group(7.0±3.8 vs 7.1±2.4,P=0.840).Absolute global offset change within 5 mm,5-10 mm and lager than 10 mm were 71.4%(20/28),28.6%(8/28)and 0 in rTHA group,which were 45.2%(14/31),29.0%(9/31)and 25.8%(8/31)in mTHA group(all P<0.05).A positive relation was found between intraoperative feedback of global offset change in robot system and postoperative measured global offset in rTHA group(r=0.77,P<0.001).It was found that rotation center changes concentrated in outer upper quadrant in both groups,and rotation center change in rTHA group concentrated mainly in the area less than 10 mm,however,rotation center change in mTHA group was more dispersive compared with rTHA group.Conclusion rTHA may accurately reconstruct hip offset and rotation center,intraoperation feedback of global offset change may be an effective reference.