机器人辅助技术对全髋关节置换术髋臼假体位置和下肢长度恢复的影响

Effect of the acetabular cup positioning and leg length restoration after total hip arthroplasty using robotic-assisted surgery system

目的分析在全髋关节置换术(THA)中使用机器人辅助技术对术后髋臼假体位置和下肢长度恢复的影响。方法回顾性收集2019年9月至2021年6月在北京大学第三医院完成的机器人辅助下单侧、初次THA(rTHA)的患者共113例,并连续性纳入在同一时间段内使用传统器械进行THA(cTHA)的患者共133例。rTHA组男37例,女76例,年龄(62±9)岁;cTHA组男59例,女74例,年龄(60±12)岁。比较两组患者术后髋臼假体的前倾角、外展角,计算髋臼假体位于Lewinnek和Callanan安全区的比例。测量并比较对侧髋关节正常或已接受过置换手术的患者双下肢长度的差异。结果所有患者术后髋臼假体的外展角为39.0°±5.5°,前倾角为14.1°±5.1°。rTHA和cTHA组假体外展角(39.3°±2.9°比38.7°±7.0°,P=0.383)和前倾角(13.4°±4.3°比14.7°±5.6°,P=0.054)的差异均无统计学意义。以Lewinnek安全区作为标准,rTHA组髋臼假体位于安全区内的比例是97.3%(110/113),cTHA组是75.9%(101/133);以Callanan安全区作为标准,rTHA组和cTHA组假体位于安全区内的比例分别是94.7%(107/113)和66.2%(88/133),差异均有统计学意义(均P<0.01)。rTHA与cTHA组术后双下肢不等长的绝对值差异无统计学意义(P=0.445),但cTHA组有23.0%(29/126)的病例双下肢不等长超过5 mm,而rTHA组仅有9.7%(9/93)。结论机器人辅助技术提高了THA中髋臼假体安放的准确性,提高了髋臼假体位于安全区内的比例,在术后下肢长度恢复方面也更具优势。

Objective To assess the improvement of the robotic-assisted total hip arthroplasty(rTHA)regarding the acetabular cup positioning and the leg length restoration.Methods Clinical data of 246 patients undergoing primary unilateral THA from September 2019 to June 2021 in Peking University Third Hospital were retrospectively reviewed,including patients treated with rTHA(n=113)and conventional THA(cTHA)(n=133).Thirty-seven male patients along with 76 females were enrolled into the rTHA group with a mean age of(62±9)years.In comparison,the average age of cTHA group was(60±12)years with 59 males and 74 females.The postoperative inclination and anteversion of the acetabular cup and the rate of acetabular cup within the Lewinnek and Callanan"safe zone"were documented and analyzed.For the patient with normal or surgically restored contralateral hip,the leg length discrepancy was also measured and compared between the two groups.Results The overall mean postoperative inclination and anteversion was 39.0°±5.5°and 14.1°±5.1°,respectively.No statistically significant difference was found between the rTHA and cTHA group regarding postoperative inclination(39.3°±2.9°vs 38.7°±7.0°,P=0.383)and anteversion(13.4°±4.3°vs 14.7°±5.6°,P=0.054).In rTHA group,97.3%(110/113)of the cups were implanted within the Lewinnek"safe zone"(75.9%(101/133)in cTHA group)and 94.7%(107/113)were within the Callanan"safe zone"(66.2%(88/133)in cTHA group),and those were both higher in rTHA group(both P<0.01).There was no significant difference in postoperative leg length discrepancy between the two groups(P=0.445).Meanwhile,29(23.0%)cases of cTHA group had leg length discrepancy more than 5 mm,and it was 9.7%(9/93)in rTHA group.Conclusion It indicated the benefit of rTHA in acetabular cup positioning as well as the leg length restoration.