MAKO机器人在复杂性人工全髋关节置换术中应用的近期疗效

Short-term effectiveness of MAKO robot assisted complex total hip arthroplasty

目的探讨MAKO机器人辅助复杂性人工全髋关节置换术(total hip arthroplasty,THA)的近期疗效。方法回顾分析2020年5月—2021年6月MAKO机器人辅助下行复杂性THA的15例(17髋)患者临床资料。其中男5例,女10例;年龄19~70岁,中位年龄49岁。发育性髋关节发育不良9例(9髋),Crowe分型为Ⅱ型5髋、Ⅲ型1髋、Ⅳ型3髋;类风湿性关节炎1例(2髋);强直性脊柱炎2例(3髋);继发性关节炎(既往有髋臼骨折内固定病史)3例(3髋)。术后3个月测量髋臼杯外展角和前倾角,并与术前及术后即刻MAKO机器人测量值进行比较;术后3个月测量股骨头偏心距和双下肢长度差值(leg length discrepancy,LLD),与术前比较;术前及术后3个月采用Harris髋关节评分(HHS)、疼痛视觉模拟评分(VAS)评价髋关节功能。结果15例(17髋)患者均顺利完成手术,手术时间75~175 min,平均116.3 min;术中出血量100~800 mL,平均381.3 mL。2例患者因术中、术后并发症未纳入统计,余13例(15髋)患者术中无血管、神经损伤等严重并发症,3例术后出现肌间静脉血栓形成。13例(15髋)均获随访,随访时间3~15个月,平均8个月。末次随访时患者假体位置均无改变,无松动征象。术后即刻及3个月时髋臼外展角与术前比较差异无统计学意义(P>0.05),髋臼前倾角较术前明显降低(P<0.05);术后即刻和3个月间比较髋臼外展角和前倾角差异均无统计学意义(P>0.05)。术后3个月LLD、偏心距、HHS评分和VAS评分均较术前显著改善(P<0.05)。结论MAKO机器人辅助复杂性THA可以取得较好近期疗效,改善患髋活动范围,减少下肢长度差异,提高患者生活质量。

Objective To investigate the short-term effectiveness of MAKO robot assisted complex total hip arthroplasty(THA).Methods The clinical data of 15 patients(17 hips)underwent MAKO robot assisted complex THA between May 2020 and June 2021 were analyzed retrospectively.There were 5 males and 10 females with the age ranged from 19 to 70 years(median,49 years),included 9 cases(9 hips)of developmental dysplasia of the hip(Crowe typeⅡin5 hips,typeⅢin 1 hip,and typeⅣin 3 hips),1 case(2 hips)of rheumatoid arthritis,2 cases(3 hips)of ankylosing spondylitis,3 cases(3 hips)of secondary arthritis with a history of acetabular fracture and internal fixation.The acetabular cup abduction angle and anteversion angle were measured at 3 months after operation,and compared with those measured by MAKO robot system before and immediately after operation.The femoral offset and leg length discrepancy(LLD)were measured at 3 months after operation,which were compared with those before operation.Harris hip score(HHS)and visual analogue scale(VAS)score were used to evaluate hip function before operation and at 3 months after operation.Results All 15 patients(17 hips)completed the operation successfully.The operation time was 75-175minutes,with an average of 116.3 minutes;the intraoperative blood loss was 100-800 mL,with an average of 381.3 mL.Two patients were not included in the statistics because of intraoperative and postoperative complications,the remaining13 patients(15 hips)had no serious complication such as vascular and nerve injuries,and 3 patients had intermuscular vein thrombosis.The 13 patients(15 hips)were followed up 3-15 months,with an average of 8 months.At last follow-up,the position of prosthesis did not change and there was no signs of loosening.There was no significant difference in acetabular abduction angle at immediate and 3 months after operation when compared with preoperative one(P>0.05),and the acetabular anteversion angle was significantly lower than that before operation(P<0.05).There was no significant difference in acetabular abduction angle and anteversion angle between at immediate and 3 months after operation(P>0.05).The LLD,offset,HHS score,and VAS score were significantly improved at 3 months after operation when compared with preoperative ones(P<0.05).Conclusion MAKO robot assisted complex THA can achieve good shortterm effectiveness,improve the hip range of motion,reduce the length difference between bilateral lower limbs,and improve the quality of patients’life.