增强模式MAKO机器人辅助后外侧入路全髋关节置换术的早期疗效对比研究

Comparison of early clinical outcomes between enhanced MAKO robot-assisted total hip arthroplasty from posterior lateral approach and conventional total hip arthroplasty

目的:比较采用增强(Enhanced)模式MAKO机器人辅助后外侧入路全髋关节置换术(RTHA)与常规THA手术的早期临床疗效。方法:回顾性分析2021年5—12月采用增强模式MAKO RTHA治疗的77例患者的临床资料,并与同期采用传统后外侧入路全髋关节置换术(THA)治疗的77例患者进行对比。比较RTHA组与常规THA组患者的手术时间、总失血量。术后测量髋臼外展角、前倾角、双下肢长度差(LLD)、两侧联合偏心距差异(ΔCO)。比较RTHA组术中与术后LLD及ΔCO的一致性,同时比较两组髋臼外展角、前倾角,术后LLD及ΔCO的差异。术后随访收集两组Harris髋关节评分。结果:RTHA组术中测量的LLD和ΔCO与术后影像学测量LLD和ΔCO比较,差异无统计学意义。RTHA组术中机器人测量股骨前倾角14.9°±7.8°、联合前倾角37.4°±9.1°。RTHA组术后LLD(0.65±3.40)mm,常规THA组术后LLD(2.54±4.46)mm,差异有统计学意义(P=0.013)。RTHA组术后ΔCO(-0.15±6.27)mm,常规THA组(2.65±6.40)mm,差异有统计学意义(P=0.020)。RTHA组髋臼前倾角平均23.1°±4.3°,常规THA组26.6°±4.1°,差异有统计学意义(P<0.001)。RTHA组髋臼外展角平均42.1°±2.8°,常规THA组40.9°±5.8°,差异无统计学意义。两组患者随访6~12个月,RTHA组末次随访Harris髋关节评分平均(90.5±6.8)分,常规THA组(90.1±6.5)分,差异无统计学意义。结论:增强模式下MAKO机器人辅助THA能提高髋臼杯植入的准确性,可更精确恢复下肢长度及联合偏心距,对股骨侧前倾的判断有助于个体化调整髋臼前倾。RTHA和传统THA手术术后短期疗效无统计学差异。

Objectives: To compare the early clinical outcome of robot-assisted total hip arthroplasty(RTHA) with enhanced mode and conventional total hip arthroplasty(THA). Methods: Seventy-seven consecutive hips undergoing enhanced MAKO RTHA from May to December 2021 were retrospectively reviewed and compared with consecutive 77 hips undergoing THA. The operative time and total blood loss were compared. The cup inclination, anteversion, leg length difference(LLD), difference of combined offset(ΔCO) were measured. The intraoperative LLD and ΔCO were compared with the postoperative those parameters in the RTHA group. The postoperative cup inclination, anteversion, LLD and ΔCO were compared between RTHA and THA. The clinical outcome was evaluated with Harris hip score at the latest follow-up. Results: There was no significant difference between the intraoperative LLD, ΔCO and the postoperative those parameters in the RTHA group. The average femoral component anteversion was 14.9°±7.8°and the combined anteversion was 37.4°±9.1°in RTHA group. The LLD in RTHA group was less compared with that in THA group[(0.65±3.40)vs.(2.54±4.46)mm, P=0.013]. The average ΔCO was(-0.15±6.27) mm in RTHA group,(2.65±6.40) mm in THA group, and there was significant difference between the two groups(P=0.020). The cup inclination was 23.1°±4.3° in RTHA group, 26.6°±4.1°in THA group, and the difference was statistically significant(P<0.001). The cup anteversion was 42.1°±2.8° in RTHA group, 40.9°±5.8°in THA group, and the difference was not significant. The Harris hip score was 90.5±6.8 in RTHA group, 90.1±6.5 in THA group at the final follow-up, and there was no significant difference in the Harris score. Conclusions: MAKO RTHA with enhanced mode can improve the accuracy of cup implant and better restore the leg length and combined offset. The detectable stem version can provide clue for the adjustment of cup orientation. There was no significant difference between RTHA and THA in short-term efficacy.