机器人辅助全髋关节置换术围手术期并发症的特点及危险因素分析

Characteristics and risk factors of perioperative complications in robot-assisted total hip arthroplasty

目的:深入研究机器人辅助全髋关节置换术围手术期并发症的特点及危险因素。方法:选择2020年7月至2021年12月采用MAKO机器人辅助全髋关节置换术患者125例,其中男61例,女64例,平均年龄(65.2±7.6)岁。收集并统计患者的性别、年龄、体重指数、糖尿病史、术前血红蛋白水平、围手术期并发症、手术时间及诊断。采用单因素分析及logistic回归分析围手术期并发症的危险因素。结果:17例患者(21例次)发生围手术期并发症,包括髋臼隐匿性假体周围骨折14例次、股骨柄隐匿性假体周围骨折1例次、重度贫血及输血4例次、脑梗死1例次和肺炎1例次。所有隐匿性假体周围骨折患者均正常康复。单因素分析结果提示,并发症组和无并发症组间性别、年龄、高血压病史、糖尿病史、术前血红蛋白水平、体重指数、手术时间和诊断差异无统计学意义;重度贫血组和无重度贫血组术前血红蛋白水平差异有统计学意义(P<0.05)。Logistic回归分析提示,术前血红蛋白水平与术后重度贫血存在显著相关性。结论:机器人辅助全髋关节置换术存在一定的假体周围隐匿性骨折风险,但是该种隐匿性假体周围骨折不影响术后正常康复。同时,术后贫血仍然是机器人辅助全髋关节置换术后不可忽视的并发症。

Objective: To evaluate the perioperative complications of MAKO robot-assisted total hip replacement. Methods: Totally125 patients undergoing MAKO robot-assisted total hip replacements from July 2020 to December 2021 by our group were enrolled in the study including 61 males and 64 females with mean age of(65.2 ± 7.6) years. Gender, age, body mass index(BMI), diabetes history,preoperative red blood cell level, complications during hospitalization, surgical duration, and diagnoses were collected. Univariate analysis and multivariate logistic regression analysis were used for risk factor analysis of perioperative complications. Results: Twenty-one cases of complications in 17 patients were recorded, including 14 occult periprosthetic fractures of acetabulum, 1 occult periprosthetic fracture of femoral stem, 4 case of severe anemia and blood transfusion, 1 case of brain infarction, and 1 case of pneumonia. Univariate analysis showed that there was no difference in gender, age, BMI, diabetes history, preoperative red blood cell level, surgical duration,and diagnoses between the group with complication and the one without complication, while preoperative red blood cell level was statistically different between severe anemia group and no severe anemia group. Further logistic regression analysis confirmed that preoperative red blood cell level was statistically associated with postoperative severe anemia. Conclusions:MAKO robot-assisted total hip replacement has a risk of periprosthetic occult fractures, which have no impact on postoperative rehabilitation. Postoperative anemia is one of complications to be considered after robot-assisted total hip arthroplasty.