机器人辅助全膝关节置换术治疗KrackowⅠ型膝关节外翻畸形的早期临床疗效研究

Early clinical outcomes of robot-assisted total knee arthroplasty in treatment of patients with valgus knee deformity of Krackow type Ⅰ

目的:评估使用机器人辅助系统行膝关节外翻畸形全膝关节置换术的早期临床疗效。方法:回顾性分析2020年12月至2021年6月收治的16例使用机器人辅助系统和16例传统全膝关节置换术患者,均为KrackowⅠ型膝关节外翻畸形。记录并比较两组患者的术前一般资料、血红蛋白水平、视觉模拟评分(VAS)、美国特种外科医院评分(HSS)、膝关节活动度(ROM)、手术时间、髌骨外侧支持带松解率及外侧软组织松解率、残留外翻畸形,术中出血量、术后2 d血红蛋白含量、术后引流量、输血率、镇痛药物使用情况。结果:两组患者均获得随访,随访时间7~13个月,平均(8.5±4.1)个月。随访期间无感染及假体松动等并发症。两组手术时间、术中出血量、术后引流量、术后2 d血红蛋白水平、输血率比较差异无统计学意义(P>0.05);机器人组髌骨外侧支持带松解率、外侧软组织松解率、辅助镇痛药使用优于常规组(P<0.01)。两组术后24 h VAS评分、1周和6周美国特种外科医院评分(HSS)及关节活动度比较差异有统计学意义(P<0.01),但6周VAS评分、6个月HSS评分及ROM两组差异无统计学意义(P>0.05)。结论:与常规手术相比,机器人辅助全膝关节置换术治疗KrackowⅠ型膝关节外翻畸形可获得更好的术后畸形矫正、更低的外翻残留率,展现了更好的早期临床疗效。

Objective: To investigate the early clinical outcomes of robot-assisted total knee arthroplasty(RTKA) by Subvastus with Minimal Oblique Cut(SMOC) approach for valgus knee. Methods: Totally 32 patients with Krackow typeⅠvalgus deformity of the knees were analyzed retrospectively, with 16 patients treated by RTKA and 16 patients treated by conventional TKA. Preoperative demographics, hemoglobin(Hb), visual analogue scale(VAS), Hospital for special surgery(HSS) score, range of motion(ROM), surgical time, lateral retinacular and soft tissue release, residual valgus deformity, blood loss, Hb at 2 d after surgery, drainage, blood transfusion rate, and analgesic were recorded and analyzed. Results: All patients were followed up for 7-13 months with the mean of(8.5±4.1)months. No complications like infection and loose of components were found during the follow-up. There was no statistical difference in operation time, blood loss, drainage, Hb at 2 d after the operation and blood transfusion rate between the two groups(P>0.05). The lateral retinacular and soft tissue release rate and analgesic application were superior in RTKA group to that in conventional group(P<0.01). Statistical differences existed between the two groups in terms of VAS score at 24 h and ROM and HSS score at 1 week and 6week after the operation(P<0.01), while no differences were found in VAS at 6 weeks and ROM and HSS score at 6 months(P>0.05).Conclusions: Valgus knee of Krackow type Ⅰ can be treated successfully by RTKA with better lateral retinaculum and soft tissue release and lower residual valgus deformity rate, which suggests that RTKA have a better short-term clinical efficacy.