MAKO机器人辅助下全膝关节置换术治疗伴有严重内翻畸形膝骨关节炎的早期疗效研究

Early clinical outcomes of MAKO robot-assisted total knee arthroplasty for knee osteoarthritis with severe varus deformity

目的:探讨MAKO机器人辅助下全膝关节置换术治疗伴有严重内翻畸形膝骨关节炎的疗效及可行性。方法:回顾性分析2021年6月至2022年3月采用MAKO机器人辅助行全膝关节置换术治疗内翻畸形>20°或伴有严重关节外畸形的膝骨关节炎患者13例(16膝),其中关节内畸形15膝,关节外畸形1膝,年龄50~80岁,平均(65.1±8.8)岁。记录手术时长、术中出血量、假体位置、冠状面下肢力线、并发症发生情况,比较患者手术前后膝关节活动度、膝关节协会评分(KSS),评估患者遗忘关节评分(FJS)及患者满意度。结果:所有患者均获得随访,随访时间3~10个月,平均(6.5±2.5)个月,手术时长(95±7)min,术中出血量(23±5)ml,假体位置:胫骨平台内翻0.13°±0.34°,胫骨平台后倾2.75°±0.86°,股骨假体屈曲3.13°±1.45°,股骨假体外旋2.38°±1.20°,股骨假体内翻2.28°±1.00°,冠状面下肢力线内翻3.63°±1.50°,膝关节屈曲9.38°±2.78°。术后切口均甲级愈合,1例出现下肢肌间静脉血栓。至末次随访,膝关节活动度由术前75.9°±11.4°提高至103.0°±5.5°,KSS功能评分由术前(47.2±6.1)分提高至(84.5±4.0)分,KSS膝关节评分由术前(41.9±3.6)分提高至(93.7±4.1)分(P均<0.05)。FJS评分平均(73.5±8.0)分,总体患者满意率(评分为4或5分)达到93.8%(15/16)。结论:机器人辅助膝关节置换可以提供个性化手术方案,术中实时反馈提供客观判断,治疗严重内翻畸形的膝骨关节炎可以获得令人满意的短期结果。

Objective: To investigate the efficacy and feasibility of MAKO robot-assisted total knee arthroplasty(TKA) in the treatment of knee osteoarthritis(OA) with severe varus deformity. Methods: From June 2021 to March 2022, 13 patients(16 knees) with OA and varus deformity>20° or severe extra-articular deformity undergoing MAKO robot-assisted TKA in our hospital were retrospectively analyzed including 15 knees with intra-articular deformity and 1 knee with extra-articular deformity. The average age of all patients was(65.1±8.8) years(range, 50-80 years). The operation time, blood loss, prosthesis position, coronal lower extremity alignment and complications were recorded. The range of motion and KSS scores before and after surgery were compared. The FJS scores and patient satisfaction score were evaluated. Results: All patients were followed up for 3-10 months, with an average of(6.5±2.5) months.The mean operation time was(95±7) min and the mean intraoperative blood loss was(23±5)ml. The mean prosthesis positions were as following: tibial plateau varus of 0.13°±0.34°, tibial plateau slope of 2.75°±0.86°, femoral prosthesis flexion of 3.13°±1.45°, femoral prosthesis external rotation of 2.38°±1.20°, femoral prosthesis varus of 2.28°±1.00°, coronal lower limb alignment of 3.63°±1.50° and knee joint flexion of 9.38°±2.78°. All incisions healed and 1 patient developed lower extremity intermuscular venous thrombosis. At the last follow-up, the range of motion of knee joint increased from 75.9° ± 11.4° preoperatively to 103.0° ± 5.5°, KSS functional score increased from 47.2±6.1 preoperatively to 84.5±4.0, and KSS knee score increased from 41.9±3.6 preoperatively to 93.7±4.1(all P<0.05). The average FJS score was 73.5±8.0, and the overall patient satisfaction rate(score of 4 or 5) reached 93.8%(15/16).Conclusions: MAKO robot-assisted TKA can provide a personalized surgical plan and objective judgment with real-time intraoperative feedback. The treatment of knee osteoarthritis with severe varus deformity by MAKO robot-assisted TKA can achieve satisfactory shortterm outcomes.