OrthoPilot导航系统辅助全髋关节置换提高髋臼杯安置的安全与准确性

Ortho Pilot navigation system assisted total hip arthroplasty improves the accuracy and safety of acetabular cup placement

背景:人工全髋关节置换作为治疗股骨头坏死、股骨颈骨折等疾病的经典手术方式,一直存在假体位置安放不佳、术后脱位等问题。OrthoPilot导航辅助全髋关节置换理论上可以提高假体安置的准确性及安全性,目前国内对其应用于全髋关节置换的研究较少。目的:探讨OrthoPilot导航辅助全髋关节置换的可行性以及短期临床疗效。方法:回顾性分析2019年6月至2022年4月于安徽医科大学第一附属医院关节外科接受OrthoPilot导航辅助全髋关节置换的患者23例,按照性别、年龄、体质量指数及术前Harris评分进行1∶1匹配同期行徒手全髋关节置换患者23例。对术中、术后的外展角和前倾角进行测量与统计,对手术时间、总失血量、术后引流量、平均血红蛋白丢失量及术后Harris评分进行统计。结果与结论:(1)在手术时间方面,导航组为(152.4±39.9) min,非导航组为(115.3±35.4) min,两组差异有显著性意义(P=0.02);(2)在假体位置方面,导航组术中外展角为(42.3±3.5)°、术后外展角为(42.6±5.5)°,差异无显著性意义(P=0.574);导航组术中前倾角为(18.5±3.4)°、术后前倾角为(19.3±3.9)°,差异无显著性意义(P=0.567);(3)导航组术后臼杯在髋臼安全区范围内22例,安全区外1例;非导航组术后在髋臼安全区范围内17例,安全区外6例,差异有显著性意义(χ~2=4.212,P=0.04);(4)在手术疗效方面,术后两组总失血量、引流量、平均血红蛋白丢失量、Harris评分及术后下肢深静脉血栓发生率等差异无显著性意义;(5)术后平均随访3个月,两组均无早期感染及脱位患者;(6)结果表明,OrthoPilot导航辅助全髋关节置换可以提高髋臼杯安置的准确性及安全性,其短期临床效果与徒手全髋关节置换无明显差异。

BACKGROUND: As a classic surgical method for the treatment of femoral head necrosis and femoral neck fracture, total hip arthroplasty has some problems, such as poor placement of prosthesis, postoperative dislocation and so on. Ortho Pilot navigation assisted total hip arthroplasty can theoretically improve the accuracy and safety of prosthesis placement. At present, there are few studies on its application in total hip arthroplasty in China. OBJECTIVE: To explore the feasibility and short-term clinical effect of Ortho Pilot navigation assisted total hip arthroplasty.METHODS: A retrospective analysis was performed in 23 patients who received Ortho Pilot navigation assisted total hip arthroplasty in the Department of Joint surgery of the First Affiliated Hospital of Anhui Medical University from June 2019 to April 2022. A total of 23 patients with freehand total hip arthroplasty were matched at 1:1 according to sex, age, body mass index and preoperative Harris score. The anteversion and inclination angles during and after operation were measured and counted. The operation time, total blood loss, postoperative drainage, average hemoglobin loss and postoperative Harris scores were calculated. RESULTS AND CONCLUSION:(1) The operation time in the navigation group was(152.4±39.9) minutes and in the non-navigation group was(115.3±35.4) minutes, with statistically significant(P=0.02).(2) In terms of angle measurement, the anteversion angle of acetabular cup was(42.3±3.5)° during operation and(42.6±5.5)° after operation, with no significant difference(P=0.574) in the navigation group. The inclination angle of acetabular cup was(18.5±3.4)° during operation and(19.3±3.9)° after operation, with no significant difference(P=0.567) in the navigation group.(3) According to “Lewinnek safe zone”, 22 hips were in the safety zone and 1 hip outside the safety zone after operation in the navigation group, while 17 hips were in the safety zone and 6 hips outside the safety zone after operation in the non-navigation group, showing a significant difference(χ~2=4.212, P=0.04).(4) In terms of surgical treatment, there was no significant difference in total blood loss, postoperative drainage, average hemoglobin loss, Harris score, and the incidence of postoperative lower extremity deep venous thrombosis between the two groups.(5) The average follow-up was 3 months after operation, and there were no patients with early infection or dislocation in the two groups.(6) These results verify that Ortho Pilot navigation assisted total hip arthroplasty can improve the accuracy and safety of acetabular cup placement, and its short-term clinical effect is not significantly different from that of freehand total hip arthroplasty.