MAKO机器臂辅助直接前入路人工全髋关节置换术治疗骨性融合髋

Effectiveness analysis of MAKO robotic-arm assisted total hip arthroplasty via direct anterior approach for bony fused hips

目的 探讨MAKO机器臂辅助直接前入路(direct anterior approach,DAA)行人工全髋关节置换术(total hip arthroplasty,THA)治疗强直性脊柱炎(ankylosing spondylitis,AS)骨性融合髋的临床疗效。方法 2021年6月—2022年1月,采用MAKO机器臂辅助DAA行THA治疗10例(12髋)AS骨性融合髋。男7例,女3例;年龄30~71岁,平均42.4岁。AS病程12~35年,平均21.4年。术前患髋屈曲位强直3例,屈曲角度20°、30°、35°;伸直位强直9例。记录手术时间和并发症发生情况;采用手术前后疼痛视觉模拟评分(VAS)、Harris评分和牛津髋关节评分(OHS),以及术后关节活动度(屈曲、伸直、内旋、外旋、内收、外展)评价关节功能恢复情况;根据术后双髋关节正位X线片和CT平扫,测量髋臼假体外展角、前倾角、双侧髋关节联合偏心距差值以及双侧下肢长度差。结果 手术时间为80~190 min,平均134.6 min。10例患者均获随访,随访时间5~11个月,平均7.4个月。未发生切口感染、下肢深静脉血栓形成、髋关节再脱位、假体无菌性松动、死亡等严重不良事件。术后5个月髋臼假体外展角为37°~45°,平均40.3°;前倾角9°~20°,平均15.8°;双侧髋关节联合偏心距差值为0~10 mm,平均4.3 mm;双下肢长度差为0~12 mm,平均3.5 mm。末次随访时,术侧髋关节活动度为屈曲80°~100°,平均89.2°;伸直–5°~10°,平均1.7°;内旋0°~15°,平均7.1°;外旋10°~30°,平均20.4°;内收0°~20°,平均7.9°;外展10°~25°,平均16.5°。末次随访时,VAS评分、Harris评分和OHS评分均较术前显著改善,差异均有统计学意义(P<0.05)。结论 MAKO机器臂辅助DAA行THA治疗AS骨性融合髋可取得满意疗效,具有假体安装精确、利于软组织松解、术中创伤小等优势。

Objective To investigate the effectiveness of MAKO robotic-arm assisted total hip arthroplasty(THA) via direct anterior approach(DAA) for bony fused hips in ankylosing spondylitis(AS).Methods Between June 2021 and January 2022,MAKO robotic-arm assisted THA via DAA was applied to treat 10 cases(12 hips) of AS with bony fused hips.There were 7 males and 3 females;the age ranged from 30 to 71 years,with an average age of 42.4 years.The duration of AS was 12-35 years,with an average of 21.4 years.The preoperative hip was ankylosed in flexion in 3 cases,with a flexion angle of 20°,30°,35°,respectively;9 cases were ankylosed in extension.The operation time and complications were recorded;the visual analogue scale(VAS) score,Harris score,and Oxford hip scale(OHS) score before and after operation,and postoperative range of motion(flexion,extension,internal rotation,external rotation,adduction,and abduction) were used to evaluate the recovery of joint function;according to the postoperative anteroposterior X-ray film and CT scan of both hip joints,the abduction angle,anteversion angle,the difference between bilateral combined off-set and the lower limb length discrepancy were measured.Results The operation time ranged from 80 to 190 minutes(mean,134.6 minutes).All 10 patients were followed up 5-11 months(mean,7.4 months).There was no serious adverse events such as incision infection,deep vein thrombosis of lower extremities,hip redislocation,aseptic loosening of the prosthesis,or death.At 5 months after operation,the acetabular prosthesis angle of abduction was 37°-45°(mean,40.3°),anteversion angle was 9°-20°(mean,15.8°).The difference between bilateral combined off-set was 0-10 mm(mean,4.3 mm);the lower limb length discrepancy was 0-12 mm(mean,3.5 mm).At last follow-up,the average range of motion of the hip joint was 89.2° in flexion(range,80°-100°),1.7° in extension(range,–5°-10°),7.1° in internal rotation(range,0°-15°),20.4° in external rotation(range,10°-30°),7.9° in adduction(range,0°-20°),and 16.5° in abduction(range,10°-25°).At last follow-up,the VAS score,Harris score,and OHS score significantly improved when compared with those before operation(P<0.05).Conclusion The MAKO robotic-arm assisted THA via DAA can achieve satisfactory results in the treatment of AS with bony fused hip,which has the advantages of accurate prosthesis installation,soft tissue release,and less trauma during operation.