MAKO机器人辅助全膝关节置换术的早期临床疗效

Early clinical outcomes of MAKO robot-assisted total knee arthroplasty

目的:探讨MAKO机器人辅助全膝关节置换术(TKA)的早期临床疗效。方法:回顾性分析2021年6月至2022年1月采用MAKO机器人辅助TKA治疗的75例(89膝)患者的临床资料,并与同期传统TKA治疗的153例(192膝)患者进行比较。记录两组患者的术中出血量、手术时间及并发症发生情况;采用疼痛视觉模拟评分(VAS)、关节活动范围(ROM)、美国膝关节协会(AKS)评分以及关节遗忘评分(FJS-12)评价膝关节功能及疼痛情况。结果:机器人TKA组的术中出血量为247(132,462)mL,较传统TKA组的337(208,469)mL出血少(P=0.013);机器人TKA组的手术时间为(113±25)min,较传统TKA组(80±23)min延长(P<0.001)。术后切口均一期愈合。两组患者均获得随访,随访时间5~12个月,平均(8.2±2.1)个月。传统TKA组与机器人TKA组的术后并发症发生率比较(19.6%vs.20.0%),差异无统计学意义(P=0.944)。末次随访时,机器人TKA组VAS评分(1.1±1.0)分,低于传统TKA组的(1.4±0.7)分(P=0.031);机器人TKA组FJS-12评分(72.4±4.6)分与传统TKA组(72.0±5.4)分比较,差异无统计学意义(P=0.487)。末次随访时,传统TKA组和机器人TKA组的膝关节ROM、AKS膝关节评分和功能评分均较术前改善,差异有统计学意义(P<0.001);两组间比较差异均无统计学意义(P>0.05);两组术前和术后膝关节ROM、AKS膝关节评分和功能评分的差值比较,差异均无统计学意义(P>0.05)。结论:与传统TKA比较,MAKO机器人辅助TKA对膝关节软组织损伤较小,疼痛较轻,出血量少,可以早期减轻患者疼痛,具有良好的应用前景,但其远期临床疗效有待进一步明确。

Objective:To investigate the early clinical outcomes of MAKO robot-assisted total knee arthroplasty(TKA).Methods:Clinical data of 75 patients(89 knees)undergoing MAKO robot-assisted TKA in our hospital from June 2021 to January 2022 were retrospectively analyzed,and 153 patients(192 knees)undergoing conventional TKA in the same period were chosen as the control.Intraoperative bleeding,operative time and complications were recorded and compared between the two groups;visual analogue score of pain(VAS),knee range of motion(ROM),American Knee Society(AKS)score and forgotten joint score(FJS-12)were used to evaluate knee function and pain.Results:Intraoperative bleeding in the robot group was 247(132,462)mL,which was less than that in the conventional group of 337(208,469)mL,and the difference was statistically significant(P=0.013).The operative time in the robot group was(113±25)min,which was longer than that in the conventional group of(80±23)min,and the difference was statistically significant(P<0.001).All patients had their incision healed of top grade.Patients in both groups were followed up for 5 to 12 months,with a mean of(8.2±2.1)months.There was no statistically significant difference in the overall postoperative complication rate between the two groups(19.6%vs.20.0%,P=0.944).At the last follow-up,knee ROM,AKS knee score and functional score were all improved in the two groups compared with those before operation,and the differences were statistically significant(P<0.001),while there was no significant difference in those above indexes between the two groups.At the last follow-up,VAS score was lower in the robot group(1.1±1.0 points)than in the conventional group(1.4±0.7 points,P=0.031),and there was no significant difference in FJS-12 between the two groups[(72.4±4.6)vs.(72.0±5.4)points,P=0.487].Conclusions:Compared with conventional TKA,MAKO robot-assisted TKA is less traumatic to the soft tissues of the knee joint,less painful,less blood loss,and can reduce patients'pain in the early stage,which has good application prospects,but its long-term clinical efficacy needs to be further clarified.