鸿鹄机器人辅助全膝关节置换的早期学习曲线

Learning curve of domestic“Skywalker”robotic-assisted total knee arthroplasty

目的回顾性分析鸿鹄骨科机器人辅助人工膝关节置换(TKA)的手术时间和影像学数据,探讨机器人辅助TKA的临床效果和学习曲线。方法对同一手术组开展的25例机器人辅助TKA手术进行分析,将手术时间通过累积和分析法(CUSUM)进行分析,绘制机器人辅助TKA的学习曲线,根据学习曲线分为两个不同阶段,比较两个阶段的手术时间、出血量、住院天数、髋-膝-踝角等影像学数据和临床评分。结果CUSUM分析结果显示,机器人辅助TKA的学习曲线最大转折点在第13例手术,基于此将学习曲线划分为学习提高阶段和熟练掌握阶段,两个阶段患者的一般资料、术后髋-膝-踝角等影像学数据、美国特种医院(HSS)评分、膝关节活动范围(ROM)和关节置换术后忘记评分(FSJ-12)差异无统计学意义(P>0.05),但熟练掌握阶段与学习提高阶段相比,整体手术时间减少23 min,空间摆位时间下降4.4 min,光学靶标安装下降5.0 min;在手术操作平均耗时上,定位下肢力线和关节面配准的时间分别降低2.9 min和5.2 min,机械臂截骨操作时间降低14.1 min。结论利用CUSUM方法准确分析了机器人辅助TKA的学习曲线,显示熟练掌握操作此技术须累积的手术例数为13例。机器人辅助TKA学习曲线短,临床效果满意。

Objective To investigate the clinical efficacy and learning curve of robot-assisted total knee arthroplasty(TKA)by retrospectively analyzing the operation time and imaging data of TKA procedures performed with the"Skywalker"robot.Methods A total of 25 robotic-assisted TKA procedures performed by the same surgical group were retrospectively analyzed.The operation time was analyzed using the cumulative sum analysis(CUSUM)method to plot the learning curve,based on which the learning curve was divided into two stages.The operation time,bleeding volume,hospital days,hip-knee-ankle angle and other imaging data,and clinical scores of the two stages were compared.Results The CUSUM analysis revealed the maximum turning point of the learning curve at 13 cases.Based on this,the learning curve was divided into two stages:the learning improvement stage and the mastery stage.There were no significant differences in general data,postoperative hip-knee-ankle angle and other imaging data,HSS scores,knee ROM and FSJ-12 scores between the two stages(P>0.05).However,in the mastery stage,the overall operation time decreased by 23 min,the spatial positioning time decreased by 4.4 min,the optical target installation decreased by 5.0 min;the time to position the lower limb force line and joint surface alignment reduced by 2.9 min and 5.2 min,respectively,and the robotic arm osteotomy operation time reduced by 14.1 min.Conclusion The learning curve of robot-assisted TKA is precisely profiled by CUSUM analysis,indicating that operators need to perform at least 13 surgical cases to master the technique.The learning curve of robot-assisted TKA is short,and the clinical results are satisfactory.