机器人辅助全膝关节置换术治疗外翻膝的早期疗效分析

Early curative effects of robot-assisted total knee arthroplasty for valgus knee

目的探讨机器人辅助全膝关节置换术(TKA)治疗外翻膝的早期疗效。方法回顾性分析2021年1-12月期间解放军联勤保障部队第九二〇医院骨科采用TKA治疗的40例外翻膝患者资料。根据术中是否应用机器人辅助分为两组:观察组15例,男4例,女11例;年龄(65.5±6.2)岁;病程为42(36,54)个月;采用机器人辅助TKA治疗。对照组25例,男8例,女17例;年龄(65.8±7.5)岁;病程为42(36,60)个月;采用传统TKA治疗。比较两组患者的手术时间、血红蛋白下降量、术后12个月膝关节活动度、美国膝关节协会评分(KSS)、髋-膝-踝角(HKA)、股骨远端外侧角(LDFA)及胫骨近端内侧角(MPTA)等。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。观察组患者的手术时间为(148.0±21.2)min,显著长于对照组患者[(115.2±7.1)min];血红蛋白下降量为(11.8±1.1)g/L,显著少于对照组患者[(18.1±1.8)g/L],差异均有统计学意义(P<0.05)。观察组与对照组患者术后分别获13(13,14)、13(13,14)个月随访,差异无统计学意义(P>0.05)。术后12个月观察组患者KSS膝评分为(86.1±4.6)分、KSS功能评分为(86.9±3.1)分、膝关节活动度为115.7°±5.0°,显著高于对照组患者[(82.2±3.5)分、(82.8±0.9)分、108.2°±5.0°],差异均有统计学意义(P<0.05)。术后12个月患者双下肢全长X线片显示:假体位置良好,无松动、下沉等并发症发生。术后12个月观察组患者的HKA(178.5°±1.2°)、LDFA(89.1°±0.7°)显著高于对照组患者(176.6°±1.5°、88.2°±8.2°),差异均有统计学意义(P<0.05);而两组患者的MPTA比较差异无统计学意义(P>0.05)。结论计算机辅助TKA治疗外翻膝能够矫正关节畸形,精准截骨,实现下肢功能对线,较传统TKA能够获得更好的早期治疗效果。

Objective To investigate the early curative effects of robot-assisted total knee arthroplasty(TKA)in the treatment of valgus knee.Methods A retrospective study was conducted to analyze the data of 40 patients with valgus knee who had been treated by TKA at Department of Orthopaedics,The 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from January to December 2021.The patients were divided into 2 groups according to whether a robot had been used or not for TKA.In the observation group of 15 cases for which TKA was assisted by a robot,there were 4 males and 11 females with an age of(65.5±6.2)years,and the disease course was 42(36,54)months;in the control group of 25 cases for which conventional TKA was performed,there were 8 males and 17 females with an age of(65.8±7.5)years,and the disease course was 42(36,60)months.Surgical time,hemoglobin decrease,and knee joint range of motion,American Knee Society Score(KSS),hip-knee-ankle angle(HKA),lateral distal femoral angle(LDFA),and medial proximal tibial angle(MPTA)at 12 months after surgery were compared between the 2 groups.Results There was no significant difference in the preoperative general data between the 2 groups,indicating comparability(P>0.05).The surgical time in the observation group was(148.0±21.2)min,significantly longer than that in the control group[(115.2±7.1)min],and the hemoglobin decreased by(11.8±1.1)g/L in the observation group,significantly less than that in the control group[(18.1±1.8)g/L](P<0.05).The observation group and the control group were followed up for 13(13,14)and 13(13,14)months after surgery,respectively,showing no statistically significant difference(P>0.05).At 12 months after surgery,the KSS knee score,KSS functional score,and knee range of motion in the observation group were(86.1±4.6)points,(86.9±3.1)points,and 115.7°±5.0°,significantly larger than those in the control group[(82.2±3.5)points,(82.8±0.9)points,and 108.2°±5.0°](P<0.05).Reexamination of full-length radiographs of both lower limbs in all patients showed good positions of the prostheses and no such adverse events as loosening or sinking at 12 months after surgery.The HKA(178.5°±1.2°)and LDFA(89.1°±0.7°)at 12 months after surgery in the observation group were significantly larger than those in the control group(176.6°±1.5°,88.2°±8.2°)(P<0.05);there was no statistically significant difference in MPTA between the 2 groups(P>0.05).Conclusion sIn the treatment of valgus knee,robot-assisted TKA can correct joint deformity,and achieve precise osteotomy and functional alignment of lower limbs,leading to better early curative effects than conventional TKA.