机器人辅助全膝关节置换的学习曲线分析

Learning curve analysis of robotic knee system assisted total knee arthroplasty

[目的]分析机器人膝关节系统辅助全膝关节置换术(total knee arthroplasty,TKA)的学习曲线。[方法]纳入2021年9月—2022年9月在本院进行机器人膝关节系统辅助TKA手术的17例膝关节炎患者。采用累计求和(cumulative summa⁃tion,CUSUM)法分析学习曲线。[结果]根据手术先后顺序,前10例为学习组,后7例为成熟组。成熟组手术时间[(123.3±11.3)min vs(147.3±11.3)min,P<0.05]、运用机器人膝关节系统定位时间[(15.9±2.1)min vs(22.2±6.1)min,P<0.05]、调整计划假体时间[(17.6±4.2)min vs(23.5±5.2)min,P<0.05]均显著优于学习组;两组间股骨注册时间、胫骨注册时间、股骨远端截骨时间、胫骨近端截骨时间、股骨四合一截骨时间、围术期失血量、术后HKA角、切口愈合、住院时间比较差异均无统计学意义(P>0.05)。两组患者术后1个月KSS临床评分、KSS功能评分、HSS评分比较差异均无统计学意义(P>0.05)。[结论]机器人膝关节系统辅助全膝关节置换术的学习曲线在10例手术左右。

[Objective]To analyze the learning curve of robotic knee systemassisted total knee arthroplasty(TKA).[Methods]From September 2021 to September 2022,17 patients with knee arthritis underwent robotic knee systemassisted TKA surgery in our hospital.The learning curve was analyzed through the cumulative summation(CUSUM)method.The baseline characteristics,operation conditions,and postoperative outcomes at different stages of the learning curve were compared.[Results]The operation time showed a downward trend with the increase of the number of operations,and the inflection point of the learning curve was around the 10th operation.Based on the sequence,the patients were divided into the learning group and the mature group.There was no statistically significant difference in age,gender composition and course of disease between the two groups(P>0.05).The mature group proved significantly superior to the learning group in terms of operation time[(123.3±11.3)min vs(147.3±11.3)min,P<0.05],the positioning time of the robot knee system[(15.9±2.1)min vs(22.2±6.1)min,P<0.05],the prosthetic planning time[(17.6±4.2)min vs(23.5±5.2)min,P<0.05],nevertheless,there were no significant differences in femoral registration time,tibial registration time,distal femoral osteotomy time,proximal tibial osteotomy time,femoral four-in-one osteotomy time,intraoperative blood loss,postoperative HKA,incision healing,and hospital stay between the two groups(P>0.05).In addition,there were no significant differences in KSS clinical score,KSS functional score and HSS score between the two groups 1 month after surgery(P>0.05).[Conclusion]The learning curve of robotic knee system-assisted TKA surgery is around 10 operations.