骨科机器人辅助下使用新型嵌合套筒移植自体血管化腓骨治疗股骨头坏死的疗效分析

Research on the therapeutic effects of using a novel chimeric sleeve to transplant autologous vascularized fibula for the treatment of necrosis of the femoral head under the assistance of orthopedic robot

目的探究在骨科机器人辅助下,使用新型嵌合套筒移植自体血管化腓骨治疗股骨头坏死的疗效。方法于2022年5月至2023年12月收集首都医科大学附属北京积水潭医院手外科收治的股骨头坏死患者8例(8髋),平均年龄34.8岁(27~54岁),平均体质量指数(BMI)26.5(20.2~30.0)。FicatⅡ期6例(6髋),FicatⅢ期2例(2髋)。术中使用骨科机器人辅助确定植入腓骨方向和长度,辅助植入导针,并配合新型嵌合套筒制备个性化骨隧道用以植入血管化腓骨,术后定期随访髋关节X线和Harris评分。结果8例患者显露旋股外侧动静脉降支、切取血管化腓骨、股骨头髓芯减压及使用新型嵌合套筒移植血管化腓骨过程顺利。经骨科机器人工作站计算后,最终平均入点误差为1.2 mm(1.2~1.3 mm),平均靶点误差为1.9 mm(1.8~2.1 mm)。术后影像学提示腓骨远端位于股骨头负重区域中央,腓骨远端距离关节面平均7.4 mm(7.0~8.0 mm),植入腓骨血运良好。所有患者术后恢复良好。术后平均随访7.5个月,有效率100%,早期临床效果令人满意。结论骨科机器人辅助下使用新型嵌合套筒可以更加精准、稳固地植入血管化腓骨,并通过个性化的骨隧道确保腓骨血运良好,早期临床效果良好。

Objective The purpose of this retrospective study is to evaluate the effectiveness of using a novel chimeric sleeve to transplant autologous vascularized fibula in treating necrosis of the femoral head with the assistance of orthopedic robots.Methods From May 2022 to December 2023 in Department of Hand Surgery,Beijing Jishuitan Hospital,Capital Medical University,8 patients(8 hips)suffering from avascular necrosis of the femoral head were treated by transplanting autologous vascularized fibula using a novel chimeric sleeve under orthopedic robotic assistance.The average age was 34.8 years(27~54 years),and the average BMI was 26.5(20.2~30.0).There were 6 cases at Ficat stageⅡ(6 hips)and 2 cases at Ficat stage Ⅲ(2 hips).During surgeries,orthopedic robots were used to assist in determining the direction and length of fibula implantation,assisting guidewire insertion,and preparing personalized bone tunnels with the help of the novel chimeric sleeve for vascularized fibula implantation.Postoperative follow-ups included regular hip joint X-rays and Harris scoring.Results All procedures including exposure of the lateral circumflex femoral artery and vein branches,obtaining of the vascularized fibula,core decompression of the femoral head and transplantation of the vascularized fibula with the novel chimeric sleeve were smooth.After calculations at the orthopedic robot workstation,the final average entry error was 1.2 mm(1.2~1.3 mm),and the average target error was 1.9 mm(1.8~2.1mm).Postoperative imaging suggested that the distal end of the fibula was located in the central loading area of the femoral head,with an average distance from the joint surface of 7.4 mm(7.0~8.0 mm).The blood supply to the implanted fibula was good.All patients recovered well after surgery.The average follow-up period was 7.5 months post-operation,with a 100% effectiveness rate,showing early satisfactory clinical results.Conclusion Using a novel chimeric sleeve to implant the vascularized fibula is more precisely and sturdily under the assistance of orthopedic robots and ensuring a good blood supply to the fibula through personalized bone tunnels has shown good early clinical results.