机器人与遥感导航系统辅助全膝关节置换术对比研究

Comparative study of total knee arthroplasty assisted by robot and remote sensing navigation system

目的:比较机器人辅助(robot-assisted,RA)与遥感导航(remote sensing navigation alignment,RSNA)系统辅助全膝关节置换术(total knee arthroplasty,TKA)的临床疗效。方法:自2023年3月至2023年6月收治60例因重度膝骨关节炎(knee osteoarthritis,KOA)行初次单侧TKA患者,按照治疗方法不同分为RSNA组和RA组,每组30例。RSNA组男5例,女25例;年龄56~81(66.33±7.16)岁;身体质量指数(body mass index,BMI)为19.87~38.54(28.40±6.18)kg·m^(-2);病程5~36(18.20±8.98)个月;采用RSNA系统辅助进行定位截骨。RA组男7例,女23例;年龄55~82(67.83±8.61)岁;BMI为19.67~37.25(28.01±4.89)kg·m^(-2);病程3~33(17.93±9.20)个月;采用RA进行手术。比较两组手术时间、切口长度,术后2周隐性失血量、下肢血栓发生率。测量并比较两组术前和术后1周髋膝踝角(hip-knee-ankle angle,HKAA)、HKAA偏差、股骨远端外侧角(lateral distal femoral angle,LDFA)、胫骨近端内侧角(medial proximal tibial angle,MPTA)、胫骨平台后倾角(posterior tibial slope,PTS),并于术前及术后3、6个月采用Western Ontario and McMaster大学骨关节炎指数(Western Ontario and McMaster Universities Osteiarthritis Index,WOMAC)和美国膝关节协会评分(Knee Society score,KSS)进行功能恢复情况评价。结果:两组患者手术均顺利进行,术中无血管、神经损伤等严重并发症,术后伤口Ⅰ期愈合,随访时间为6个月。RSNA组手术时间、术后2周隐性失血量、切口长度分别为(94.35±5.75)min、(130.54±17.53)ml、(14.73±2.14)cm,RA组分别为(102.57±6.88)min、(146.33±19.47)ml、(16.78±2.32)cm,RSNA组优于RA组(P<0.05)。两组术后2周均未发生深静脉血栓,RSNA组5例发生肌间静脉血栓,RA组8例发生肌间静脉血栓,差异无统计学意义(P>0.05)。RSNA组术前HKAA、LDFA、MPTA分别为(173.00±5.54)°、(86.96±3.45)°、(82.79±3.35)°,术后1周分别为(178.34±1.85)°、(89.92±0.42)°、(89.84±0.73)°;RA组术前HKAA、LDFA、MPTA分别为(173.31±6.48)°、(87.15±3.40)°、(82.99±3.05)°,术后1周分别为(178.52±1.79)°、(90.03±0.39)°、(90.15±0.47)°;两组术后1周HKAA、LDFA、MPTA较术前均明显改善(P<0.05),术前及术后1周两组间HKAA、LDFA、MPTA、PTS比较,差异无统计学意义(P>0.05);术后1周HKAA偏差分布比较,差异无统计学意义(χ^(2)=2.611,P=0.456)。两组术前与术后3、6个月WOMAC、KSS比较,差异无统计学意义(P>0.05),两组术后3、6个月WOMAC、KSS较术前改善(P<0.05)。结论:RA与RSNA系统辅助TKA均可获得精准的截骨,RA手术精准性更高,RSNA系统辅助手术创伤较小,操作较简捷。

Objective To compare clinical efficacy of robot-assisted(RA)and remote sensing navigation alignment(RSNA)system-assisted total knee arthroplasty(TKA).Methods From March 2023 to June 2023,60 patients who underwent the first unilateral TKA due to severe knee osteoarthritis(KOA)were admitted and divided into RSNA group and RA group according to different treatment methods,with 30 patients in each group.There were 5 males and 25 females in RSNA group,aged from 56 to 81 years old with an average of(66.33±7.16)years old;body mass index(BMI)ranged from 19.87 to 38.54 kg·m^(-2)with an average of(28.40±6.18)kg·m^(-2);the courses of disease ranged from 5 to 36 months with an average of(18.20±8.98)months;RSNA system was used to assist the positioning of osteotomy.There were 7 males and 23 females in RA group,aged from 55 to 82 years old with an average of(67.83±8.61)years old;BMI ranged from 19.67 to 37.25 kg·m^(-2)with an average of(28.01±4.89)kg·m^(-2);the courses of disease ranged from 3 to 33 months with an average of(17.93±9.20)months;RA was performed.Operation time,incision length,latent blood loss at 2 weeks after operation and incidence of lower extremity thrombosis were compared between two groups.Hip-knee ankle angle(HKAA),HKAA deviation,lateral distal femoral angle(LDFA),medial proximal tibial angle(MPTA)and posterior tibial slope(PTS)were compared between two groups;Western Ontario McMaster Universities Osteoarthritis Index(WOMAC)and Knee Society score(KSS)were used to evaluate functional recovery before operation,3 and 6 months after operation.Results The operation was performed successfully in both groups,and there were no serious complications such as vascular and nerve injury during operation.The wound healed well at stageⅠafter operation,and the follow-up time was 6 months.The operation time,latent blood loss at 2 weeks after operation and incision length in RSNA group were(94.35±5.75)min,(130.54±17.53)ml and(14.73±2.14)cm,respectively;while(102.57±6.88)min,(146.33±19.47)ml and(16.78±2.32)cm in RA group,respectively.RSNA group was better than RA group(P<0.05).No deep vein thrombosis occurred in both groups at 2 weeks after operation,5 patients occurred intermuscular vein thrombosisin in RSNA group and 8 patients in RA group,the difference was not statistically significant(P>0.05).In RSNA group,HKAA,LDFA and MPTA were(173.00±5.54)°,(86.96±3.45)°,(82.79±3.35)°before operation,and(178.34±1.85)°,(89.92±0.42)°,(89.84±0.73)°at 1 week after operation,respectively.In RA group,HKAA,LDFA and MPTA were(173.31±6.48)°,(87.15±3.40)°and(82.99±3.05)°before operation,and(178.52±1.79)°,(90.03±0.39)°and(90.15±0.47)°at 1 week after operation,respectively.HKAA,LDFA and MPTA were significantly improved in both groups at 1 week after operation(P<0.05).There were no significant difference in HKAA,LDFA,MPTA and PTS between two groups before operation and 1 week after operation(P>0.05).There was no significant difference in deviation distribution of HKAA at 1 week after operation(χ^(2)=2.611,P=0.456).There were no significant difference in WOMAC and KSS between two groups before operation,3 and 6 months after operation(P>0.05),and postoperative WOMAC and KSS at 3 and 6 months between two groups were improved compared with those before operation(P<0.05).Conclusion Both RA and RSNA system assisted TKA could obtain accurate osteotomy,RA has higher surgical accuracy,RSNA system assisted operation has less trauma,and operation is simpler.