摘要
目的总结机器人辅助直接上方入路人工全髋关节置换术(total hip arthroplasty,THA)的早期疗效及初步应用经验。方法 2021年3月—4月,机器人辅助下经直接上方入路行THA 11例(11髋)。男7例,女4例;年龄26~73岁,平均55岁。髋关节发育不良继发骨关节炎5例,股骨头坏死6例。术前髋关节Harris评分为(55.8±6.3)分。记录手术时间、切口长度、失血量、术后输血及住院时间、手术并发症发生情况。采用疼痛视觉模拟评分(VAS)以及Harris评分评价髋关节疼痛及功能。X线片测算双下肢长度差,复查假体位置,测量髋臼假体外展角、前倾角,并与术前设计结果比较。结果除1例因显露困难改行常规后外侧入路手术外,其余10例均顺利完成手术。10例患者手术时间65~120 min,平均89 min;切口长度9~13 cm,平均10.5 cm;失血量110~740 mL,平均400 mL;1例患者术后输血2 U。患者切口均Ⅰ期愈合,无神经血管损伤、下肢深静脉血栓形成及骨折等并发症发生。术后住院时间2~6 d,平均4.4 d;随访时间1~3个月,平均2.1个月。出院时9例VAS评分0分,1例为2分。末次随访时,髋关节Harris评分为(84.9±6.7)分,与术前比较差异有统计学意义(t=-8.717,P=0.000)。髋臼假体植入后机器人验证其外展角为(37.4±2.0)°、前倾角为(17.1±4.5)°,与术前计划(38.2±1.6)°、(16.6±3.7)°比较,差异均无统计学意义(t=1.809,P=0.104;t=–1.103,P=0.299)。双下肢长度差为–2~4 mm。随访期间均未出现假体脱位、松动及假体周围感染等。结论机器人辅助直接上方入路行THA可获得良好早期疗效。
Objective To evaluate the early effectiveness of the robot-assisted total hip arthroplasty(THA) via direct superior approach(DSA). Methods Between March 2021 and April 2021, 11 patients(11 hips) were treated with a robot-assisted THA via DSA. There were 7 males and 4 females, with an average age of 55 years(range, 26-73 years). There were 5 patients of osteoarthritis secondary to hip dysplasia and 6 patients of osteonecrosis of femoral head. Preoperative hip Harris score was 55.8±6.3. The operation time, volume of blood loss, length of incision, postoperative blood transfusion and hospital stay, and the incidence of surgical complications were recorded. The visual analogue scale(VAS)score and Harris score were used to evaluate hip joint pain and function. The leg length discrepancy(LLD) was measured on the X-ray films. The inclination angle and anteversion angle of the acetabular component were also measured, and the difference between the planned and actual values were compared. Results One THA was performed via conventional posterolateral approach finally because of poor exposure. The rest of 10 THAs were performed with assistance of robotic arm via DSA. The average operation time was 89 minutes(range, 65-120 minutes);the average length of incision was10.5 cm(range, 9-13 cm);and the average blood loss was 400 mL(range, 110-740 mL). One patient was given a blood transfusion for 2 unit. All incisions healed by first intention and no neurovascular injury, deep vein thrombosis, or fracture occurred. The length of hospital stay after operation was 2-6 days(mean, 4.4 days). The duration of follow-up was1-3 months(mean, 2.1 months). The VAS score was 0 in 9 patients and 2 in 1 patient at the day of discharge. At last follow-up, the hip Harris score was 84.9±6.7, showing significant difference when compared with that before operation(t=-8.717, P=0.000). The inclination and anteversion angles were(37.4±2.0)° and(17.1±4.5)°, respectively, and there was no significant difference when compared with the planned values
作者
张纪
王兴山
杨德金
周一新
ZHANG Ji;WANG Xingshan;YANG Dejin;ZHOU Yixin(Department of Orthopaedic Surgery,Beijing Jishuitan Hospital,Fourth Clinical College of Peking University,Beijing,100035,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2021年第10期1240-1245,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金面上项目(82072457)。
关键词
机器人辅助人工全髋关节置换术
Mako机器人
直接上方入路
微创手术
Robot-assisted total hip arthroplasty
Mako robot
direct superior approach
total hip arthroplasty
minimally invasive surgery
