MAKO机械臂辅助全髋关节置换术在不同类型髋关节疾病中的早期疗效分析

Early Efficacy Analysis of MAKO Robotic Arm Assisted Total Hip Arthroplasty in Different Types of Hip Diseases

摘要: 目的：探讨MAKO机械臂辅助全髋关节置换术在不同类型髋关节疾病中应用的早期疗效。方法：回顾性分析2021年1月至2021年12月因先天性髋关节发育不良(Developmental dysplasia of the hip, DDH)接受MAKO机械臂辅助全髋关节置换术的患者13例为DDH组，因股骨头缺血性坏死(Avascular necrosis, AVN)接受MAKO机械臂辅助全髋关节置换术的患者29例为AVN组。除DDH组女性患者比例偏高外，两组患者年龄、身高、体重、体质指数、术前Harris髋关节评分、西安大略和麦克马斯特大学(Western Ontario and McMaster Universities, WOMAC)骨关节炎指数、术前下肢长度差差异均无统计学意义(P > 0.05)。记录并比较两组患者手术时间、并发症发生率、术后影像学参数(外展角、前倾角、下肢长度差)、术后髋臼假体在Lewinnek安全区和Callanan安全区内的放置率、术后3个月和6个月的Harris评分、WOMAC指数和遗忘关节评分。结果：DDH组手术时间为(101.54 ± 11.79) min，与AVN组手术时间为(97.59 ± 16.88) min相比，手术时间差异无统计学意义(t = 0.762, P = 0.450)。DDH组下肢长度差为(3.95 ± 2.86) mm，与AVN组下肢长度差(3.71 ± 2.71) mm相比，差异无统计学意义(t = 0.263, P = 0.794)。两组患者术后髋臼假体外展角(43.62˚ ± 2.57˚, 41.62˚ ± 4.77˚)差异无统计学意义(t = 1.419, P = 0.164)；术后髋臼假体前倾角(15.41˚ ± 4.67˚, 12.78˚ ± 4.75˚)差异无统计学意义(t = 1.671, P = 0.102)；术后髋臼假体外展角度与术前计划的差值(3.85˚ ± 2.18˚, 3.67˚ ± 2.61˚)差异无统计学意义(t = 0.216, P = 0.830)；术后髋臼假体前倾角度与术前计划的差值(3.17˚ ± 3.32˚, 3.82˚ ± 3.54˚)无统计学意义(t = 0.559, P = 0.579)；术后偏心距差(4.82 ± 2.83, 4.98 ± 3.82) mm，无统计学差异(t = 0.133, P = 0.895)。DDH组髋臼假体在Lewinnek安全区的放置率为90.9%，AVN组为89.7%，组间差异无统计学意义(P = 0.906)。DDH组髋臼假体角度在Callanan安全区的比例为84.62%，AVN组比例为65.52%，差异无统计学意义(P = 0.205)。术后3个月和术后6个月两组患者Harris髋关节功能评分、WOMAC指数、遗忘关节评分的组间差异无统计学意义。DDH组和AVN组术后6个月Harris髋关节功能评分改善值分别为(36.23 ± 5.13)分和(37.14 ± 5.81)分，差异无统计学意义(t = 0.484, P = 0.616)；WOMAC指数改善值分别为(48.62 ± 11.84)分和(45.72 ± 8.94)分，差异无统计学意义(t = 0.875, P = 0.387)。各组患者均无术中及术后并发症发生。结论：MAKO机械臂辅助全髋关节置换术在面对DDH和AVN两种疾病时其操作性、安全性、精准性等表现稳定，具有良好的早期疗效。

Abstract: Objective: To investigate the early efficacy of MAKO robotic arm-assisted total hip replacement in different types of hip diseases. Methods: A retrospective analysis of 13 patients undergoing MAKO robotic arm-assisted total hip replacement due to Developmental dysplasia of the hip (DDH) from January 2021 to December 2021 was performed in DDH group. Ascular surgery of 29 patients re-ceiving MAKO robotic arm-assisted total hip replacement due to Avascular necrosis (AVN) of the femoral head were in the AVN group. Age, height, weight, body mass index, preoperative Harris hip score, Western Ontario and McMaster Universities (Western Ontario and McMaster Universities). There were no significant differences in osteoarthritis index and lower limb length before operation (P > 0.05). Operation time, complication rate, postoperative imaging parameters (dilation Angle, anterior inclination, lower limb length difference), placement rate of postoperative CT acetabular prosthesis in the Lewinnek safety zone and the Callanan safety zone, Harris score, WOMAC index, and amnesia joint score at 3 and 6 months after surgery were recorded and compared between the two groups. Results: The operating time of DDH group was (101.54 ± 11.79) min, and that of AVN group was (97.59 ± 16.88) min. There was no significant difference in operating time (t = 0.762, P = 0.450). The lower limb length difference of DDH group was (3.95 ± 2.86) mm, which was not statistically significant compared with that of AVN group (3.71 ± 2.71) mm, (t = 0.263, P = 0.794). There was no significant difference in the external extension Angle of acetabular prosthesis between the two groups (43.62˚ ± 2.57˚, 41.62˚ ± 4.77˚) (t = 1.419, P = 0.164). There was no significant difference in anterior inclination of acetabular prosthesis (15.41˚ ± 4.67˚, 12.78˚ ± 4.75˚) (t = 1.671, P = 0.102). There was no significant difference between the external extension Angle of acetabular prosthesis and the preoperative plan (3.85˚ ± 2.18˚, 3.67˚ ± 2.61˚) (t = 0.216, P = 0.830). There was no significant difference between the anterior inclination Angle of the acetabular prosthesis and the preoperative plan (3.17˚ ± 3.32˚, 3.82˚ ± 3.54˚) (t = 0.559, P = 0.579). Postoperative eccentricity difference (4.82 ± 2.83, 4.98 ± 3.82) mm was not statistically significant (t = 0.133, P = 0.895).The placement rate of acetabular prosthesis in the Lewinnek safe zone was 90.9% in the DDH group and 89.7% in the AVN group, with no statistically significant difference between groups (P = 0.906). The proportion of acetabular prosthesis Angle in the Callanan safe zone was 84.62% in the DDH group and 65.52% in the AVN group, with no statistical significance (P = 0.205). There were no significant differences in Harris hip function score, WOMAC index and amnestic joint score between the two groups at 3 and 6 months after surgery. The Harris hip func-tion score of DDH group and AVN group was (36.23 ± 5.13) points and (37.14 ± 5.81) points, re-spectively, with no significant difference (t = 0.484, P = 0.616). The improvement values of WOMAC index were (48.62 ± 11.84) points and (45.72 ± 8.94) points, respectively, with no statistical significance (t = 0.875, P = 0.387). No intraoperative or postoperative complications occurred in each group. Conclusion: MAKO robotic arm-assisted total hip replacement is stable in operation, safety and precision in the treatment of DDH and AVN diseases, and has good early efficacy.