机器人辅助后外侧入路全髋关节置换术的早期临床疗效

Early Clinical Efficacy of Robot-Assisted Posterolateral Approach for Total Hip Arthroplasty

摘要: 目的：探讨机器人辅助下全髋关节置换(total hip arthroplasty, THA)的早期疗效，为临床决策提供帮助。方法：回顾分析2021年5月~2022年10月于青岛大学附属医院行全髋关节置换术且符合纳入标准的患者200例，根据手术方式不同分为两组，其中100例行机器人辅助后外侧入路全髋关节置换术，100例行传统后外侧入路全髋关节置换术，两组患者一般情况比较无统计学差异(P > 0.05)，具有可比性。术中记录并比较两组患者手术时间、出血量及术后并发症的发生情况，术后3个月记录并比较髋臼前倾角、髋臼外展角、髋臼假体水平距离、髋臼假体垂直距离、股骨假体偏心距、股骨假体柄–干夹角、双下肢长度差，术后15个月采用髋关节Harris评分、牛津大学髋关节评分、Berg平衡量表、遗忘关节评分(F-Js)评价患者功能恢复情况。结果：两组患者均获随访，随访时间12~18个月，平均140.7个月，两组Harris评分、牛津髋关节评分评分、Berg平衡量表、双下肢长度差较术前均有明显改善且差异有统计学意义(P < 0.05)。机器人组Berg平衡量表、牛津髋关节评分及髋臼前倾角均高于普通组，差异有统计学意义(P < 0.05)；机器人组术后双下肢长度差低于普通组，差异有统计学意义(P < 0.05)；两组Harris评分、遗忘关节评分、髋臼外展角、髋臼假体水平距离、髋臼假体垂直距离、股骨假体柄–干夹角、股骨假体偏心距比较差异无统计学意义(P > 0.05)。结论：与传统THA相比，机器人辅助THA手术时间更长，术中出血量更多，具有一定学习曲线，但定位更加准确，髋臼假体的定位与植入更加精准，患者的髋关节功能及平衡能力能够得到更好的恢复，但其远期疗效还需进一步研究。

Abstract: Objective: To evaluate the early efficacy of robot-assisted total hip arthroplasty (THA) for clinical decision making. Methods: A retrospective analysis was performed on 200 patients who met the inclusion criteria and underwent total hip arthroplasty in the Affiliated Hospital of Qingdao University from May 2021 to October 2022. The patients were divided into two groups according to the different surgical methods. Among them, 100 underwent total hip arthroplasty through a robot-assisted posterolateral approach and 100 underwent traditional posterolateral approach. There was no statistical difference in the general situation between the two groups (P > 0.05), which was comparable. Intraoperative time, amount of blood loss and occurrence of postoperative complications were recorded and compared between the two groups. At 3 months after surgery, acetabular inclination angle, acetabular abduction angle, horizontal distance of acetabular prosthesis, vertical distance of acetabular prosthesis, eccentricity of femoral prosthesis, stem-stem angle of femoral prosthesis and length difference of both lower limbs were recorded and compared. Harriis score, Oxford hip score, Berg balance Scale and amnestic joint score were used to evaluate functional recovery 15 months after surgery. Results: Patients in both groups were followed up for 12 to 18 months, with an average of 14.7 months. Harris score, Oxford hip score, Berg balance scale and lower limb length difference between the two groups were significantly improved compared with those before surgery, and the difference was statistically significant (P < 0.05). Berg balance Scale, Oxford hip score and acetabular inclination angle in robot group were higher than those in ordinary group, the difference was statistically significant (P < 0.05). The difference of postoperative lower limb length in robot group was lower than that in ordinary group, and the difference was statistically significant (P < 0.05). There were no significant differences in Harris score, forgotten joint score, acetabular evocation angle, horizontal distance of acetabular prosthesis, vertical distance of acetabular prosthesis, stem-stem angle of femoral prosthesis and eccentricity of femoral prosthesis between the two groups (P > 0.05). Conclusion: Compared with traditional THA, robot-assisted THA has a longer operation time, more intraoperative blood loss, and a certain learning curve. However, the positioning is more accurate, the positioning and implantation of acetabular prostheses are more accurate, and the hip function and balance ability of patients can be better restored. However, its long-term efficacy needs further study.