机器人辅助全膝关节置换改善胫骨假体旋转对线的临床研究

Clinical Research on Robotic Arm-Assisted Total Knee Arthroplasty to Improve Rotation Alignment of Tibial Prosthesis

摘要: 目的：本文旨在通过对比机器人辅助膝关节置换手术(Robotic Arm-Assisted Total Knee Arthroplasty, RATKA)患者与全膝关节置换术(Total Knee Arthroplasty, TKA)患者术后胫骨假体旋转对线及临床疗效，得出机器人辅助全膝关节置换可以改善假体旋转对线及早期疗效。方法：2022年6月至2023年3月，在青岛大学附属医院接受全膝关节置换术的骨关节炎患者，共113人，比较2组患者年龄、BMI、性别、术前、术后3个月及术后1年的KSS评分、WOMAC评分、膝关节活动度、VAS评分等，并测量胫骨假体轴线分别相对于胫骨假体平台几何中心点至胫骨结节内侧缘点的连线、胫骨假体平台几何中心点至胫骨结节中内1/3点的连线、股骨假体轴线的夹角。结果：相对于股骨假体轴线，RATKA组患者的胫骨假体轴线平均内旋1.77˚ ± 0.69˚，TKA组的胫骨假体轴线平均内旋2.40˚ ± 1.75˚，差异有统计学意义(P < 0.05)。相对于胫骨结节内侧线，RATKA组患者的胫骨假体轴线平均内旋0.55˚ ± 3.99˚，TKA组的胫骨假体轴线平均外旋0.77˚ ± 4.04˚，但差异无统计学意义(P > 0.05)。相对于胫骨结节中内侧线，RATKA组患者的胫骨假体轴线平均内旋4.64˚ ± 2.18˚，TKA组的胫骨假体轴线平均内旋5.91˚ ± 2.01˚，差异有统计学意义(P < 0.05)。RATKA组患者术后3个月的VAS评分较TKA组VAS评分更低，KSS评分较TKA组更高，差异具有统计学意义(P < 0.05)。结论：与传统TKA相比，RATKA有助于精确胫骨假体旋转对线，机器人辅助TKA也明显提升了患者术后舒适度，机器人辅助TKA不仅仅为精准关节外科手术保驾护航，更是手术创伤的挽救者，对提升患者满意度、改善术后疗效等方面存在极大意义。

Abstract: Objective: This article aims to compare the rotation alignment of prostheses and clinical efficacy of tibial prosthesis rotation between robotic-arm assisted total knee arthroplasty (RATKA) patients and total knee arthroplasty (TKA) patients, and to conclude that robotic-arm assisted total knee arthroplasty can improve prosthesis rotation alignment and early efficacy. Method: A total of 113 patients with osteoarthritis who underwent total knee arthroplasty in the Affiliated Hospital of Qingdao University from June 2022 to March 2023 were analyzed. The age, BMI, gender, KSS score, WOMAC score, knee range of motion, VAS score, etc. were compared between the two groups of pa-tients at 3 months and 1 year after surgery. The tibial prosthesis axis was measured relative to the geometric center point of the tibial prosthesis platform to the medial edge point of the tibial nodule, the geometric center point of the tibial prosthesis platform to the medial 1/3 point of the tibial nodule, and the angle between the femoral prosthesis axis. Result: Compared with the femoral prosthesis axis, the average internal rotation of the tibial prosthesis axis in the RATKA group was 1.77˚ ± 0.69˚, and the average internal rotation of the tibial prosthesis axis in the TKA group was 2.40˚ ± 1.75˚, the difference was statistically significant (P < 0.05). Compared with the medial line of the tibial tubercle, the average internal rotation of the tibial prosthesis axis in the RATKA group was 0.55˚ ± 3.99˚, and the average external rotation of the tibial prosthesis axis in the TKA group was 0.77˚ ± 4.04˚, but the difference was not statistically significant (P > 0.05). Compared with the medial line of the tibial tubercle, the average internal rotation of the tibial prosthesis axis in the RATKA group was 4.64˚ ± 2.18˚, and the average internal rotation of the tibial prosthesis axis in the TKA group was 5.91˚ ± 2.01˚, the difference was statistically significant (P < 0.05). The VAS score of patients in the RATKA group was lower than that in the TKA group at 3 months after surgery, and the KSS score was higher than that in the TKA group, with statistical significance (P < 0.05). Conclu-sion: Compared with traditional TKA, RATKA helps with precise alignment of tibial prosthesis rota-tion, and RATKA significantly improves patient postoperative comfort. RATKA not only provides protection for precision joint surgery, but also saves surgical trauma. It has great significance in improving patient satisfaction and postoperative efficacy.