Ross Keir A, Wiznia Daniel H, Long William J, Schwarzkopf Ran
Department of Orthopedic Surgery, New York University School of Medicine, New York, NY.
Department of Orthopaedic Surgery and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut.
JBJS Rev. 2021 May 18;9(5):e20.00200. doi: 10.2106/JBJS.RVW.20.00200.
»: The potential benefits of computer-assisted surgical (CAS) navigation and robotic total knee arthroplasty (TKA) systems, such as increased reliability of restoring the mechanical axis, fewer outliers, more rapid hospital discharge, less physical therapy requirements, decreased blood loss, and decreased revision rates, have led to their application not only in primary cases but also in complex cases such as preoperative deformity and revision.
»: Early evidence demonstrates that CAS navigation may help to improve alignment in complex cases of femoral and tibial deformity and in cases of femoral bowing.
»: Data regarding deformity correction with robotic systems are similar to CAS navigation with regard to alignment, but are more limited. There are also scant data regarding revision cases and cases of previous intramedullary canal instrumentation.
»: Concerns remain regarding cost, learning curves, and operative times. There are potential long-term cost savings associated with a decrease in revisions and readmissions that require additional investigation.
»: Early evidence for the use of these emerging technologies for deformity correction and revision cases is promising, but their impact on long-term functional outcomes remains to be demonstrated. Additional well-designed comparative studies are warranted.
计算机辅助手术(CAS)导航和机器人全膝关节置换术(TKA)系统具有潜在益处,比如恢复机械轴的可靠性提高、异常值减少、住院时间缩短、物理治疗需求降低、失血量减少以及翻修率降低,这些益处使得它们不仅应用于初次手术病例,还应用于诸如术前畸形和翻修等复杂病例。
早期证据表明,CAS导航可能有助于改善股骨和胫骨畸形复杂病例以及股骨弓形病例的对线情况。
关于机器人系统进行畸形矫正的数据在对线方面与CAS导航相似,但更为有限。关于翻修病例和既往髓内管器械植入病例的数据也很少。
对于成本、学习曲线和手术时间仍存在担忧。与翻修和再次入院减少相关的潜在长期成本节约需要进一步研究。
这些新兴技术用于畸形矫正和翻修病例的早期证据很有前景,但其对长期功能结果的影响仍有待证明。需要更多精心设计的比较研究。