[经直接上方入路机器人辅助全髋关节置换术的早期疗效]
[Early effectiveness of robot-assisted total hip arthroplasty via direct superior approach].
作者信息
Zhang Ji, Wang Xingshan, Yang Dejin, Zhou Yixin
机构信息
Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, P.R.China.
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Oct 15;35(10):1240-1245. doi: 10.7507/1002-1892.202105115.
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 was 10.5 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 was 1-3 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 ( =-8.717, =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 [(38.2±1.6)°, (16.6±3.7)°] ( =1.809, =0.104; =-1.103, =0.299). The LLD ranged from -2 to 4 mm. No complication such as dislocation, aseptic loosening, or periprosthetic joint infection occurred.
CONCLUSION
The robot-assisted THA via DSA has encouraged early effectiveness.
目的
评估经直接上方入路（DSA）的机器人辅助全髋关节置换术（THA）的早期疗效。
方法
2021年3月至2021年4月，11例患者（11髋）接受了经DSA的机器人辅助THA治疗。其中男性7例，女性4例，平均年龄55岁（范围26 - 73岁）。髋关节发育不良继发骨关节炎患者5例，股骨头坏死患者6例。术前髋关节Harris评分为55.8±6.3。记录手术时间、失血量、切口长度、术后输血及住院时间以及手术并发症的发生率。采用视觉模拟评分（VAS）和Harris评分评估髋关节疼痛及功能。通过X线片测量双下肢长度差异（LLD）。同时测量髋臼假体的倾斜角和前倾角，并比较计划值与实际值之间的差异。
结果
最终1例THA因暴露不佳经传统后外侧入路完成。其余10例THA经DSA在机器人手臂辅助下完成。平均手术时间为89分钟（范围65 - 120分钟）；平均切口长度为10.5厘米（范围9 - 13厘米）；平均失血量为400毫升（范围110 - 740毫升）。1例患者输血2单位。所有切口一期愈合，未发生神经血管损伤、深静脉血栓形成或骨折。术后住院时间为2 - 6天（平均4.4天）。随访时间为1 - 3个月（平均2.1个月）。出院时9例患者VAS评分为0，1例患者为2分。末次随访时，髋关节Harris评分为84.9±6.7，与术前相比差异有统计学意义（=-8.717，=0.000）。倾斜角和前倾角分别为（37.4±2.0）°和（17.1±4.5）°，与计划值[（38.2±1.6）°，（16.6±3.7）°]相比差异无统计学意义（=1.809，=0.104；=-1.103，=0.299）。LLD范围为-2至4毫米。未发生脱位、无菌性松动或假体周围关节感染等并发症。
结论
经DSA的机器人辅助THA具有良好的早期疗效。
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