Dai H Y, Zhu K C, Wang Q J, Zhang X L, Wang Q
Department of Orthopedic Surgery, the 6th People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China.
Zhonghua Yi Xue Za Zhi. 2022 Jan 4;102(1):49-55. doi: 10.3760/cma.j.cn112137-20210806-01754.
To explore the learning curve and short-term clinical outcomes of Mako robotic-assisted direct anterior approach total hip arthroplasty (THA). The preoperative basic data, surgical information and postoperative rehabilitation of 50 patients who underwent Mako robotic-assisted THA for hip diseases in Department of Orthopedic Surgery of the 6th People's Hospital Affiliated to Shanghai Jiao Tong University from December 2018 to December 2020 were analyzed retrospectively, included operation time, intraoperative blood loss, postoperative complications, postoperative imaging parameters (abduction angle, anteversion angle, lower limb length difference, eccentricity difference) and postoperative hip joint Harris score (hip Harris score, HHS). There were 16 males and 34 females, with a mean age of 50-79(67±10) years. The postoperative clinical results of Mako robotic-assisted total hip arthroplasty was analyzed. A cumulative sum analysis (CUSUM) was performed on the operation time (OT). The CUSUM learning curve was modeled by curve fitting and R² was used to testify the goodness. The different phase of the learning curve was compared with several observation indicators. All patients were followed up for more than 6 months. Two patients had poor wound healing and 5 patients had symptoms of lateral femoral cutaneous nerve injury, which disappeared within 1-2 months. No serious complications such as dislocation, aseptic loosening, periprosthetic infection or revision occurred in all the patients. The average operation time was (81±16) min, and the intraoperative blood loss was (456±84) ml. The average Harris hip score at the last follow-up was 88.6±2.5. The radiological evaluation showed that the positions of the acetabular cups were all in the Lewinnnek safety zone; the limb length discrepancy was (0.15±0.50) cm, the offset was (-0.11±0.72) cm. The OT decreased with the accumulation of the cases. The CUSUM learning curve was best modeled as cubic curve,the fitting curve reached the top at the 19th case. As a cut-off point, the 19th point divided the learing curve into two phases. There were statistical differences in OT, pelvic array installation time, acetabular registration time, acetabular reaming time (all <0.05), but there was no significant differences in Harris hip score, acetabular prosthesis anteversion angle and abduction angle between the two groups (all >0.05). The learning curve of Mako robot-assisted DAA-THA is about 19 cases. Mako robot-assisted DAA-THA can ensure the accuracy of prosthetic placement and the safety of the operation during the learning curve, and the short-term clinical results after surgery is excellent.
探讨Mako机器人辅助直接前路全髋关节置换术（THA）的学习曲线及短期临床疗效。回顾性分析2018年12月至2020年12月在上海交通大学附属第六人民医院骨科行Mako机器人辅助THA治疗髋部疾病的50例患者的术前基础资料、手术信息及术后康复情况，包括手术时间、术中出血量、术后并发症、术后影像学参数（外展角、前倾角、下肢长度差、偏心距差）及术后髋关节Harris评分（髋部Harris评分，HHS）。其中男性16例，女性34例，平均年龄50 - 79（67±10）岁。分析Mako机器人辅助全髋关节置换术的术后临床结果。对手术时间（OT）进行累积和分析（CUSUM）。通过曲线拟合建立CUSUM学习曲线模型，并用R²检验拟合优度。将学习曲线的不同阶段与多个观察指标进行比较。所有患者均随访6个月以上。2例患者伤口愈合不佳，5例患者出现股外侧皮神经损伤症状，均在1 - 2个月内消失。所有患者均未发生脱位、无菌性松动、假体周围感染或翻修等严重并发症。平均手术时间为（81±16）分钟，术中出血量为（456±84）毫升。末次随访时Harris髋关节平均评分为88.6±2.5。影像学评估显示髋臼杯位置均在Lewinnnek安全区内；肢体长度差异为（0.15±0.50）厘米，偏心距为（-0.11±0.72）厘米。OT随病例数的增加而减少。CUSUM学习曲线最佳拟合为三次曲线，拟合曲线在第19例时达到顶点。以第19例为分界点，将学习曲线分为两个阶段。两组在OT、骨盆阵列安装时间、髋臼注册时间、髋臼扩髓时间上均有统计学差异（均<0.05），但两组在Harris髋关节评分、髋臼假体前倾角和外展角上无显著差异（均>0.05）。Mako机器人辅助DAA - THA的学习曲线约为19例。Mako机器人辅助DAA - THA在学习曲线期间能确保假体植入的准确性和手术安全性，且术后短期临床效果良好。
