Fu Kai, Zhu Bowen, Jiang Qing, Chen Dongyang
Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China.
Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Jiangsu, 210008, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Nov 15;36(11):1357-1362. doi: 10.7507/1002-1892.202206101.
To investigate the effectiveness of MAKO robotic-arm assisted total hip arthroplasty (THA) via direct anterior approach (DAA) for bony fused hips in ankylosing spondylitis (AS).
Between June 2021 and January 2022, MAKO robotic-arm assisted THA via DAA was applied to treat 10 cases (12 hips) of AS with bony fused hips. There were 7 males and 3 females; the age ranged from 30 to 71 years, with an average age of 42.4 years. The duration of AS was 12-35 years, with an average of 21.4 years. The preoperative hip was ankylosed in flexion in 3 cases, with a flexion angle of 20°, 30°, 35°, respectively; 9 cases were ankylosed in extension. The operation time and complications were recorded; the visual analogue scale (VAS) score, Harris score, and Oxford hip scale (OHS) score before and after operation, and postoperative range of motion (flexion, extension, internal rotation, external rotation, adduction, and abduction) were used to evaluate the recovery of joint function; according to the postoperative anteroposterior X-ray film and CT scan of both hip joints, the abduction angle, anteversion angle, the difference between bilateral combined off-set and the lower limb length discrepancy were measured.
The operation time ranged from 80 to 190 minutes (mean, 134.6 minutes). All 10 patients were followed up 5-11 months (mean, 7.4 months). There was no serious adverse events such as incision infection, deep vein thrombosis of lower extremities, hip redislocation, aseptic loosening of the prosthesis, or death. At 5 months after operation, the acetabular prosthesis angle of abduction was 37°-45° (mean, 40.3°), anteversion angle was 9°-20° (mean, 15.8°). The difference between bilateral combined off-set was 0-10 mm (mean, 4.3 mm); the lower limb length discrepancy was 0-12 mm (mean, 3.5 mm). At last follow-up, the average range of motion of the hip joint was 89.2° in flexion (range, 80°-100°), 1.7° in extension (range, -5°-10°), 7.1° in internal rotation (range, 0°-15°), 20.4° in external rotation (range, 10°-30°), 7.9° in adduction (range, 0°-20°), and 16.5° in abduction (range, 10°-25°). At last follow-up, the VAS score, Harris score, and OHS score significantly improved when compared with those before operation ( <0.05).
The MAKO robotic-arm assisted THA via DAA can achieve satisfactory results in the treatment of AS with bony fused hip, which has the advantages of accurate prosthesis installation, soft tissue release, and less trauma during operation.
探讨MAKO机器人手臂辅助下经直接前路（DAA）全髋关节置换术（THA）治疗强直性脊柱炎（AS）合并髋关节骨性融合的有效性。
2021年6月至2022年1月，采用MAKO机器人手臂辅助下经DAA全髋关节置换术治疗10例（12髋）AS合并髋关节骨性融合患者。其中男性7例，女性3例；年龄30～71岁，平均42.4岁。AS病程12～35年，平均21.4年。术前髋关节屈曲强直3例，屈曲角度分别为20°、30°、35°；伸直强直9例。记录手术时间及并发症；采用视觉模拟评分（VAS）、Harris评分、牛津髋关节评分（OHS）评估术前、术后关节功能恢复情况，记录术后髋关节活动度（屈曲、伸直、内旋、外旋、内收、外展）；根据术后双髋关节正位X线片及CT扫描测量外展角、前倾角、双侧联合偏心距差值及下肢长度差异。
手术时间80～190分钟（平均134.6分钟）。10例患者均获随访，随访时间5～11个月（平均7.4个月）。未发生切口感染、下肢深静脉血栓、髋关节再脱位、假体无菌性松动及死亡等严重不良事件。术后5个月时，髋臼假体外展角37°～45°（平均40.3°），前倾角9°～20°（平均15.8°）。双侧联合偏心距差值0～10毫米（平均4.3毫米）；下肢长度差异0～12毫米（平均3.5毫米）。末次随访时，髋关节平均活动度：屈曲89.2°（范围80°～100°），伸直1.7°（范围-5°～10°），内旋7.1°（范围0°～15°），外旋20.4°（范围10°～30°），内收7.9°（范围0°～20°），外展16.5°（范围10°～25°）。末次随访时，VAS评分、Harris评分及OHS评分较术前均显著改善（<0.05）。
MAKO机器人手臂辅助下经DAA全髋关节置换术治疗AS合并髋关节骨性融合效果满意，具有假体安装准确、软组织松解充分、术中创伤小等优点。
