基于中国手术系统的机器人辅助全膝关节置换术的学习曲线分析。
Learning curve analysis of robotic-assisted total knee arthroplasty with a Chinese surgical system.
机构信息
Department of Sports Medicine and Joint Surgery, The People's Hospital of Liaoning Province, The People's Hospital of China Medical University, 33 Wenyi Road, Shenyang, 110000, China.
出版信息
J Orthop Surg Res. 2023 Nov 27;18(1):900. doi: 10.1186/s13018-023-04382-4.
PURPOSE
The aim of this study was to analyze the learning curve of total operative time, bone cutting accuracy, and limb alignment in total knee arthroplasty (TKA) using a Chinese image-based knee surgery robot known as HURWA. Additionally, a comparison was conducted with conventional TKA to ascertain the benefits of robotic-assisted TKA.
METHODS
In this retrospective study, we analyzed a series of patients (n = 90) who underwent robotic-assisted total knee arthroplasty using the HURWA robot between December 2021 and October 2022. The procedures were performed by one of three orthopedic surgeons with varying levels of experience. As a control group, we selected the last 30 conventional TKA cases performed by each of these three surgeons. To determine the learning curve, we recorded the operative time, bone cutting error, and pre- and post-surgery radiographs.
RESULTS
The study found no significant differences in total operative time, bone cutting accuracy, or limb alignment among the three surgeons. Of the three surgeons, surgeon 1, who had the most experience in joint arthroplasty, reached the learning curve in case 8, with the shortest bone cutting time and robot time. Surgeon 2 reached the learning curve in case 16, while surgeon 3 reached the learning curve in case 9. There was no observable learning curve effect for bone cutting accuracy and limb alignment. However, the percentage of cases where limb alignment differed from preoperative planning by 3° or less was higher in robotic-assisted TKA (77.97%) than in conventional TKA (47.19%).
CONCLUSION
The study determined that the learning curve for robotic-assisted TKA using the HURWA knee surgery robot ranged from 8 to 20 cases. No observable learning curve effect was detected for bone cutting accuracy or limb alignment. Experienced surgeons using the HURWA robot for bone cutting took less time and reached the learning curve earlier. The HURWA robot achieved better limb alignment without depending on the experience of conventional TKA.
目的
本研究旨在分析使用中国自主研发的基于影像的膝关节手术机器人 HURWA 进行全膝关节置换术（TKA）的总手术时间、截骨精度和肢体对线的学习曲线，并与传统 TKA 进行比较，以确定机器人辅助 TKA 的优势。
方法
本回顾性研究纳入了 2021 年 12 月至 2022 年 10 月期间 90 例接受 HURWA 机器人辅助全膝关节置换术的患者。该手术由三位经验不同的骨科医生之一完成。作为对照组，我们选择了这三位医生最近 30 例常规 TKA 手术。为了确定学习曲线，我们记录了手术时间、截骨误差以及术前和术后的 X 光片。
结果
研究发现，三位医生的总手术时间、截骨精度或肢体对线没有显著差异。在三位医生中，关节置换经验最丰富的医生 1 在第 8 例患者中达到了学习曲线，截骨时间和机器人时间最短。医生 2 在第 16 例患者中达到了学习曲线，而医生 3 在第 9 例患者中达到了学习曲线。截骨精度和肢体对线没有明显的学习曲线效应。然而，机器人辅助 TKA 中肢体对线与术前计划相差 3°或更小的比例（77.97%）高于传统 TKA（47.19%）。
结论
本研究表明，使用 HURWA 膝关节手术机器人进行机器人辅助 TKA 的学习曲线范围为 8 至 20 例。截骨精度或肢体对线没有明显的学习曲线效应。经验丰富的医生使用 HURWA 机器人进行截骨时用时更少，并且更早地达到了学习曲线。HURWA 机器人在不依赖传统 TKA 医生经验的情况下，实现了更好的肢体对线。
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