基于 CT 的锯切机器人系统与无 CT 辅助、导向夹具机器人系统在全膝关节置换术中的对线准确性和临床结果比较。

Comparison of Alignment Accuracy and Clinical Outcomes between a CT-Based, Saw Cutting Robotic System and a CT-Free, Jig-guided Robotic System for Total Knee Arthroplasty.

机构信息

Department of Orthopedics, Peking University Third Hospital, Beijing, China.

Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.

出版信息

Orthop Surg. 2024 May;16(5):1168-1174. doi: 10.1111/os.14055. Epub 2024 Apr 7.

DOI:10.1111/os.14055

PMID:38584130

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11062876/

Abstract

OBJECTIVE

The different cutting mode of robot-assisted TKAs may influence the accuracy of alignment. The purpose of this study was to compare alignment accuracy and early clinical outcomes between a CT-based, saw cutting robotic system (MAKO) and a CT-free, jig-guided robotic system (ROSA) for total knee arthroplasty (TKA).

METHODS

A total of 20 MAKO TKAs and 20 ROSA TKAs from June 2021 to June 2022 were retrospectively analyzed. Differences in the postoperative hip-knee-ankle (HKA) angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior tibial slope (PTS) and 3° outlier frequency of the HKA, LDFA, MPTA and PTS were studied at 3 months and 1 year of follow-up. The operative time and total blood loss (TBL) were compared between these two groups. Clinical outcomes at 1 year after surgery, including range of motion (ROM), Western Ontario McMaster University Osteoarthritis Index (WOMAC) score, and Knee Society Score-2011 (KSS-2011), were also compared between these two groups.

RESULTS

The baseline characteristics of the two groups were comparable. There were no significant differences in the mean deviations of postoperative HKA, LDFA, MPTA or PTS between the two groups at 3 months or 1 year (all ps > 0.05). Moreover, there was no significant difference in the percentage of 3° outliers for HKA, LDFA, MPTA, or PTS between the two groups at 3-month or 1-year follow-up (all ps > 0.05). The mean operation time of MAKO was longer than that of ROSA (112.7 ± 12.8 min vs 94.8 ± 23.0 min, p = 0.001), but the mean TBL (1356.7 ± 648.5 mL vs 1384.5 ± 676.3 mL) and transfusion rate (15.0% vs 5.0%) were not significantly different between the two groups (all ps > 0.05). No significant differences were found in postoperative ROM, WOMAC score or KSS score at 1 year (all ps > 0.05).

CONCLUSION

The MAKO and ROSA had similar accuracy and precision in TKA alignment. The clinical outcomes at 1 year after surgery were also comparable.

摘要

目的

机器人辅助全膝关节置换术（TKA）的不同截骨方式可能会影响关节对线的准确性。本研究旨在比较基于 CT 的锯切机器人系统（MAKO）和无 CT 的导向夹具机器人系统（ROSA）在 TKA 中的对线准确性和早期临床结果。

方法

回顾性分析 2021 年 6 月至 2022 年 6 月间接受 MAKO TKA 和 ROSA TKA 的 20 例患者。研究术后 3 个月和 1 年随访时髋关节-膝关节-踝关节（HKA）角、外侧远端股骨角（LDFA）、内侧近端胫骨角（MPTA）、后胫骨倾斜角（PTS）以及 HKA、LDFA、MPTA 和 PTS 的 3°离群值的差异。比较两组患者的手术时间和总失血量（TBL）。术后 1 年时比较两组患者的临床结果，包括膝关节活动度（ROM）、西部安大略省麦克马斯特大学骨关节炎指数（WOMAC）评分和膝关节学会评分 2011 版（KSS-2011）。

结果

两组患者的基线特征具有可比性。术后 3 个月和 1 年时，两组患者的 HKA、LDFA、MPTA 或 PTS 的平均偏差均无显著差异（均 P＞0.05）。此外，两组患者术后 3 个月和 1 年随访时 HKA、LDFA、MPTA 或 PTS 的 3°离群值比例也无显著差异（均 P＞0.05）。MAKO 的平均手术时间长于 ROSA（112.7±12.8 min 比 94.8±23.0 min，P=0.001），但平均 TBL（1356.7±648.5 mL 比 1384.5±676.3 mL）和输血率（15.0%比 5.0%）差异无统计学意义（均 P＞0.05）。两组患者术后 1 年时的 ROM、WOMAC 评分或 KSS 评分均无显著差异（均 P＞0.05）。