Tang Hai, Zhang Hong-Mei, Shan Peng-Cheng, Hu Pei-Yan, Jing Lin, Yan Qi, Li Yuan-Yuan, Wang Xin-Yue, Liu Si-Ye, He Ming-Jiang
The First Department of Osteoarthropathy, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China.
Zhongguo Gu Shang. 2024 Sep 25;37(9):862-9. doi: 10.12200/j.issn.1003-0034.20240341.
To compare clinical efficacy of robot-assisted (RA) and remote sensing navigation alignment (RSNA) system-assisted total knee arthroplasty (TKA).
From March 2023 to June 2023, 60 patients who underwent the first unilateral TKA due to severe knee osteoarthritis (KOA) were admitted and divided into RSNA group and RA group according to different treatment methods, with 30 patients in each group. There were 5 males and 25 females in RSNA group, aged from 56 to 81 years old with an average of(66.33±7.16) years old;body mass index(BMI) ranged from 19.87 to 38.54 kg·m with an average of (28.40±6.18) kg·m;the courses of disease ranged from 5 to 36 months with an average of (18.20±8.98) months; RSNA system was used to assist the positioning of osteotomy. There were 7 males and 23 females in RA group, aged from 55 to 82 years old with an average of (67.83±8.61) years old;BMI ranged from 19.67 to 37.25 kg·m with an average of (28.01±4.89) kg·m; the courses of disease ranged from 3 to 33 months with an average of (17.93±9.20) months;RA was performed. Operation time, incision length, latent blood loss at 2 weeks after operation and incidence of lower extremity thrombosis were compared between two groups. Hip-knee ankle angle (HKAA), HKAA deviation, lateral distal femoral angle ( LDFA), medial proximal tibial angle (MPTA) and posterior tibial slope (PTS) were compared between two groups;Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society score (KSS) were used to evaluate functional recovery before operation, 3 and 6 months after operation.
The operation was performed successfully in both groups, and there were no serious complications such as vascular and nerve injury during operation. The wound healed well at stageⅠafter operation, and the follow-up time was 6 months. The operation time, latent blood loss at 2 weeks after operation and incision length in RSNA group were (94.35±5.75) min, (130.54±17.53) ml and (14.73±2.14) cm, respectively;while (102.57±6.88) min, (146.33±19.47) ml and (16.78±2.32) cm in RA group, respectively. RSNA group was better than RA group (<0.05). No deep vein thrombosis occurred in both groups at 2 weeks after operation, 5 patients occurred intermuscular vein thrombosisin in RSNA group and 8 patients in RA group, the difference was not statistically significant (>0.05). In RSNA group, HKAA, LDFA and MPTA were (173.00±5.54) °, (86.96±3.45) °, (82.79±3.35) ° before operation, and (178.34±1.85) °, (89.92±0.42) °, (89.84±0.73) ° at 1 week after operation, respectively. In RA group, HKAA, LDFA and MPTA were (173.31±6.48) °, (87.15±3.40) ° and (82.99±3.05) ° before operation, and (178.52±1.79) °, (90.03±0.39) ° and (90.15±0.47) ° at 1 week after operation, respectively. HKAA, LDFA and MPTA were significantly improved in both groups at 1 week after operation (<0.05). There were no significant difference in HKAA, LDFA, MPTA and PTS between two groups before operation and 1 week after operation (>0.05). There was no significant difference in deviation distribution of HKAA at 1 week after operation (=2.611, =0.456). There were no significant difference in WOMAC and KSS between two groups before operation, 3 and 6 months after operation (>0.05), and postoperative WOMAC and KSS at 3 and 6 months between two groups were improved compared with those before operation (<0.05).
Both RA and RSNA system assisted TKA could obtain accurate osteotomy, RA has higher surgical accuracy, RSNA system assisted operation has less trauma, and operation is simpler.
比较机器人辅助（RA）与遥感导航定位（RSNA）系统辅助全膝关节置换术（TKA）的临床疗效。
选取2023年3月至2023年6月因重度膝关节骨关节炎（KOA）行初次单侧TKA的患者60例，根据治疗方法不同分为RSNA组和RA组，每组30例。RSNA组男5例，女25例，年龄56～81岁，平均（66.33±7.16）岁；体重指数（BMI）为19.87～38.54 kg·m，平均（28.40±6.18）kg·m；病程5～36个月，平均（18.20±8.98）个月；采用RSNA系统辅助截骨定位。RA组男7例，女23例，年龄55～82岁，平均（67.83±8.61）岁；BMI为19.67～37.25 kg·m，平均（28.01±4.89）kg·m；病程3～33个月，平均（17.93±9.20）个月；采用RA进行手术。比较两组手术时间、切口长度、术后2周隐性失血量及下肢血栓发生率；比较两组髋-膝-踝角（HKAA）、HKAA偏差、股骨远端外侧角（LDFA）、胫骨近端内侧角（MPTA）及胫骨后倾角（PTS）；采用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和膝关节协会评分（KSS）评估术前、术后3个月及6个月的功能恢复情况。
两组手术均顺利完成，术中均未发生血管、神经损伤等严重并发症。术后Ⅰ期伤口愈合良好，随访时间6个月。RSNA组手术时间、术后2周隐性失血量及切口长度分别为（94.35±5.75）min、（130.54±17.53）ml、（14.73±2.14）cm；RA组分别为（102.57±6.88）min、（146.33±19.47）ml、（16.78±2.32）cm。RSNA组优于RA组（P<0.05）。术后2周两组均未发生深静脉血栓形成，RSNA组有5例发生肌间静脉血栓形成，RA组有8例，差异无统计学意义（P>0.05）。RSNA组术前HKAA、LDFA、MPTA分别为（173.00±5.54）°、（86.96±3.45）°、（82.79±3.35）°，术后1周分别为（178.34±1.85）°、（89.92±0.42）°、（89.84±0.73）°。RA组术前HKAA、LDFA、MPTA分别为（173.31±6.48）°、（87.15±3.40）°、（82.99±3.05）°，术后1周分别为（178.52±1.79）°、（90.03±0.39）°、（90.15±0.47）°。两组术后1周HKAA、LDFA、MPTA均较术前明显改善（P<0.05）。术前及术后1周两组HKAA、LDFA、MPTA及PTS比较，差异无统计学意义（P>0.05）。术后1周HKAA偏差分布差异无统计学意义（P=2.611，P=0.456）。两组术前、术后3个月及6个月WOMAC、KSS比较，差异无统计学意义（P>0.05），且两组术后3个月及6个月WOMAC、KSS较术前均改善（P<0.05）。
RA和RSNA系统辅助TKA均能获得准确截骨，RA手术精度更高，RSNA系统辅助手术创伤更小，操作更简单。
