Sanchez-Sotelo Joaquin
Division of Shoulder and Elbow Surgery, Department of Orthepedic Surgery, Mayo Clinic, Rochester, MN, USA.
JSES Int. 2025 Mar 12;9(3):974-980. doi: 10.1016/j.jseint.2025.02.004. eCollection 2025 May.
Robotic assistance has demonstrated to provide value in the field of hip and knee arthroplasty. As a result, it is becoming increasingly popular. On the contrary, robot-assisted shoulder arthroplasty is in its infancy. The various commercially available robots for arthroplasty applications are quite different regarding the features they provide. For shoulder arthroplasty, the Rosa system is already available to selected users, and the Mako system will be available soon. Rosa is considered a collaborative robot that positions cutting guides and reamers as a combined effort between the robot and the surgeon; once the desired position of the guide or reamer is achieved, the robot enters static mode, and the surgeon performs the humerus osteotomy or reams the glenoid in collaboration with the robot; currently, augment preparation is not provided. Mako provides an effector end that prepares bone and uses haptic boundaries to avoid error; details on the Mako shoulder application have not been released. The main theoretical benefits of robot-assisted shoulder arthroplasty include accuracy and precision, data acquisition, and with certain robots, the promise to avoid soft-tissue injury with haptic boundaries, prepare a bone through minimally invasive or cuff-preserving exposures, and the potential for motion assessment and soft-tissue balance. The disadvantages include cost, a certain learning curve, complications related to array insertion, potential for cognitive bias, need for a larger operating room space, and the potential for malfunction. Although adoption is likely to happen in many centers, cost and space constrains may favor alternative technologies, such as mixed reality navigation, especially in ambulatory surgery centers.
机器人辅助已证明在髋关节和膝关节置换领域具有价值。因此,它越来越受欢迎。相反,机器人辅助肩关节置换术仍处于起步阶段。各种用于关节置换应用的市售机器人在其所提供的功能方面有很大不同。对于肩关节置换术,Rosa系统已可供选定用户使用,Mako系统也即将推出。Rosa被认为是一种协作机器人,它通过机器人与外科医生的共同努力来定位切割导向器和扩孔钻;一旦导向器或扩孔钻达到所需位置,机器人进入静态模式,外科医生与机器人协作进行肱骨截骨或扩锉关节盂;目前,不提供增强准备功能。Mako提供一个可准备骨骼并利用触觉边界避免误差的效应器末端;Mako肩关节应用的详细信息尚未公布。机器人辅助肩关节置换术的主要理论优势包括准确性和精确性、数据采集,以及对于某些机器人而言,有望通过触觉边界避免软组织损伤、通过微创或保留袖套的暴露方式准备骨骼,以及进行运动评估和软组织平衡的潜力。其缺点包括成本、一定的学习曲线、与阵列插入相关的并发症、认知偏差的可能性、需要更大的手术室空间以及故障的可能性。尽管许多中心可能会采用,但成本和空间限制可能更倾向于采用替代技术,如混合现实导航,尤其是在门诊手术中心。
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