机器人辅助下膝关节单髁置换术初步临床结果  

Preliminary clinical results of robotic-assisted unicompartmental knee arthroplasty

作　　者：王俏杰[1] 柴伟[2] 王琦[1] 陈云苏[1] 沈灏[1] 彭晓春[1] 倪明[2] 付君[2] 陈继营[2] 张先龙[1] Wang Qiaojie Chai Wei Wang Qi Chen Yunsu Shen Hao Peng Xiaochun Ni Ming Fu Jun Chen Jiying Zhang Xianlong(Division of Adult Reconstruction, Department of Orthopaedic Surgery, Shanghai 6th People＇s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, Chin Division of Adult Reconstruction, Department of Orthopaedic Surgery, Chinese People＇s Liberation Army General Hospital, Beijing 100853, Chin)

机构地区：[1]上海交通大学附属第六人民医院骨科关节外科,200233 [2]解放军总医院骨科关节外科

出　　处：《中华解剖与临床杂志》2017年第2期108-115,共8页Chinese Journal of Anatomy and Clinics

摘　　要：目的 探讨机器人辅助下膝关节单髁置换术（UKA）能否提高手术的精准性,以及其安全性和短期疗效.方法 对2016年9-12月在上海交通大学附属第六人民医院和解放军总医院骨科关节外科接受机器人辅助下UKA治疗的20例患者临床资料进行回顾性分析.术前诊断均为膝关节骨关节炎,每家医院各10例患者;男3例,女17例;年龄51~79岁,平均65岁;BMI（26.9±3.4） kg/m2.均采用MAKO RIO机器人手术系统和RESTORIS MCK单髁膝关节假体（STRYKER MAKO Surgical,美国）进行手术,其中有5例患者同时接受双侧UKA.记录手术时间及出血量、术后疼痛情况,测量术前及术后下肢力线、术后胫骨假体植入角度,术前和术后进行膝关节功能评分.结果 单侧UKA手术术中止血带使用时间平均为（27±10） min.15例单侧单髁置换患者术后第2天时总失血量平均为（476±290）mL,无一例患者需要接受输血治疗.术后8、16和24 h VAS评分平均分别为（3.2±1.2）分、（1.8±0.8）分和（1.1±0.3）分.20例（25膝）患者均获得随访,随访时间为8~20周,平均14.1周.末次随访时,患侧膝关节的美国膝关节协会评分临床评分由术前的（57±13）分提高至（90±6）分,功能评分由术前的（48±18）分提高至（79±12）分,差异均有统计学意义（t=14.941、10.014,P值均〈0.01）;胫骨假体冠状位的植入角度为内翻0°~3.9°,平均1.7°±1.2°,与术前计划的目标角度（内翻1°）偏差0°~3°,平均为1.1°±0.9°.2家医院两组病例胫骨假体冠状位角度与目标位置的偏差分别为1.2°±1.1°和1.0°±0.6°,差异无统计学意义（t=0.421, P〉0.05）.随访期间所有病例均未观察到手术部位感染、深静脉血栓形成以及血管神经损伤等手术相关的并发症.结论 机器人辅助下UKA能够实现微创条件下的精准手术,并具有优异的安全性;其远期临床效果及对膝关节功能改善的作用,尚需进一步的对照研究和长�Objective To investigate the accuracy of robotic-assisted UKA and its safety and short term functional outcomes.Methods The clinical data of 20 patients who received robotic-assisted UKA in Shanghai 6th People＇s Hospital and Chinese PLA General Hospital from September 2016 to December 2016 were retrospectively reviewed, with 10 patients in each hospital.All patients had a preoperative diagnosis of osteoarthritis.Five patients received simultaneous bilateral UKA.Of all the 20 patients, there were 3 male patients and 17 female patients, with an average age of 65 years old （range from 51 to 79 years old） and an average BMI of （26.9±3.4） kg/m2.All the procedures were performed with MAKO RIO robotic-assisted surgical system and RESTORIS MCK unicompartmental knee prosthesis （STRYKER MAKO Surgical, USA）.Each patient＇s operation time, blood loss and post-operative pain scores were recorded.Pre-operative and post-operative knee society scores were recorded;lower limb alignment and the position of the tibial component in coronal plane were measured.Results For patients who received unilateral procedure, the mean operating time of tourniquet was （27±10） minutes.The average total blood loss on post-op day 2 was （476±290） mL, and no transfusion was needed for any patient.The mean visual analogue scale pain score at 8, 16 and 24 hours after surgery was 3.2±1.2, 1.8±0.8 and 1.1±0.3, respectively.All 20 patients （25 knees） were followed-up at a minimal time of 8 weeks （average 14.1 weeks, range from 8 to 20 weeks）.On latest follow-up visit, the mean Knee Society Score was improved from a pre-operative value of 57±13 to 90±6, the mean function score was improved from a preoperative value of 48±18 to 79±12, both changes were statistically significant （t=14.941 and 10.014 respectively, all P values〈0.01）.The position of the tibial component relative to the mechanical axis of the tibial in coronal plane was at a mean varus of 1.7°±1.2°（range, 0°-3.9°）, the mean deviation from

关 键 词：骨关节炎 膝 关节成形术 置换 膝 膝关节单髁置换术 机器人手术 

分 类 号：R687.4[医药卫生—骨科学] TP242[医药卫生—外科学]