加速康复下机器人辅助全髋关节置换术与传统全髋关节置换术的早期临床效果比较  

Comparison of short-term efficacy between robot-assisted total hip arthroplasty and that of manual: a prospective study from the perspective of enhanced recovery after surgery

作　　者：王章宇 廖军义 程强[1] 梁熙[1] 胡宁[1] 黄伟[1] WANG Zhangyu;LIAO Junyi;CHENG Qiang;LIANG Xi;HU Ning;HUANG Wei(Department of Orthopaedic Surgery,First Affiliated Hospital of Chongqing Medical University Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院骨科,重庆400016

出　　处：《中华骨与关节外科杂志》2022年第8期584-590,共7页Chinese Journal of Bone and Joint Surgery

基　　金：重庆市适宜技术推广项目(2019jstg017);重庆市卫健委医学科研项目(2022wsjk010);重庆市科卫联合医学科研项目(2022DBXM002)。

摘　　要：目的:比较机器人辅助全髋关节置换术(rTHA)与传统全髋关节置换术(mTHA)的早期临床疗效,评估在加速康复原则下rTHA对患者术后康复的影响。方法:前瞻性分析2020年5月至2020年9月共计46例因继发性/原发性髋骨关节炎、股骨头缺血坏死或者发育性髋关节发育不良(CroweⅠ型和CroweⅡ型)、行初次全髋关节置换术患者的临床资料,其中24例接受rTHA,22例接受mTHA。所有患者都按照本中心加速康复外科(ERAS)方案进行管理。观察并记录患者手术前后的Harris髋关节评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)和疼痛模拟评分(VAS)用于评估围手术期和短期随访(12周)中的预后情况。同时记录患者的手术时间、住院时间、失血量(包括隐性失血量和显性失血量)、炎症因子、营养标志物、术前和术后影像学资料。结果:mTHA组1例患者在术后48 h内发生一次脱位,其余患者在术后12周内均未发生脱位。r THA组的手术时间明显长于mTHA组(P<0.01),rTHA组术后第6周Harris髋关节评分明显高于mTHA组(P<0.01),r THA组的髋臼杯前倾角与mTHA相比差异有统计学意义(P<0.01),rTHA组和m THA组的髋臼杯位置位于“Lewinnek安全区”内的概率分别为95.8%和50.0%(P<0.01)。两组患者VAS评分、髋臼杯外展角、炎症指标、营养指标、失血量、住院时间比较,差异均无统计学意义。结论:机器人辅助全髋关节置换术使髋臼假体位置更加精准。尽管rTHA较mTHA手术时间更长,但并不会影响患者的早期快速康复,仍需要对患者进行长期的术后随访以进一步讨论髋关节的功能情况及并发症发生率。Objective: To explore the short-term efficacy of robot-assisted total hip arthroplasty(rTHA) comparing with manual total hip arthroplasty(mTHA) and assess the effect of rTHA on postoperative rehabilitation under the enhanced recovery after surgery(ERAS) strategies. Methods: Totally 46 patients undergoing primary total hip arthroplasty in our hospital from May 2020 to September2020 due to secondary/primary hip osteoarthritis, avascular necrosis of the femoral head or developmental hip dysplasia(Crowe Ⅰ andⅡ) were enrolled in this prospective study including 24 patients receiving rTHA and 22 patients receiving mTHA. All patients were followed with ERAS protocols. Harris hip score, WOMAC score and visual analogue scale(VAS) before and after operation were used for evaluating the functional recovery. Operation time, hospitalization time, blood loss(including hidden blood loss and dominate blood loss), inflammatory indicators, nutritional markers and imaging data were recorded. Results: Except for one patient in mTHA group, no patients were reported dislocation within the follow-up time of three months. The operation time was longer and the Harris score at 6 weeks after operation was higher in rTHA group than in m THA group(P<0.01). There was significant difference in acetabular cup anteversion between the two groups(P<0.01). There were 95.8% in rTHA group and 50.0% in mTHA group with acetabular cup locating within the Lewinnek safe zone(P<0.01). No statistical difference was found in VAS, abduction angle of acetabular cup, inflammatory indicators, nutritional markers, blood loss and length of hospital stay between the two groups. Conclusions: Robot-assisted THA has better cup positioning. Although longer operation time was taken in rTHA group compared with mTHA group, it does not affect the early faster recovery of patients followed with ERAS protocols. Long-term follow-up should be carried out to further explore hip function and complication rate.

关 键 词：机器人 全髋关节置换术 加速康复外科 

分 类 号：R687.4[医药卫生—骨科学]