机器人辅助技术在髋臼骨折后全髋关节置换术中的应用研究  

Use of robot-assisted technique in total hip arthroplasty after acetabular fracture

作　　者：张纪[1] 邵宏翊[1] 邓旺 周一新[1] ZHANG Ji;SHAO Hongyi;DENG Wang;ZHOU Yixin(Department of Orthopaedic Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院矫形骨科,北京100035

出　　处：《中华骨与关节外科杂志》2022年第8期598-604,共7页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金(82072457)。

摘　　要：目的:探讨应用机器人辅助技术进行髋臼骨折后全髋关节置换术的早期临床疗效。方法:回顾性分析2019年10月至2021年12月因髋臼骨折接受机器人辅助全髋关节置换术的13例患者的临床资料,其中男9例,女4例,年龄28~73岁,平均(53.6±11.8)岁。记录患者手术时间、总失血量、术后住院天数、术中及术后并发症。记录术中髋臼假体植入后机器人验证测量的髋臼假体外展角、前倾角,并与术前计划值进行比较。通过双下肢全长X线片测量双下肢长度差。通过双髋关节正位X线片测量并比较双侧髋关节旋转中心的垂直距离和水平距离。比较术前和末次随访时Harris髋关节评分。结果:手术时间(137±49)min,失血量(599±227)ml,术后平均住院天数(6.2±1.9)d。1例术中出现股骨骨距劈裂,用一根钢缆环扎。髋臼假体植入后,机器人验证其外展角为40.1°±2.4°,前倾角为17.7°±2.7°,与术前计划40.5°±2.2°、17.5°±2.7°比较,差异无统计学意义(P=0.165、0.687)。与术前相比,术后双下肢长度差改善[(22.7±14.5)mm vs.(4.4±3.5)mm,P<0.001]。术后患侧髋关节旋转中心垂直距离为(22.6±5.0)mm,水平距离为(36.2±3.8)mm,与健侧(20.9±2.7)mm、(35.7±3.3)mm比较,差异无统计学意义(P=0.187、0.736)。本研究患者随访6~31个月,平均(17.0±8.1)个月。术前Harris髋关节评分(53.1±13.3)分,末次随访时Harris髋关节评分(90.5±8.0)分,与术前比较,末次随访时Harris髋关节评分明显改善(P<0.001)。所有患者未发现髋臼或股骨假体松动表现,未出现与手术相关的骨折、脱位、感染、深静脉血栓相关疾病等并发症。结论:应用机器人辅助技术进行髋臼骨折后全髋关节置换术可以获得良好的早期临床疗效,且可以准确地重建髋关节旋转中心。Objective: To explore short-term clinical outcomes of the robot-assisted total hip arthroplasty(RTHA) after acetabular fracture. Methods: From October 2019 and December 2021, 13 patients after acetabular fracture were treated with RTHA. There were 9males and 4 females, with an average age of(53.6±11.8) years(range, 28-73 years). The operation time, volume of blood loss, postoperative hospital stay, and complications during and after the operation were recorded. The intraoperative inclination angle and anteversion angle of the acetabular component were documented and compared with the planned values. The leg length discrepancy(LLD) was measured on the total lower-limb X-ray photography. The vertical and horizontal distances of the center of rotation(COR) were measured on the anteroposterior pelvis view radiographs, and compared with the values of the contralateral side. The postoperative and preoperative Harris hip scores(HHS) were recorded and compared. Results:The operation time was(137±49) minutes, the blood loss was(599±227) ml, and the postoperative hospital stay was(6.2±1.9) days. Calcar crack occurred in 1 patient, and was treated with cerclage. The inclination and anteversion angles were 40.1°±2.4° and 17.7°±2.7°, respectively, which had no significant differences with the planned values(40.5°±2.2°, 17.5°±2.7°;P=0.165, 0.687). The postoperative LLD was(4.4±3.5) mm, which was significant smaller compared to preoperative value(22.7±14.5) mm(P<0.001). The vertical and horizontal distances of COR were(22.6±5.0) mm and(36.2±3.8) mm,respectively, which had no significant differences with the contralateral side(20.9±2.7) mm,(35.7±3.3) mm(P=0.187, 0.736). The average duration of follow-up was(17.0±8.1) months. The HHS was 90.5±8.0 at the final follow-up, which was significant higher than the preoperative value(53.1±13.3, P<0.001). No aseptic loosening of acetabular or femoral components was observed at the final followup. No complication such as fracture, dislocation, infection, and deep v

关 键 词：全髋关节置换术 机器人 髋臼骨折 

分 类 号：R687.4[医药卫生—骨科学]