机器人辅助全膝关节置换术流程优化及学习曲线研究  

Workflow optimization for robot-assisted total knee arthroplasty and learning curve

作　　者：赵晶 余沐洋 彭慧明[3] 陈俊杰 王英杰[3] 王惠珍 翁习生[3] 冯宾[3] ZHAO Jing;YU Muyang;PENG Huiming;CHEN Junjie;WANG Yingjie;WANG Huizhen;WENG Xisheng;FENG Bin(Operation Room,Peking Union Medical College Hospital,Chinese Academy of Medical Science&Peking Union Medical College,Beijing 100730;Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100730;Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Science&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院手术室,北京100730 [2]中国医学科学院,北京协和医学院,北京100730 [3]中国医学科学院,北京协和医学院,北京协和医院骨科,北京100730

出　　处：《中华骨与关节外科杂志》2023年第4期333-339,共7页Chinese Journal of Bone and Joint Surgery

基　　金：北京协和医院临床高水平医院临床科研业务费资助(2022-PUMCH-A-124);中国医学科学院医学与健康科技创新工程项目(2022-I2M-C&T-B-031)。

摘　　要：目的:介绍使用MAKO机器人辅助全膝关节置换术(RTKA)操作的优化流程,并分析采用该手术流程进行手术的学习曲线。方法:回顾性分析2021年8月至12月行MAKO RTKA的31例患者资料,其中1例因术中机械臂出现注册系统错误改为手动手术而剔除,其余30例引入提高手术室使用效率的优化流程,采用重叠操作的原则,逐步介绍手术操作具体流程。按手术时间顺序,每10个病例分为一组,统计三组止血带使用时间差异,比较术中股骨远端、胫骨近端截骨,股骨及胫骨冠状面夹角,股骨外旋角及胫骨后倾角差异。比较术前、术后髋膝踝角(HKA)。采用累积求和分析法(CUSUM)绘制RTKA学习曲线。结果:采用优化流程成功完成30例RTKA。三组止血带使用时间分别为(104.4±10.3)min,(87.3±5.6)min,(77.3±4.1)min,止血带使用时间差异有统计学意义(P<0.05)。三组术中股骨远端、胫骨近端截骨,股骨及胫骨冠状面夹角,股骨外旋角及胫骨后倾角比较差异无统计学意义(P>0.05)。HKA由术前7.9°±5.9°,改善为术后1.6°±1.5°。CUSUM结果显示,经过11例手术后度过学习曲线。结论:优化的RTKA流程可提高手术效率、缩短手术时间。MAKO RTKA需要经历11台手术的学习曲线。学习曲线会影响手术时间,但不影响术后疗效及恢复。Objective:To introduce the optimization of workflow for the MAKO robot-assisted total knee arthroplasty(RTKA),and to evaluate the learning curve of the RTKA operation.Methods:Patients who underwent MAKO RTKA from August to December 2021 were retrospectively reviewed.The optimized workflow was introduced to improve the operation efficiency.The principle of overlapping procedures was adopted and the procedures were introduced step by step.The patients were divided into three groups for every consecutive 10 patients.The tourniquet time was analyzed.Intraoperative distal femoral and proximal tibial cut,femoral and tibial coronal angle,femoral external rotation angle and tibial slope angle were compared among three groups.The hip-knee-ankle(HKA)before and after operation were compared.The learning curve was analyzed by cumulative summation(CUSUM).Results:Totally 30 patients successfully finished with RTKA.The tourniquet time of the three groups were(104.4±10.3)min,(87.3±5.6)min and(77.3±4.1)min respectively with significant difference among three groups(P<0.05).There was no significant difference among the three groups in terms of intraoperative distal femoral and proximal tibial cut,the femoral and tibial coronal angle,femoral external rotation angle and tibial slope angle.HKA was improved from 7.9°±5.9°before operation to 1.6°±1.5°after operation.CUSUM method was used to analyze the learning curve and found that the learning curve was finished after 11 patients.Conclusions:The optimized workflow of RTKA can improve the operation efficiency and shorten the operation time.MAKO RTKA requires a learning curve of 11 cases.The learning curve will affect the operation time,but will not affect the postoperative efficacy.

关 键 词：机器人 全膝关节置换术 手术流程 学习曲线 

分 类 号：R687.4[医药卫生—骨科学]