机器人导航髓芯减压联合腓骨移植治疗早期股骨头坏死疗效观察  

Effect of robot-navigation-assisted core decompression combined with fibula grafting on early osteonecrosis of the femoral head

作　　者：曹志明 彭强 李晓彬 范磊 蔡腾 高强 乔钰双 刘涛 CAO Zhiming;PENG Qiang;LI Xiaobin;FAN Lei;CAI Teng;GAO Qiang;QIAO Yushuang;LIU Tao(Xintiang Medical University,Xinriang,Henan 453000,China;Department of Orthopaedics,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450o03,China)

机构地区：[1]新乡医学院,河南新乡453000 [2]河南省人民医院郑州大学人民医院骨科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2024年第5期503-507,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省科技攻关计划项目(232102310105)。

摘　　要：目的 比较早期股骨头坏死患者行传统髓芯减压联合腓骨移植、机器人导航髓芯减压联合腓骨移植保髋治疗的效果和安全性。方法 2021年1月—2022年12月河南省人民医院行髓芯减压联合腓骨移植术的早期股骨头坏死患者52例(52髋),行机器人导航手术者23例为机器人组,行传统手术者29例为对照组。比较2组性别、年龄、体质量指数、病程、病因、Ficat分期、手术时间、一次置针成功率、术中出血量、X线透视次数;分别于术前及术后1年行髋关节Harris评分评价髋关节功能,行视觉模拟评分(VAS)评价疼痛程度;记录术后感染、下肢静脉血栓、股骨颈骨折、股骨头塌陷等并发症发生情况;比较2组术后1年优良率。结果 (1)2组性别比例、年龄、体质量指数、病程、病因、Ficat分期比较差异均无统计学意义(P>0.05)。(2)机器人组手术时间[(38.17±7.39)min]短于对照组[(55.83±10.66)min](t=-6.754,P<0.001),术中出血量[(47.78±8.06)mL]、X线透视次数[(8.09±1.35)次]少于对照组[(71.31±8.97)mL、(13.76±2.68)次](t=-9.817,P<0.001;t=-9.250,P<0.001),一次置针成功率(100.00%)高于对照组(31.03%)(χ^(2)=25.776,P<0.001)。(3)机器人组术前髋关节Harris评分[(67.13±4.34)分]、VAS[4.0(4.0,5.0)分]与对照组[(67.38±3.59)、4.0(3.5,4.0)分]比较差异均无统计学意义(t=-0.226,P=0.822;U=-0.843,P=0.399)。机器人组、对照组术后1年髋关节Harris评分[(85.35±3.76)、(82.93±3.40)分]均高于术前(t=-4.215,P<0.001;t=-4.744,P<0.001)、VAS[1.0(0,1.0)、1.0(0,1.0)分]均低于术前(Z=-4.290,P<0.001;Z=-4.781,P<0.001);机器人组术后1年髋关节Harris评分高于对照组(t=2.429,P=0.019),VAS与对照组比较差异无统计学意义(U=-0.476,P=0.634)。(4)2组术后均未发生感染、下肢静脉血栓、股骨颈骨折等并发症。术后1年,2组均无行髋关节置换术病例,机器人组均未发生股骨头塌陷,对照组3例发生股骨头塌陷。机器人组术后1年优�Objective To compare the efficacy and safety of traditional core decompression combined with fibula grafting versus robot-navigation-assisted core decompression combined with fibula grafting for hip preservation in patients with early osteonecrosis of the femoral head.Methods From January 2021 to December 2022,52 patients(52 hips)with early osteonecrosis of the femoral head were treated in Henan Provincial People's Hospital,among whom 23 patients underwent robot-navigation-assisted core decompression combined with fibula grafting(robot group),and 29 patients underwent traditional core decompression combined with fibula grafting(control group).The gender,age,body mass index,course of disease,cause of disease,Ficat stage,operative time,success rate at the first attempt of needle insertion,intraoperative blood loss and frequency of X-ray fluoroscopy were compared between two groups.Hip function was evaluated by Harris score before surgery and 12 months after surgery,and pain degree was evaluated by visual analogue scale(VAS).The complications such as postoperative infection,venous thrombosis of lower extremity,femoral neck fracture and femoral head collapse were recorded.The postoperative l-year excellent and good rate was compared between two groups.Results(1)There were no significant differences in the gender ratio,age,body mass index,course of disease,cause of disease and Ficat stage between two groups(P>0.05).(2)The operative time was shorter,the intraoperative blood loss volume was less,the success rate at the first attempt of needle insertion was higher,and the frequency of X-ray fluoroscopy was less in robot group[(38.17±7.39)min,(47.78±8.06)mL,100.00%,8.09±1.35]than that in control group[(55.83±10.66)min,(71.31±8.97)mL,31.03%,13.76±2.68]respectively(t=-6.754,P<0.001;t=-9.817,P<0.001;χ^(2)=25.776,P<0.001;t=-9.250,P<0.001).(3)There wereno significant differences in Harris score and VAS score between robot group[67.13±4.34,4.0(4.0,5.0)] and control group[67.38±3.59,4.0(3.5,4.0)](t=-0.226,P=0.822;U=-0.8

关 键 词：股骨头坏死 腓骨段移植 髓芯减压 机器人导航 

分 类 号：R687.3[医药卫生—骨科学]