Early results of ARTHROBOT robot-assisted total hip arthroplasty
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[目的]比较机器人ARTHROBOT辅助全髋置换术(robot-assisted total hip arthroplasty,rTHA)与传统手工全髋置换术(manual total hip arthroplasty,mTHA)的早期效果.[方法]回顾性分析2022年4月-2022年11月本院行THA的58例患者的临床资料.根据术前医患沟通结果,28例采用rTHA,另外30例采用mTHA,对比两组围手术期、随访及影像学资料.[结果]两组患者均手术顺利,未见术中并发症.rTHA组手术时间、切口总长度、治疗费用均显著大于mTHA组(P＜0.05).rTHA组术后无脱位者,而mTHA组1例因假体位置不良,脱位,行翻修术.随时间推移,两组患者VAS评分、Harris评分、髋伸-屈及内-外旋ROM均显著改善(P＜0.05).rTHA组Harris评分术后1个月[(70.8±3.3)vs(68.2±5.1),P=0.043]、末次随访时[(92.0±3.6)vs(89.7±4.2),P=0.025]及术后 6 个月髋内-外旋 ROM[(48.5±5.9)° vs(44.1±6.6)°,P=0.009]均显著优于 mTHA 组.影像方面,rTHA 组术后双下肢长度差(leglength discrepancy,LLD)[(0.4±0.2)mm vs(0.6±0.3)mm,P=0.003]、双侧股骨偏心距(femo-ral offset deviation,FOD)差值[(0.3±0.2)mm vs(0.7±0.5)mm,P＜0.001]、双侧髋臼偏心距(acetabular offset deviation,AOD)差值[(0.3±0.2)mm vs(0.5±0.3)mm,P=0.004]和联合偏心距(combined offset deviation,COD)差值[(0.4±0.4)mm vs(0.8±0.6)mm,P＜0.001]均显著小于 mTHA 组,而两组髋臼外展角(acetabular abduction angle,AAA)和髋臼前倾角(acetabular anteversion,AA)差异无统计学意义(P＞0.05).以Lewinnek安全区为标准,rTHA组安全区内病例数占比[例(％),26(92.9)vs 21(70.0),P=0.026]显著高于mTHA组(P＜0.05).[结论]机器人ARTHROBOT辅助THA使假体置入更精准,髋臼杯置入安全区的比例更高,能更好恢复患髋偏心距,有利于减少LLD,疗效更佳.
[Objective]To compare the early clinical outcomes of robot-assisted total hip arthroplasty(rTHA)with manual total hip ar-throplasty(mTHA).[Methods]A retrospective research was performed on 58 patients who underwent THA in our hospital from April 2022 to November 2022.According to preoperative doctor-patient communication,28 patients underwent the rTHA,while other 30 patients had the conventional mTHA performed.The perioperative period,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups had corresponding THA conducted successfully,with no intraoperative complications.The rTHA consumed signifi-cantly longer operation time,with significantly greater total incision length and treatment cost than those of the mTHA group(P＜0.05).How-ever,no postoperative dislocation happened in the rTHA group,while 1 case in the mTHA group underwent revision for dislocation due to poor placement of the prosthesis.The VAS score,Harris score,hip extension-flexion and internal-external rotation(ROM)were significant-ly improved in both groups over time(P＜0.05).The rTHA group proved significantly superior to the mTHA group in terms of Harris score 1 month after operation[(70.8±3.3)vs(68.2±5.1),P=0.043]and at the last follow-up[(92.0±3.6)vs(89.7±4.2),P=0.025],as well as internal-external rotation ROM 6 months postoperatively[(48.5±5.9)° vs(44.1±6.6)°,P=0.009].With respect of imaging,the rTHA group was signifi-cantly better than the mTHA in terms of leg length discrepancy(LLD)[(0.4±0.2)mm vs(0.6±0.3)mm,P=0.003],bilateral difference of fem-oral offset deviation(FOD)[(0.3±0.2)mm vs(0.7±0.5)mm,P＜0.001],bilateral difference of acetabular offset deviation(AOD)[(0.3±0.2)mm vs(0.5±0.3)mm,P=0.004],and bilateral difference of combined offset deviation(COD)[(0.4±0.4)mm vs(0.8±0.6)mm,P＜0.001],de-spite of that there was no significant difference in acetabular abduction angle(AAA)and acetabular anteversion(AA)between the two groups(P＞0.05).Taking Lewinnek safe zone as the standard,the rTHA group was also significantly superior to the mTHA group[cases(％),26(92.9)vs 21(70.0),P=0.026].[Conclusion]This ARTHROBOT-assisted THA does make the implant placement more accurate,with higher ratio of acetabular cup in the safe zone,which can better restore the off-set of the affected hip,and is conducive to reducing LLD with better curative effect.
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