机器人辅助与传统方法行全髋关节置换术后下肢长度差异比较

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目的:比较机器人辅助与传统方法行全髋关节置换术(total hip arthroplasty, THA)术后下肢长度差异(leg length discrepancy,LLD)。方法:回顾性分析2019年1月至2020年5月,分别采用机器人辅助和传统方法行THA患者资料,其中机器人辅助行THA组(机器人组)38例(54髋),男18例,女20例;年龄(53.5±13.6)岁;BMI为(26.2±3.4)kg/mn 2;股骨头坏死21例(32髋),CrownⅠ、Ⅱ型先天性髋关节发育不良17例(22髋)。传统方法行THA组(常规组)38例(54髋),男19例,女19例;年龄(52.3±14.7)岁;BMI为(25.7±2.9)kg/mn 2;先天性髋关节发育不良19例(30髋),股骨头坏死19例(24髋)。比较两组的手术时间、术后LLD、Harris评分、关节遗忘评分、术前与术后LLD的差值,同时评价手术方法与髋关节长度变化的相关性。n 结果:机器人组手术时间为(73.3±14.1)min较常规组[(59.3±12.6)min]长,两者比较差异有统计学意义(n t=2.732,n P=0.003)。机器人组术后LLD为(2.3±3.4)mm,小于常规组(6.7±5.4)mm,两者比较差异有统计学意义(n t=3.521,n P5 mm。机器人组术后与术前预计髋关节长度差值为(2.8±2.2)mm,小于常规组(7.9±5.3)mm,两者比较差异有统计学意义(n t=2.357,n P<0.001)。机器人组术中反馈的髋关节长度变化结果与术后测量的髋关节长度具有相关性(n r=0.983,n P<0.001)。末次随访时,机器人组Harris评分和髋关节遗忘评分分别为(83.1±5.3)分和(32.5±4.9)分,常规组为(82.9±7.2)分和(31.9±6.7)分,两组比较差异均无统计学意义(n t=0.221,0.356;n P=0.819,0.731)。机器人组1例术后出现定位点渗血,给予缝合,愈合良好;常规组1例术中发现髋臼后壁骨折,术后避免负重4周,恢复良好。n 结论:机器人辅助THA较常规THA可以精准的恢复双下肢长度,缩小LLD。机器人术中对LLD的实时监控可以准确给予术者参考。“,”Objective:To compare the difference of LLD (leg length discrepancy) between robot-assisted and conventional methods of total hip arthroplasty (THA).Methods:Data of 38 patients who had THA performed by robot-assisted or conventional methods from January 2019 to May 2020 were retrospectively analyzed. There were 38 cases (54 hips) in robot-assisted THA group (robot group) with 18 males and 20 females (age 53.5±13.6 years, BMI 26.2±3.4 kg/mn 2), and there were 21 cases (32 hips) with osteonecrosis of the femoral head, 17 cases (22 hips) with Crown typeⅠandⅡdevelopmental dysplasia of the hip. There were 38 cases (54 hips) in conventional THA group (conventional group), with 19 males and 19 females, (age 52.3±14.7 years old, BMI 25.7±2.9 kg/mn 2), and there were 19 cases (30 hips) with developmental dysplasia of the hip, and 19 cases (24 hips) with osteonecrosis of the femoral head. The operative time, postoperative LLD, Harris score, forgotten joint score-12 (FJS-12) and the difference between preoperative and postoperative LLD between the two groups were compared, and the correlation between surgical methods and the change of hip length was also evaluated.n Results:The operation time of the robot group was 73.3±14.1 min and which was 59.3±12.6 min in conventional THA group (n t=2.732, n P=0.003). In the robot group, the postoperative LLD was 2.3±3.4 mm, which was less than that of the conventional group 6.7±5.4 mm (n t=3.521, n P < 0.001). When the absolute value of LLD was larger than 5 mm as an abnormal value, it was 2.6% (1/38) in the robot group and 47.3% (18/38) in the conventional group. The difference of hip length (HL) in planning and post-operation in the robot group was 2.8±2.2 mm, which was smaller than that in the conventional THA group 7.9±5.3 mm ( n t=2.357, n P < 0.001). In addition, there was a correlation between the change of hip length results and the postoperative measurement of hip length in the robot group ( n r=0.983, n P < 0.001). At the last follow-up, Harris score and FJS-12 were recorded in the robot group and coventional group. The scores were 83.1±5.3 and 32.5±4.9 respectively in the robot group, 82.9±7.2 and 31.9±6.7 in the conventional group, respectively. There was no significant difference between the two groups ( n t=0.221, 0.356; n P=0.819, 0.731). Postoperative bleeding occurred in 1 case in the robot group with postoperative suture healed well. The fracture of the posterior wall of the acetabulum was found in the conventional group and the patient avoids weight bearing 4 weeks after operation. The postoperative recovery was good and no other related complications were found.n Conclusion:Robot-assisted THA can accurately restore the length of both legs and reduce LLD compared with conventional THA. The real-time monitoring of LLD during robot operation can give the operator an accurate reference.
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