机器人辅助与常规全膝关节置换的比较△

Comparison of robot-assisted and conventional total knee arthroplasty

摘要:

[目的] 比较机器人辅助全膝关节置换术 （robotic-assited total knee arthroplasty, RA-TKA） 与常规膝关节置换术 （conventional total knee arthroplasty, C-TKA）的假体安放位置及短期临床疗效。[方法]回顾性分析 2023 年 2 月—2023 年 10 月 43 例行 TKA 手术患者的临床资料，根据医患沟通结果，将患者分为 RA-TKA 组 21 例，C-TKA 组 22 例。比较两组围手术期、 随访及影像学资料。[结果]所有患者均顺利完成手术，RA-TKA 组手术时间 [(99.8±15.2) min vs (82.4±11.5) min, P＜0.001]、切口总长度 [(13.1±1.1) cm vs (12.3±0.7) cm, P=0.011] 均显著长于 C-TKA 组。平均随访时间 （15.2±2.4） 个月。与术前相比，两组患者末次随访时 VAS、HSS、KSS、WOMAC 评分及膝伸屈 ROM 均显著改善 （P＜0.05），两组术前及末次随访时上述指标的差异均无统计学意义（P＞0.05）。影像方面，RA-TKA 组术后即刻及末次随访时，髋-膝-踝角（hip-knee-ankle angle, HKA）[(178.1± 1.3)° vs (176.1±2.3)°, P＜0.001; (178.2±0.9)° vs (177.0±2.3)°, P=0.023]、矢状面胫骨组件角 （lateral tibia component, LTC） [(87.9± 1.1)° vs (89.2±1.8)°, P=0.009; (88.0±0.9)° vs (89.1±1.6)°, P=0.006] 均显著优于 C-TKA 组，而两组冠状面股骨组件角 （frontal femo- ral component, FFC）、矢状面股骨组件角 （lateral femoral component, LFC）、冠状面胫骨组件角 （frontal tibia component, FTC） 比较的差异均无统计学意义（P＞0.05）。[结论]RA-TKA 术后具有更好的下肢机械轴、更精准的截骨及假体植入位置，与 C-TKA 相比，短期临床疗效并无差异。

Abstract:

[Objective] To compare the clinical consequences of robot-assisted total knee arthroplasty (RA-TKA) versus conventional total knee arthroplasty (C-TKA). [Methods] A retrospective study was conducted on 43 patients who received TKA from February 2023 to October 2023. According to the doctor-patient communication, 21 patients underwent RA-TKA, while other 22 patients received C-TKA. The documents regarding perioperative period, follow-up and imaging were compared between two groups. [Results] All patients in both groups had TKA performed successfully. The RA-TKA group proved significantly greater than the C-TKA group in terms of operative time [(99.8±15.2) min vs (82.4±11.5) min, P＜0.001] and the total incision length [(13.1±1.1) cm vs (12.3±0.7) cm, P=0.011]. All patients in both groups were followed up for (15.2±2.4) months in a mean. The VAS, HSS, KSS, WOMAC scores and knee extension-flexor ROM were significantly improved in both groups at the last follow-up compared with those before surgery (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05). As for imaging, the RA-TKA proved significantly superior to the CTKA in terms of hip-knee-ankle angle (HKA) [(178.1±1.3)° vs (176.1±2.3)°, P＜0.001; (178.2±0.9)° vs (177.0±2.3)°, P=0.023], lateral tibia component (LTC) [(87.9±1.1)° vs (89.2±1.8)°, P=0.009; (88.0±0.9)° vs (89.1±1.6)°, P=0.006] immediately after surgery and at the last follow-up. However, there were no significant differences in frontal femoral component (FFC), lateral femoral component (LFC), and frontal tibia component (FTC) between the two group postoperatively (P＞0.05). [Conclusion] The RA-TKA has better lower limb alignment, more accurate osteotomy and implant position after operation, regardless of that no difference in short-term clinical efficacy is found compared with C-TKA.