膝骨关节炎内翻畸形导航辅助全膝置换术

Robot-assisted total knee arthroplasty for knee osteoarthritis complicated with varus deformity

摘要:

[目的]比较导航辅助与传统技术全膝置换（total knee arthroplasty, TKA）治疗膝骨关节炎内翻畸形的临床疗效。[方法]回顾性分析 2021 年 1 月—2023 年 10 月在本院采用 TKA 术治疗的膝骨关节炎内翻畸形 92 例患者的临床资料。依据术前医患沟通结果，46 例采用导航辅助 TKA 术 （导航组），46 例采用传统 TKA 术 （传统组）。比较两组围术期、随访以及影像资料。[结果]导航组的手术时间显著长于传统组 [(97.2±7.8) min vs (86.7±6.5) min, P＜0.001]，但前者的出血量显著少于后者 [(224.1± 21.8) mL vs (240.2±23.6) mL, P＜0.001]，两组切口长度、首次下床时间、住院时间、切口愈合时间、并发症发生率差异无统计学意义（P＞0.05）。随着时间推移，两组患者 WOMAC 评分、VAS 评分均逐渐降低，HSS 评分、伸-屈 ROM 均逐渐升高（P＜0.05），相应时间点两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，与术前相比，末次随访时两组的 FTA 角显著降低，而 MPTA 角和 PTS 角均增加（P＜0.05）。末次随访时，导航组的 FTA 角显著小于传统组 [(172.7±10.5)° vs (178.4±12.6)°, P＜0.05]，而前者的 MPTA 角显著大于后者 [(87.7±7.4)° vs (78.8±6.5)°, P＜0.001]。[结论] 导航辅助 TKA 术治疗膝骨关节炎内翻畸形能获得与传统 TKA 手术治疗一致的临床疗效，导航辅助手术时间长，但出血量更少，下肢力线矫正效果更佳。

Abstract:

[Objective] To compare the clinical efficacy of robot-assisted total knee arthroplasty (TKA) versus traditional technique TKA for knee osteoarthritis complicated with varus deformity. [Methods] A retrospective study was conducted on 92 patients who received TKA for knee osteoarthritis complicated with varus deformity in our hospital from January 2021 to October 2023. According to preoperative doctor-patient communication, 46 patients received robot-assisted TKA (robot group), while other 46 patients received traditional TKA (traditional group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] Although the robot group consumed significantly longer operative time than the traditional group [(97.2±7.8) min vs (86.7±6.5) min, P＜0.001], the former had significantly less blood loss than the latter group [(224.1±21.8) mL vs [240.2±23.6] mL, P＜0.001]. However, there was no significant difference in incision length, bed rest time, hospital stay, incision healing time and complication rate between the two groups (P＞0.05). The WOMAC score and VAS score were significantly decreased, while HSS score and extension-flexion ROM were significantly increased in both groups over time (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05). Regarding to imaging, the FTA was significantly decreased, while the MPTA and PTS were increased in both groups postoperatively compared with those preoperatively (P＜0.05). At the latest follow-up, the robot group had significantly lesser FTA [(172.7±10.5)° vs (178.4±12.6)°, P＜0.05], while significantly greater MPTA than the traditional group [(87.7±7.4)° vs (78.8±6.5)°, P＜0.001]. [Conclusion] Robot-assisted TKA for knee osteoarthritis complicated with varus deformity achieves the same clinical efficacy as traditional TKA surgery. However, the robot-assisted surgery has longer operation time, less blood loss, and better lower limb alignment correction.