文献类型：期刊文献

中文题名：机器人辅助全膝关节置换术治疗膝骨关节炎内翻畸形的早期疗效

英文题名：Early impact of robot-assisted total knee arthroplasty on the treatment of varus knee arthritis

作者：杨鑫[1];程晴灏[2];张富强[2];樊华[1];张福康[1];张壮壮[1];杨永泽[1];张安任[1];郭洪章[2]

第一作者：杨鑫

机构：[1]甘肃中医药大学第一临床医学院甘肃省人民医院,甘肃兰州730000;[2]甘肃省人民医院骨科四病区,甘肃兰州730000

第一机构：甘肃中医药大学临床医学院

年份：2025

卷号：38

期号：4

起止页码：343

中文期刊名：中国骨伤

外文期刊名：China Journal of Orthopaedics and Traumatology

基金：甘肃省自然科学基金(编号:20JR10RA358);兰州市科技厅项目(编号:2023-2-101)。

语种：中文

中文关键词：机器人;全膝关节置换术;膝骨关节炎;内翻畸形

外文关键词：Robot;Total knee arthroplasty;Knee osteoarthritis;Varus deformity

摘要：目的:探讨机器人辅助人工全膝关节置换术(total knee arthroplasty,TKA)治疗膝骨关节炎(knee osteoarthris,KOA)内翻畸形患者的临床疗效及优势。方法:回顾性分析2022年10月至2023年6月,行TKA治疗59例重度KOA导致膝关节内翻畸形患者的临床资料,年龄59~81(70.90±4.63)岁;男19例,女40例;按手术方式不同分为机器人组和传统组。机器人组28例,男8例,女20例,年龄(70.54±4.80)岁,病程(14.89±8.72)个月;传统组31例,男11例,女20例,年龄(71.39±4.50)岁,病程(12.32±6.73)个月。记录两组并发症发生情况,手术时间、术中出血量、术后下床时间。并比较两组手术前后膝关节活动度、美国膝关节协会评分(Knee Society scores,KSS),疼痛视觉模拟评分(visual analogue scale,VAS)评估患者疼痛。观察比较两组手术前后的髋-膝-踝角(hip-knee-ankle angle,HKA)、股骨远端外侧角(lateral distal femoral angle,LDFA)、胫骨近端内侧角(medial proximal tibial angle,MPTA),术后6个月胫骨平台后倾角(lateral tibia component,LTC)、冠状面胫骨组件角(frontal tibia component,FTC)、冠状面股骨组件角(frontal femoral component,FFC)、矢状面股骨组件角(lateral femoral component,LFC)。结果:所有患者伤口Ⅰ期愈合,无并发症发生;所有患者获得随访,时间6~8(6.5±1.5)个月。术前两组影像学(HKA、LDFA、MPTA)评价指标、膝关节活动度、VAS、KSS比较,差异均无统计学意义(P>0.05)。机器人组和传统组手术时间[(109.11±7.16)min vs.(83.90±7.85)min]、切口长度[(16.60±2.33)cm vs.(14.47±1.41)cm]、术中出血量[(106.93±6.15)ml vs.(147.97±7.62)ml]、术后下床时间[(17.86±1.84)h vs.(21.77±2.68)h]及术后6个月的FFC[(88.96±0.84)°vs.(87.93±1.09)°]、LFC[(88.57±1.10)°vs.(87.16±1.21)°]比较,差异有统计学意义(P<0.05)。术后1、3、6个月,机器人组KSS[(75.96±3.96)、(81.53±3.78)、(84.50±3.29)分],VAS[(3.68±0.67)、(2.43±0.79)、(0.54±0.64)分],膝关节活动度[(113.32±4.72)°、(123.93±3.99)°、(135.36±2.34)°];传统组KSS[(73.77±4.18)、(76.48±3.60)、(80.19±3.28)分],VAS[(4.16±1.04)、(3.03±0.75)、(1.42±0.76)分],膝关节活动度[(109.19±6.95)°、(119.94±6.08)°、(134.48±2.14)°]。与术前相比,两组术后1、3、6个月KSS、VAS、膝关节活动度均显著改善,差异有统计学意义(P<0.001)。两组术后HKA[(180.39±1.95)°vs.(178.52±2.23)°]、LDFA[(89.67±0.63)°vs.(89.63±0.63)°]、MPTA[(89.44±0.55)°vs.(89.29±0.60)°],均较术前改善,差异有统计学意义(P<0.001)。术后1、3、6个月,机器人组KSS、VAS均优于传统组(P<0.05);术后1、3个月,机器人组膝关节活动度均高于传统组,差异有统计学意义(P<0.05),但术后6个月,机器人组膝关节活动度与传统组比较,差异无统计学意义(P>0.05)。结论:机器人辅助TKA是一种安全有效的TKA系统。与传统组相比,机器人组不仅可以帮助术前存在内翻畸形的患者获得更好的肢体轴线和假体对位,而且还能获得更好的影像和临床效果。
Objective To investigate the clinical efficacy and advantages of robot-assisted total knee arthroplasty(TKA)in patients with varus knee osteoarthritis.Methods Between October 2022 and June 2023,a total of 59 patients with severe knee osteoarthritis resulting in varus were treated with total knee arthroplasty,aged from 59 to 81 years with an average(70.90±4.63)years,including 19 mals and 40 females.The patients were divided into two groups based on the surgical method used:28 patients in the robot group and 31 patients in the traditional group.The robot group consisted of 8 males and 20 femalse patients,with an average age of(70.54±4.80)years and an average disease duration of(14.89±8.72)months.The traditional group consisted of 11 males and 20 females patients,with an average age of(71.39±4.5)years and an average disease duration of(12.32±6.73)months.The operative duration,amount of bleeding during the operation,postoperative activity time after the operation,hip-knee-ankle angle(HKA),lateral distal femoral angle(LDFA),medial proximal tibial angle(MPTA),and complications were compared between the two groups before and after the operation.Lateral tibia component(LTC),frontal tibia component(FTC),frontal femoral component(FFC)and lateral femoral component(LFC)were measured 6 months after operation Additionally,the degree of knee joint motility,American Knee Society score(KSS),and visual analogue scale(VAS)were compared before and after the operation.Results All patients had gradeⅠwound healing without any complications,and all patients were followed up for 6 to 8 months,with an average of(6.5±1.5)months.There were no significant differences preoperative imaging evaluation indexes(including HKA,LDFA,and MPTA),preoperative knee mobility,preoperative VAS,and preoperative KSS between the two groups(P>0.05).Comparing the operation time(109.11±7.16)min vs.(83.90±7.85)min,length of the incision(16.60±2.33)cm vs.(14.47±1.41)cm,intraoperative bleeding(106.93±6.15)ml vs.(147.97±7.62)ml,postoperative activity time(17.86±1.84)h vs.(21.77±2.68)h,between the two groups showed statistically significant differences(P<0.05).There were significant differences in FFC(88.96±0.84)°vs.(87.93±1.09)°and LFC(88.57±1.10)°vs.(87.16±1.2)°between the two groups at 6 months after operation(P<0.05).The robotic group 1,3,6 months after KSS(75.96±3.96),(81.53±3.78),(84.50±3.29)scores,VAS(3.68±0.67),(2.43±0.79),(0.54±0.64),knee joint mobility(113.32±4.72)°,(123.93±3.99)°,(135.36±2.34)°;Traditional group KSS(73.77±4.18),(76.48±3.60),(80.19±3.28)scores,VAS(4.16±1.04),(3.03±0.75),(1.42±0.76)scores,knee joint mobility(109.19±6.95)°,(119.94±6.08)°,(134.48±2.14)°.Compared to before surgery,both groups showed significant improvement in KSS,VAS and knee mobility during the three follow-up visits(P<0.001).Additionally,postoperative HKA(180.39±1.95)°vs.(178.52±2.23)°,LDFA(89.67±0.63)°vs.(89.63±0.63)°,and MPTA(89.44±0.55)°vs.(89.29±0.60)°were significantly improved in both groups compared to before surgery(P<0.001).The robotic group had higher KSS than the traditional group at 1,3,and 6 months after surgery(P<0.05).The robotic group also had lower VAS than the traditional group at 1,3,and 6 months after surgery(P<0.05).Furthermore,knee mobility was higher in the robotic group than those in the traditional group at 1 and 6 months after surgery(P<0.05),but there was no significant difference between the two groups at 6 months after surgery.Conclusion Robot-assisted total knee arthroplasty is a safe and effective method for total knee replacement.The use of robotics can improve the limb axis and prosthesis alignment for patients with preoperative varus deformity,resulting in better clinical and imaging outcomes compared to the conventional group.