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目的：比较机器人辅助全髋关节置换术（THA）与传统THA的髋臼假体置入准确性与中期疗效。方法：选取2020年2—9月重庆医科大学附属第一医院收治的因髋骨关节炎、股骨头缺血性坏死、发育性髋关节发育不良而行THA的100例患者进行前瞻性研究。入院后采用随机数字表法将其分为rTHA组（50例）和mTHA组（50例），分别行机器人辅助THA和传统THA。记录并比较两组患者手术时间、术后首次下地活动时间及持续时间；依据术后影像学资料评估髋臼杯置入角度是否在安全区内；记录并比较两组患者手术前后疼痛视觉模拟评分（VAS）、Harris髋关节评分（HHS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、36项健康调查简表（SF-36）评分及术后关节遗忘评分（FJS）。结果：最终rTHA组纳入48例患者、mTHA组纳入47例患者进行分析。所有患者获得48～53个月的随访，平均（50.4±1.7）个月。rTHA组患者髋臼杯置入角度在Lewinnek安全区、Callanan安全区内的比例均较mTHA组患者高（P均<0.001）。与mTHA组患者相比，rTHA组患者手术时间更长（P<0.001），术后首次下地活动时间更短（P<0.001），术后首次下地活动持续时间更长（P<0.001）。术后3周、6周，rTHA组患者HHS均较mTHA组患者高（P均<0.05）。术后3个月，rTHA组患者FJS较mTHA组患者高（P<0.05）。末次随访时，rTHA组患者疼痛VAS评分较mTHA组患者低（P<0.05），而HHS、FJS均较mTHA组患者高（P均<0.05）。结论：与传统THA相比，机器人辅助THA的髋臼杯置入准确性、可重复性更高，且中期疗效更佳。
Abstract：Objective: To compare the accuracy of acetabular prosthesis placement and mid-term outcomes of robot-assisted total hip arthroplasty(rTHA) and traditional manual total hip arthroplasty(mTHA). Methods: A prospective study was conducted on 100 patients who underwent THA for hip osteoarthritis, avascular necrosis of the femoral head, or developmental dysplasia of the hip at the First Affiliated Hospital of Chongqing Medical University from February to September 2020. Patients were randomly divided into two groups using a random numbers table: 50 patients underwent rTHA(rTHA group) and 50 patients underwent traditional mTHA(mTHA group). The surgical time, time to first postoperative ambulation, and duration of first postoperative ambulation were recorded and compared. The placement angle of the acetabular cup was assessed based on postoperative imaging data to determine if it was within the safe zone. Visual analogue scale(VAS) for pain, Harris hip score(HHS), Western Ontario and McMaster Universities osteoarthritis index(WOMAC), 36-item short form health survey(SF-36) preoperatively and postoperatively, as well as forgotten joint score(FJS)postoperatively were recorded and compared between the two groups. Results: A total of 48 patients in the rTHA group and 47 patients in the mTHA group were included in the final analysis. All patients were followed up for 48 to 53 months, with an average of(50.4±1.7)months. The rTHA group demonstrated significantly higher proportions of acetabular cup placement within the Lewinnek and Callanan safety zones compared to the mTHA group(both P<0.001). Compared to the mTHA group, the rTHA group had longer surgical times(P<0.001), shorter time to first postoperative ambulation(P<0.001), and longer duration of first postoperative ambulation(P<0.001). At 3 and 6 weeks postoperatively, the rTHA group had significantly higher HHS scores than the mTHA group(both P<0.05). At 3 months postoperatively, the FJS was significantly higher in the rTHA group than in the mTHA group(P<0.05). At the final follow-up, the rTHA group had significantly lower VAS pain scores compared to the mTHA group(all P<0.05), while the HHS and FJS were significantly higher in the rTHA group(all P<0.05). Conclusions: Compared to traditional mTHA, rTHA has higher accuracy and repeatability in acetabular cup placement and better mid-term clinical outcomes.
[1] Ferguson RJ, Palmer AJ, Taylor A, et al. Hip replacement[J]. Lancet, 2018, 392(10158):1662-1671.
[2] Perets I, Mu BH, Mont MA, et al. Current topics in roboticassisted total hip arthroplasty:a review[J]. Hip Int, 2020, 30(2):118-124.
[3] Gwam CU, Mistry JB, Mohamed NS, et al. Current epidemiology of revision total hip arthroplasty in the United States:national inpatient sample 2009 to 2013[J]. J Arthroplasty, 2017, 32(7):2088-2092.
[4] Clement ND, Gaston P, Bell A, et al. Robotic arm-assisted versus manual total hip arthroplasty[J]. Bone Joint Res,2021, 10(1):22-30.
[5] Ripolles-Melchor J, Abad-Motos A, Diez-Remesal Y, et al.Association Between use of enhanced recovery after surgery protocol and postoperative complications in total hip and knee arthroplasty in the postoperative outcomes within enhanced recovery after surgery protocol in elective total hip and knee arthroplasty study(POWER2)[J]. JAMA Surg, 2020, 155(4):e196024.
[6] Kayani B, Tahmassebi J, Ayuob A, et al. A prospective randomized controlled trial comparing the systemic inflammatory response in conventional jig-based total knee arthroplasty versus robotic-arm assisted total knee arthroplasty[J]. Bone Joint J, 2021, 103-B(1):113-122.
[7] Bargar WL, Parise CA, Hankins A, et al. Fourteen year follow-up of randomized clinical trials of active roboticassisted total hip arthroplasty[J]. J Arthroplasty, 2018, 33(3):810-814.
[8]陶黎,彭冈力,曾勇明,等. 1∶1等长骨骼数字X线摄影技术[J].放射学实践, 2014, 29(6):701-703.
[9]周宗科,翁习生,曲铁兵,等.中国髋、膝关节置换术加速康复——围术期管理策略专家共识[J].中华骨与关节外科杂志, 2016, 9(1):1-9.
[10]左孝海,陈洁,王家炜,等.髋膝置换术后即日与次日下地活动的比较[J].中国矫形外科杂志, 2023, 31(15):1431-1433.
[11] Murray DW. The definition and measurement of acetabular orientation[J]. J Bone Joint Surg Br, 1993, 75(2):228-232.
[12] Murphy MP, Killen CJ, Ralles SJ, et al. A precise method for determining acetabular component anteversion after total hip arthroplasty[J]. Bone Joint J, 2019, 101-B(9):1042-1049.
[13] Higgins SW, Spratley EM, Boe RA, et al. A novel approach for determining three-dimensional acetabular orientation:results from two hundred subjects[J]. J Bone Joint Surg Am, 2014, 96(21):1776-1784.
[14] Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties[J]. J Bone Joint Surg Am,1978, 60(2):217-220.
[15] Callanan MC, Jarrett B, Bragdon CR, et al. The John Charnley Award:risk factors for cup malpositioning:quality improvement through a joint registry at a tertiary hospital[J]. Clin Orthop Relat Res, 2011, 469(2):319-329.
[16]郭人文,柴伟,李想,等.机器人辅助在股骨头坏死全髋关节置换术中的应用[J].中华骨科杂志, 2020, 40(13):819-827.
[17] Bosker BH, Verheyen CC, Horstmann WG, et al. Poor accuracy of freehand cup positioning during total hip arthroplasty[J]. Arch Orthop Trauma Surg, 2007, 127(5):375-379.
[18] Danoff JR, Bobman JT, Cunn G, et al. Redefining the acetabular component safe zone for posterior approach total hip arthroplasty[J]. J Arthroplasty, 2016, 31(2):506-511.
[19] Chai W, Guo RW, Puah KL, et al. Use of Robotic-arm assisted technique in complex primary total hip arthroplasty[J]. Orthop Surg, 2020, 12(2):686-691.
[20] Perets I, Walsh JP, Close MR, et al. Robot-assisted total hip arthroplasty:clinical outcomes and complication rate[J]. Int J Med Robot, 2018, 14(4):e1912.
[21] Kamara E, Robinson J, Bas MA, et al. Adoption of robotic vs fluoroscopic guidance in total hip arthroplasty:is acetabular positioning improved in the learning curve?[J]. J Arthroplasty, 2017, 32(1):125-130.
[22] Tamaki Y, Goto T, Wada K, et al. Robotic arm-assisted total hip arthroplasty via a minimally invasive anterolateral approach in the supine position improves the precision of cup placement in patients with developmental dysplasia of the hip[J]. J Orthop Sci, 2024, 29(2):559-565.
[23] Zhang S, Liu Y, Yang M, et al. Robotic-assisted versus manual total hip arthroplasty in obese patients:a retrospective case-control study[J]. J Orthop Surg Res, 2022, 17(1):368.
[24] Suarez-Ahedo C, Lopez-Reyes A, Martinez-Armenta C, et al. Revolutionizing orthopedics:a comprehensive review of robot-assisted surgery, clinical outcomes, and the future of patient care[J]. J Robot Surg, 2023, 17(6):2575-2581.
[25] Constantinescu DS, Costello JN, Yakkanti RR, et al. Varying complication rates and increased costs in technologyassisted total hip arthroplasty versus conventional instrumentation in 1, 372, 300 primary total hips[J]. J Arthroplasty, 2024, 39(7):1771-1776.
[26] Weinfurt KP, Reeve BB. Patient-reported outcome measures in clinical research[J]. JAMA, 2022, 328(5):472-473.
[27] Domb BG, Chen JW, Lall AC, et al. Minimum 5-year outcomes of robotic-assisted primary total hip arthroplasty with a nested comparison against manual primary total hip arthroplasty:a propensity score-matched study[J]. J Am Acad Orthop Surg, 2020, 28(20):847-856.
[28] Bukowski BR, Anderson P, Khlopas A, et al. Improved functional outcomes with robotic compared with manual total hip arthroplasty[J]. Surg Technol Int, 2016, 29:303-308.
[29]王鑫光,张国为,田华.全髋关节置换术后关节遗忘评分的变化和阈值:最小临床重要差异、最小重要变化、最小可检测变化和患者可接受的症状状态[J].中华医学杂志,2022, 102(10):748.
基本信息:
DOI：
中图分类号:R687.4
引用信息:
[1]孙银松,王德华,周鹭等.机器人辅助与传统全髋关节置换术中期疗效比较[J].中华骨与关节外科杂志,2025,18(01):4-10.
基金信息:
2024年重庆市研究生科研创新项目（CYS240292）; 2025年重庆市科卫联合医学科研中青年高端人才项目（2025GDRC009）; 2022年度重庆市技术创新与应用发展重点项目（CSTB2021TIAD-KPX0069）; 重庆医科大学第一附属医院2023年“学科登峰计划”（cyyy-xkdfjh-lcyj-202304）