2025 01 v.18 19-26
国产可视化导航与MAKO手术机器人辅助全髋关节置换术治疗Crowe Ⅳ型发育性髋关节发育不良的临床效果比较
基金项目(Foundation):
国家自然科学基金区域联合重点项目（U22A20355）
邮箱(Email):
chaiwei301@163.com;
DOI:
中文作者单位:
中国人民解放军总医院第四医学中心骨科医学部;国家骨科与运动康复临床医学研究中心;
摘要(Abstract):
目的：比较国产可视化导航与MAKO手术机器人辅助全髋关节置换术（THA）治疗Crowe Ⅳ型发育性髋关节发育不良（DDH）的临床效果。方法：回顾性选取2022年1月至2023年7月中国人民解放军总医院第四医学中心接受可视化导航或MAKO手术机器人辅助THA的44例（56髋）Crowe Ⅳ型DDH患者作为研究对象，按性别、年龄、体重指数进行倾向性评分1∶1匹配，分为使用可视化导航辅助THA的导航组（23例，28髋）和使用MAKO手术机器人辅助THA的机器人组（21例，28髋）。记录两组患者围手术期相关指标（包括手术时间、术中出血量和股骨转子下截骨的发生情况），观察并比较术后12个月两组患者的假体位置（包括髋臼假体前倾角和外展角），比较术前和术后12个月两组患者髋关节影像学指标[包括髋关节旋转中心高度（V-COR）、旋转中心水平距离（H-COR）、股骨偏心距（FO）、双下肢长度差异（LLD），以及假体在位情况、截骨愈合情况、假体周围骨溶解情况]、髋关节功能[包括Harris髋关节评分（HHS）和牛津大学髋关节评分（OHS）]，记录两组患者并发症的发生情况。结果：患者随访时间为12～16个月，平均（13.36±1.20）个月。导航组患者手术时间短于机器人组，术中出血量少于机器人组，差异均有统计学意义（P均<0.05）。两组患者股骨转子下截骨的发生情况比较，差异无统计学意义（P>0.05）。术后12个月，两组患者前倾角、外展角比较，差异均无统计学意义（P均>0.05）。术后12个月，两组患者V-COR、H-COR、LLD均小于本组术前，FO均大于本组术前，差异均有统计学意义（P均<0.05）。术后12个月，所有患者假体均稳定在位，未发生假体松动、骨溶解和异位骨化。术后12个月，两组患者HHS均高于本组术前，OHS均低于本组术前，差异均有统计学意义（P均<0.05）。术后12个月，导航组患者HHS高于机器人组，差异有统计学意义（P<0.05）。术后12个月，两组患者均未发生假体周围骨折、脱位、无菌性松动、感染及翻修等并发症，无术中可视化导航和手术机器人出现的相关不良事件。结论：与临床常用的MAKO手术机器人相比，国产可视化导航具有成本低、易于推广的优势。其在辅助THA治疗Crowe Ⅳ型DDH时，具有手术时间短、术中出血少，且能够实现较为理想的假体定位、生物力学恢复，临床效果令人满意。
关键词(KeyWords):
可视化导航;全髋关节置换术;Crowe Ⅳ型;发育性髋关节发育不良
| 85 | 1 | 32 |
| 下载次数 | 被引频次 | 阅读次数 |
参考文献
[1] Greber EM, Pelt CE, Gililland JM, et al. Challenges in total hip arthroplasty in the setting of developmental dysplasia of the hip[J]. J Arthroplasty, 2017, 32(9s):S38-S44.
[2] Hayashi S, Hashimoto S, Kuroda Y, et al. Robotic-arm assisted THA can achieve precise cup positioning in developmental dysplasia of the hip:a case control study[J]. Bone Joint Res, 2021, 10(10):629-638.
[3] Zhang S, Ma M, Kong X, et al. Robotic-assisted total hip arthroplasty in patients with developmental dysplasia of the hip[J]. Int Orthop, 2024, 48(5):1189-1199.
[4] Ueoka K, Kabata T, Kajino Y, et al. The accuracy of the computed tomography-based navigation system in total hip arthroplasty is comparable with crowe type iv and crowe type i dysplasia:a case-control study[J]. J Arthroplasty,2019, 34(11):2686-2691.
[5] Honl M, Dierk O, Gauck C, et al. Comparison of roboticassisted and manual implantation of a primary total hip replacement. A prospective study[J]. J Bone Joint Surg Am,2003, 85(8):1470-1478.
[6] Bukowski BR, Sandhu KP, Bernatz JT, et al. CT required to perform robotic-assisted total hip arthroplasty can identify previously undiagnosed osteoporosis and guide femoral fixation strategy[J]. Bone Joint J, 2023, 105-b(3):254-260.
[7] 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.
[8]柴伟,张博涵,孔祥朋,等.可视化智能辅助髋臼镜像重建技术治疗CroweⅡ、Ⅲ型发育性髋关节发育不良[J].中华骨科杂志, 2024, 44(6):345-353.
[9] Mei XY, Etemad-Rezaie A, Safir OA, et al. Intraoperative measurement of acetabular component position using imageless navigation during revision total hip arthroplasty[J].Can J Surg, 2021, 64(4):E442-E448.
[10] 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.
[11] Zhang B, Du Y, Zhang Y, et al. Comparison of functional and radiographic outcomes between two fixation methods for extended trochanteric osteotomy in revision total hip arthroplasty:a retrospective cohort study[J]. J Arthroplasty,2022, 37(9):1844-1850.
[12] Lachiewicz PF, Messick P. Precoated femoral component in primary hybrid total hip arthroplasty:results at a mean 10-year follow-up. J Arthroplasty. 2003;18(1):1-5.
[13] Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987;69(1):45-55.
[14] Gruen TA, McNeice GM, Amstutz HC."Modes of failure"of cemented stem-type femoral components:a radiographic analysis of loosening. Clin Orthop Relat Res. 1979(141):17-27.
[15] Moore MS, McAuley JP, Young AM, Engh CA, Sr. Radiographic signs of osseointegration in porous-coated acetabular components. Clin Orthop Relat Res. 2006;444:176-183.
[16] Sicat CS, Buchalter DB, Luthringer TA, et al. Intraoperative technology use improves accuracy of functional safe zone targeting in total hip arthroplasty[J]. J Arthroplasty,2022, 37(7s):S540-S545.
[17] Tetsunaga T, Yamada K, Tetsunaga T, et al. Comparison of the accuracy of CT and accelerometer-based navigation systems for cup orientation in total hip arthroplasty[J]. Hip Int,2021, 31(5):603-608.
[18] Grammatopoulos G, Alvand A, Monk AP, et al. Surgeons'accuracy in achieving their desired acetabular component orientation[J]. J Bone Joint Surg Am, 2016, 98(17):e72.
[19] Zhou Y, Shao H, Huang Y, et al. Does robotic assisted technology improve the accuracy of acetabular component positioning in patients with DDH?[J]. J Orthop Surg(Hong Kong), 2021, 29(2):23094990211025325.
[20] Hepinstall M, Mota F, Naylor B, et al. Robotic-assisted total hip arthroplasty in patients who have developmental hip dysplasia[J]. Surg Technol Int, 2021, 39:338-347.
[21] Ando W, Takao M, Hamada H, et al. Comparison of the accuracy of the cup position and orientation in total hip arthroplasty for osteoarthritis secondary to developmental dysplasia of the hip between the Mako robotic arm-assisted system and computed tomography-based navigation[J]. Int Orthop, 2021, 45(7):1719-1725.
[22] Tanino H, Mitsutake R, Takagi K, et al. Does a commercially available augmented reality-based portable hip navigation system improve cup positioning during tha compared with the conventional technique? A randomized controlled study[J]. Clin Orthop Relat Res, 2024, 482(3):458-467.
[23] Sugano N, Takao M, Sakai T, et al. Does CT-based navigation improve the long-term survival in ceramic-on-ceramic THA?[J]. Clin Orthop Relat Res, 2012, 470(11):3054-3059.
[24] Nilsdotter A, Bremander A. Measures of hip function and symptoms:Harris hip score(HHS), hip disability and osteoarthritis outcome score(HOOS), Oxford hip score(OHS),lequesne index of severity for osteoarthritis of the hip(LISOH), and American Academy of Orthopedic Surgeons(AAOS)hip and knee questionnaire[J]. Arthritis Care Res(Hoboken), 2011, 63 Suppl 11:S200-S207.
[2] Hayashi S, Hashimoto S, Kuroda Y, et al. Robotic-arm assisted THA can achieve precise cup positioning in developmental dysplasia of the hip:a case control study[J]. Bone Joint Res, 2021, 10(10):629-638.
[3] Zhang S, Ma M, Kong X, et al. Robotic-assisted total hip arthroplasty in patients with developmental dysplasia of the hip[J]. Int Orthop, 2024, 48(5):1189-1199.
[4] Ueoka K, Kabata T, Kajino Y, et al. The accuracy of the computed tomography-based navigation system in total hip arthroplasty is comparable with crowe type iv and crowe type i dysplasia:a case-control study[J]. J Arthroplasty,2019, 34(11):2686-2691.
[5] Honl M, Dierk O, Gauck C, et al. Comparison of roboticassisted and manual implantation of a primary total hip replacement. A prospective study[J]. J Bone Joint Surg Am,2003, 85(8):1470-1478.
[6] Bukowski BR, Sandhu KP, Bernatz JT, et al. CT required to perform robotic-assisted total hip arthroplasty can identify previously undiagnosed osteoporosis and guide femoral fixation strategy[J]. Bone Joint J, 2023, 105-b(3):254-260.
[7] 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.
[8]柴伟,张博涵,孔祥朋,等.可视化智能辅助髋臼镜像重建技术治疗CroweⅡ、Ⅲ型发育性髋关节发育不良[J].中华骨科杂志, 2024, 44(6):345-353.
[9] Mei XY, Etemad-Rezaie A, Safir OA, et al. Intraoperative measurement of acetabular component position using imageless navigation during revision total hip arthroplasty[J].Can J Surg, 2021, 64(4):E442-E448.
[10] 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.
[11] Zhang B, Du Y, Zhang Y, et al. Comparison of functional and radiographic outcomes between two fixation methods for extended trochanteric osteotomy in revision total hip arthroplasty:a retrospective cohort study[J]. J Arthroplasty,2022, 37(9):1844-1850.
[12] Lachiewicz PF, Messick P. Precoated femoral component in primary hybrid total hip arthroplasty:results at a mean 10-year follow-up. J Arthroplasty. 2003;18(1):1-5.
[13] Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987;69(1):45-55.
[14] Gruen TA, McNeice GM, Amstutz HC."Modes of failure"of cemented stem-type femoral components:a radiographic analysis of loosening. Clin Orthop Relat Res. 1979(141):17-27.
[15] Moore MS, McAuley JP, Young AM, Engh CA, Sr. Radiographic signs of osseointegration in porous-coated acetabular components. Clin Orthop Relat Res. 2006;444:176-183.
[16] Sicat CS, Buchalter DB, Luthringer TA, et al. Intraoperative technology use improves accuracy of functional safe zone targeting in total hip arthroplasty[J]. J Arthroplasty,2022, 37(7s):S540-S545.
[17] Tetsunaga T, Yamada K, Tetsunaga T, et al. Comparison of the accuracy of CT and accelerometer-based navigation systems for cup orientation in total hip arthroplasty[J]. Hip Int,2021, 31(5):603-608.
[18] Grammatopoulos G, Alvand A, Monk AP, et al. Surgeons'accuracy in achieving their desired acetabular component orientation[J]. J Bone Joint Surg Am, 2016, 98(17):e72.
[19] Zhou Y, Shao H, Huang Y, et al. Does robotic assisted technology improve the accuracy of acetabular component positioning in patients with DDH?[J]. J Orthop Surg(Hong Kong), 2021, 29(2):23094990211025325.
[20] Hepinstall M, Mota F, Naylor B, et al. Robotic-assisted total hip arthroplasty in patients who have developmental hip dysplasia[J]. Surg Technol Int, 2021, 39:338-347.
[21] Ando W, Takao M, Hamada H, et al. Comparison of the accuracy of the cup position and orientation in total hip arthroplasty for osteoarthritis secondary to developmental dysplasia of the hip between the Mako robotic arm-assisted system and computed tomography-based navigation[J]. Int Orthop, 2021, 45(7):1719-1725.
[22] Tanino H, Mitsutake R, Takagi K, et al. Does a commercially available augmented reality-based portable hip navigation system improve cup positioning during tha compared with the conventional technique? A randomized controlled study[J]. Clin Orthop Relat Res, 2024, 482(3):458-467.
[23] Sugano N, Takao M, Sakai T, et al. Does CT-based navigation improve the long-term survival in ceramic-on-ceramic THA?[J]. Clin Orthop Relat Res, 2012, 470(11):3054-3059.
[24] Nilsdotter A, Bremander A. Measures of hip function and symptoms:Harris hip score(HHS), hip disability and osteoarthritis outcome score(HOOS), Oxford hip score(OHS),lequesne index of severity for osteoarthritis of the hip(LISOH), and American Academy of Orthopedic Surgeons(AAOS)hip and knee questionnaire[J]. Arthritis Care Res(Hoboken), 2011, 63 Suppl 11:S200-S207.
基本信息:
DOI：
中图分类号:R687.4
引用信息:
[1]张博涵,郭人文,谢鸿斌等.国产可视化导航与MAKO手术机器人辅助全髋关节置换术治疗Crowe Ⅳ型发育性髋关节发育不良的临床效果比较[J].中华骨与关节外科杂志,2025,18(01):19-26.
基金信息:
国家自然科学基金区域联合重点项目（U22A20355）