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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。
Abstract：Objective: To compare the clinical outcomes of domestic visual navigation and MAKO surgical robot-assisted total hip arthroplasty(THA) in the treatment of Crowe type Ⅳ developmental dysplasia of the hip(DDH). Methods: A retrospective study was conducted on 44 patients(56 hips) with Crowe type Ⅳ DDH who underwent visual navigation or MAKO surgical robot-assisted THA at the Fourth Medical Center of Chinese PLA General Hospital from January 2022 to July 2023. Patients were matched 1∶1 according to gender, age, and body mass index, and were divided into the navigation group(23 cases, 28 hips) that underwent visual navigationassisted THA and the robot group(21 cases, 28 hips) that underwent MAKO surgical robot-assisted THA. Perioperative indicators of both groups including operation time, intraoperative blood loss, and the occurrence of subtrochanteric osteotomy were recorded. The prosthesis position of both groups including the anteversion and abduction angles of the acetabular prosthesis was observed and compared at 12 months postoperatively. Hip joint imaging indicators, including vertical center of rotation(V-COR), horizontal center of rotation(H-COR), femoral offset(FO), leg length discrepancy(LLD), prosthesis position, osteotomy healing, and periprosthetic osteolysis, as well as hip joint function, including Harris Hip Score(HHS) and Oxford Hip Score(OHS) were compared preoperatively and 12-month postoperatively. Complications in both groups were also recorded. Results: All patients were followed up for 12 to 18months, with an average of(13.36±1.20) months. The navigation group had shorter surgical times and less intraoperative blood loss compared to the robot group, with both differences being statistically significant(both P<0.05). There was no statistically significant difference in the occurrence of subtrochanteric osteotomy between the two groups(P>0.05). At 12 months postoperatively, there were no statistically significant differences between the two groups in terms of anteversion and abduction angles(both P>0.05). At 12 months postoperatively, V-COR, H-COR, and LLD in both groups were smaller than those before surgery, while FO was larger than before surgery, with all differences being statistically significant(all P<0.05). At 12 months postoperatively, all prostheses were stable in position, and there were no occurrences of prosthesis loosening, osteolysis, or heterotopic ossification. At 12 months postoperatively,the HHS in both groups was higher than before surgery, while the OHS was lower than before surgery, with all differences being statistically significant(both P<0.05). At 12 months postoperatively, the HHS in the navigation group was higher than that in the robotic group, with a statistically significant difference(P<0.05). At 12 months postoperatively, neither group experienced complications such as periprosthetic fractures, dislocations, aseptic loosening, infections, or revisions. Moreover, there were no adverse events related to the intraoperative visual navigation and surgical robots. Conclusions: Compared to the commonly used MAKO surgical robot in clinics,the domestic visual navigation has the advantages of low cost and easy promotion. When assisting in the treatment of Crowe type ⅣDDH with THA, it has the advantages of shorter surgical time and less intraoperative blood loss. It can achieve ideal prosthesis positioning and biomechanical recovery, with satisfactory clinical outcomes.
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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）