2025 01 v.18 11-18
机器人辅助下功能性对线与机械轴对线全膝关节置换术的早期临床疗效：一项前瞻性双盲随机对照试验
基金项目(Foundation):
邮箱(Email):
dr_zhangxianlong@sjtu.edu.cn;
DOI:
中文作者单位:
上海交通大学医学院附属第六人民医院骨科;
摘要(Abstract):
目的：比较机器人辅助下功能性对线（FA）与机械轴对线（MA）全膝关节置换术（TKA）的早期临床疗效。方法：前瞻性纳入2021年9月至2022年3月上海交通大学医学院附属第六人民医院收治的拟行TKA治疗的100例膝骨关节炎（KOA）患者。采用随机数字表法进行分组，采用FA的50例患者作为FA-TKA组，采用MA的50例作为MA-TKA组。比较两组患者的术中指标，包括下肢力线、间隙平衡、软组织松解和手术时间；评估术后6个月的临床疗效，包括患者满意度Likert评分、疼痛视觉模拟评分（VAS）、膝关节活动度（ROM）、膝关节损伤和骨关节炎结果评分（KOOS）、2011年美国膝关节协会评分（2011 KSS）和关节遗忘评分（FJS）。结果：100例患者中1例失随访，其余患者均获得6个月以上随访，最终FA-TKA组50例和MA-TKA组49例纳入研究。与MA-TKA组相比，FA-TKA组患者明显减少了软组织松解次数、松解范围，缩短了手术时间（P均<0.05）；术后6个月KOOS-疼痛、KOOS-日常生活、KOOS-生活质量和FJS均有显著提高（P均<0.05），爬楼时的疼痛VAS评分明显降低（P<0.05）。结论：TKA中采用FA可减少软组织松解，缩短手术时间，减轻术后疼痛，患者的早期临床预后良好。
关键词(KeyWords):
全膝关节置换术;机器人;个性化对线;功能性对线;机械轴对线
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参考文献
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[29] Choi BS, Kim SE, Yang M, et al. Functional alignment with robotic-arm assisted total knee arthroplasty demonstrated better patient-reported outcomes than mechanical alignment with manual total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2023, 31(3):1072-1080.
[30] Smith AF, Eccles CJ, Bhimani SJ, et al. Improved patient satisfaction following robotic-assisted total knee arthroplasty[J]. J Knee Surg, 2021, 34(7):730-738.
[31] Hamilton DF, Loth FL, Giesinger JM, et al. Validation of the english language forgotten joint score-12 as an outcome measure for total hip and knee arthroplasty in a British population[J]. Bone Joint J, 2017, 99-B(2):218-224.
[32] Roos EM, Toksvig-Larsen S. Knee injury and osteoarthritis outcome score(KOOS)-validation and comparison to the WOMAC in total knee replacement[J]. Health Qual Life Outcomes, 2003, 1:17.
[2] Ramkumar PN, Navarro SM, Haeberle HS, et al. No difference in outcomes 12 and 24 months after lower extremity total joint arthroplasty:a systematic review and metaanalysis[J]. J Arthroplasty, 2018, 33(7):2322-2329.
[3]边焱焱,程开源,常晓,等. 2011至2019年中国人工髋膝关节置换手术量的初步统计与分析[J].中华骨科杂志,2020, 40(21):8.
[4] Berend ME, Ritter MA, Meding JB, et al. Chitranjan S.Ranawat Award:tibial component failure mechanisms in total knee arthroplasty[J]. Clin Orthop Relat Res, 2004(428):26-34.
[5] Gunaratne R, Pratt DN, Banda J, et al. Patient dissatisfaction following total knee arthroplasty:a systematic review of the literature[J]. J arthroplasty, 2017, 32(12):3854-3860.
[6] Bellemans J, Colyn W, Vandenneucker H, et al. The Chitranjan Ranawat award:is neutral mechanical alignment normal for all patients? The concept of constitutional varus[J]. Clin Orthop Relat Res, 2012, 470(1):45-53.
[7] Riviere C, Vigdorchik JM, Vendittoli PA. Mechanical alignment:the end of an era![J]. Orthop Traumatol Surg Res,2019, 105(7):1223-1226.
[8] Kayani B, Konan S, Tahmassebi J, et al. A prospective double-blinded randomised control trial comparing robotic arm-assisted functionally aligned total knee arthroplasty versus robotic arm-assisted mechanically aligned total knee arthroplasty[J]. Trials, 2020, 21(1):194.
[9] Begum FA, Kayani B, Magan AA, et al. Current concepts in total knee arthroplasty:mechanical, kinematic, anatomical, and functional alignment[J]. Bone Jt Open, 2021, 2(6):397-404.
[10] Oussedik S, Abdel MP, Victor J, et al. Alignment in total knee arthroplasty[J]. Bone Joint J, 2020, 102-B(3):276-279.
[11]王俏杰,张先龙.机器人辅助人工全膝关节置换术中下肢对线选择与软组织平衡策略[J].中国修复重建外科杂志,2021, 35(10):1221-1226.
[12] Sajjadi MM, Okhovatpour MA, Safaei Y, et al. Is standing coronal long-leg alignment view effective in predicting the extent of medial soft tissue release in varus deformity during total knee arthroplasty?[J]. J Knee Surg, 2022, 35(11):1192-1198.
[13] Riviere C, Villet L, Jeremic D, et al. What you need to know about kinematic alignment for total knee arthroplasty[J]. Orthop Traumatol Surg Res, 2021, 107(1S):102773.
[14] D'Lima DD, Hermida JC, Chen PC, et al. Polyethylene wear and variations in knee kinematics[J]. Clin Orthop Relat Res, 2001(392):124-130.
[15] Van Hamersveld KT, Marang-van de Mheen PJ, Nelissen R. The effect of coronal alignment on tibial component migration following total knee arthroplasty:a cohort study with long-term radiostereometric analysis results[J]. J Bone Joint Surg Am, 2019, 101(13):1203-1212.
[16] Teeter MG, Naudie DD, McCalden RW, et al. Varus tibial alignment is associated with greater tibial baseplate migration at 10 years following total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(6):1610-1617.
[17] Hirschmann MT, Moser LB, Amsler F, et al. Functional knee phenotypes:a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(5):1394-1402.
[18] Hirschmann MT, Moser LB, Amsler F, et al. Phenotyping the knee in young non-osteoarthritic knees shows a wide distribution of femoral and tibial coronal alignment[J].Knee Surg Sports Traumatol Arthrosc, 2019, 27(5):1385-1393.
[19] Hess S, Moser LB, Robertson EL, et al. Osteoarthritic and non-osteoarthritic patients show comparable coronal knee joint line orientations in a cross-sectional study based on3D reconstructed CT images[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(2):407-418.
[20] Parratte S, Pagnano MW, Trousdale RT, et al. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements[J]. J Bone Joint Surg Am, 2010, 92(12):2143-2149.
[21] Tibbo ME, Limberg AK, Perry KI, et al. Effect of coronal alignment on 10-year survivorship of a single contemporary total knee arthroplasty[J]. J Clin Med, 2021, 10(1):142.
[22] Chang JS, Kayani B, Wallace C, et al. Functional alignment achieves soft-tissue balance in total knee arthroplasty as measured with quantitative sensor-guided technology[J].Bone Joint J, 2021, 103-B(3):507-514.
[23] Blakeney W, Beaulieu Y, Kiss MO, et al. Less gap imbalance with restricted kinematic alignment than with mechanically aligned total knee arthroplasty:simulations on 3-D bone models created from CT-scans[J]. Acta Orthop,2019, 90(6):602-609.
[24] Kayani B, Konan S, Tahmassebi J, et al. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty:a prospective cohort study[J]. Bone Joint J,2018, 100-B(7):930-937.
[25] Kayani B, Konan S, Ayuob A, et al. Robotic technology in total knee arthroplasty:a systematic review[J]. EFORT open reviews, 2019, 4(10):611-617.
[26] Vigdorchik JM, Wakelin EA, Koenig JA, et al. Impact of component alignment and soft tissue release on 2-year outcomes in total knee arthroplasty[J]. J Arthroplasty, 2022, 37(10):2035-2040.e5.
[27] Kubo Y, Sugiyama S, Takachu R, et al. Association between serum n-3 polyunsaturated fatty acids and quadriceps weakness immediately after total knee arthroplasty[J].PLoS One, 2020, 15(1):e0228460.
[28] Kort N, Stirling P, Pilot P, et al. Robot-assisted knee arthroplasty improves component positioning and alignment, but results are inconclusive on whether it improves clinical scores or reduces complications and revisions:a systematic overview of meta-analyses[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(8):2639-2653.
[29] Choi BS, Kim SE, Yang M, et al. Functional alignment with robotic-arm assisted total knee arthroplasty demonstrated better patient-reported outcomes than mechanical alignment with manual total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2023, 31(3):1072-1080.
[30] Smith AF, Eccles CJ, Bhimani SJ, et al. Improved patient satisfaction following robotic-assisted total knee arthroplasty[J]. J Knee Surg, 2021, 34(7):730-738.
[31] Hamilton DF, Loth FL, Giesinger JM, et al. Validation of the english language forgotten joint score-12 as an outcome measure for total hip and knee arthroplasty in a British population[J]. Bone Joint J, 2017, 99-B(2):218-224.
[32] Roos EM, Toksvig-Larsen S. Knee injury and osteoarthritis outcome score(KOOS)-validation and comparison to the WOMAC in total knee replacement[J]. Health Qual Life Outcomes, 2003, 1:17.
基本信息:
DOI：
中图分类号:R687.4
引用信息:
[1]王俏杰,闫自晓,王琦等.机器人辅助下功能性对线与机械轴对线全膝关节置换术的早期临床疗效：一项前瞻性双盲随机对照试验[J].中华骨与关节外科杂志,2025,18(01):11-18.
基金信息: