摘要
背景:随着机器人辅助全膝关节置换的兴起,它在植入物定位精度上的优势备受关注。然而,关于机器人全膝关节置换在改善患者术后关节活动度、假体翻修率、下肢力线和患者满意度方面是否优于传统全膝关节置换,现有证据尚不明确。目的:探讨Mako机器人辅助与传统全膝关节置换在临床功能与影像学上的差异及临床意义。方法:回顾性分析中日友好医院2023年1月至2024年9月接受Mako机器人辅助全膝关节置换的66例骨关节炎患者(机器人组);根据年龄、性别、体质量指数匹配59例传统全膝关节置换患者(传统组)。记录手术时间、出血量、止血带使用时间以及两组患者术前、术后3,6,12个月的临床结果,包括美国特种外科医院膝关节评分、西安大略和麦克马斯特大学骨关节炎指数、美国膝关节学会评分(功能)及膝关节活动度;术前及术后1周拍摄双下肢前后负重位全长X射线片,测量两组患者髋膝踝角、股骨外翻角、股骨远端外侧角、股骨近端外侧角和胫骨近端内侧角并进行对比。结果与结论:①机器人组较传统组手术时间更长,但止血带使用时间更短,失血量相当;②术后1周两组活动度均改善,传统组略胜一筹,但无显著性差异(P>0.05);③美国特种外科医院膝关节评分显示两组术后功能提升相近,无显著性差异(P>0.05);美国膝关节学会功能评分在术后1年时,机器人组优于传统组(P<0.05);西安大略和麦克马斯特大学骨关节炎指数表明两组术后疼痛和功能均改善,但机器人组在术后6个月和1年表现更优(P<0.05);④X射线片结果显示所有患者下肢力线改善,假体位置良好,随访期间未发生严重不良事件;⑤影像学测量显示,机器人组术后髋膝踝角、胫骨近端内侧角和股骨近端外侧角显著改善(P<0.05),而股骨外翻角和股骨远端外侧角无显著变化(P>0.05);传统组髋膝踝角和胫骨近端内侧角改善显著(P<0.05),但股骨外翻角、股骨近端外侧角和股骨远端外侧角无显著变化(P>0.05);两组术后影像学指标比较无显著性差异(P>0.05),术前与术后差值比较除股骨外翻角和股骨近端外侧角外,其余指标亦无显著性差异(P>0.05);⑥术后并发症发生率在两组间无显著性差异(P>0.05);⑦提示Mako机器人辅助全膝关节置换在术中角度、力线和平衡调整上优于传统全膝关节置换,提升了术中截骨、假体置入的精确性和个性化;术后下肢力线恢复、临床效果不劣于传统全膝关节置换,具有较好的应用前景。
BACKGROUND:With the rise of robotic-assisted total knee arthroplasty,its advantages in implant positioning accuracy have garnered significant attention.However,current evidence remains inconclusive regarding whether robotic-assisted total knee arthroplasty is superior to conventional total knee arthroplasty in improving postoperative joint range of motion,prosthesis revision rates,limb alignment,and patient satisfaction.OBJECTIVE:To investigate the differences in clinical function and radiographic outcomes between Mako robotic-assisted total knee arthroplasty and conventional total knee arthroplasty,as well as their clinical significance.METHODS:A retrospective analysis was conducted on 66 osteoarthritis patients who underwent Mako robotic-assisted total knee arthroplasty(robotic-assisted group)at the China-Japan Friendship Hospital between January 2023 and September 2024.A matched cohort of 59 patients who underwent conventional total knee arthroplasty(conventional total knee arthroplasty group)was selected based on age,gender,and body mass index.The operation time,blood loss,tourniquet usage time,and clinical outcomes of the two groups before,and 3,6,and 12 months after surgery were recorded,including Hospital for Special Surgery knee score,Western Ontario and McMaster Universities Osteoarthritis Index,Knee Society Score(functional score),and knee range of motion.Fulllength X-rays of both lower limbs in the anteroposterior weight-bearing position were taken before and 1 week after surgery,and the hip-knee-ankle angle,valgus correction angle,lateral distal femoral angle,lateral proximal femoral angle,and medial proximal tibial angle were measured and compared between both groups of patients.RESULTS AND CONCLUSION:(1)The robotic-assisted group had a longer operative time but a shorter tourniquet time compared with the conventional total knee arthroplasty group,with comparable blood loss between groups.(2)At one week postoperatively,range of motion improved in both groups,with a slightly greater improvement in the conventional total knee arthroplasty group(P>0.05).(3)Hospital for Special Surgery scores indicated similar functional improvements postoperatively,with no significant differences(P>0.05).At one year,the robotic-assisted group had significantly higher Knee Society Score function scores compared with the conventional total knee arthroplasty group(P<0.05).Western Ontario and McMaster Universities Osteoarthritis Index scores showed improvements in both groups,but the robotic-assisted group had superior outcomes at six months and one year compared with the conventional total knee arthroplasty group(P<0.05).(4)Radiographic analysis demonstrated improved lower limb alignment and optimal prosthesis positioning in all patients,with no severe adverse events during follow-up.(5)Imaging measurement displayed that the robotic-assisted group showed significant improvements in hip-knee-ankle angle,medial proximal tibial angle,and lateral proximal femoral angle postoperatively(P<0.05),whereas valgus correction angle and lateral distal femoral angle remained unchanged(P>0.05).In the conventional total knee arthroplasty group,hip-knee-ankle angle and medial proximal tibial angle significantly improved(P<0.05),while valgus correction angle,lateral proximal femoral angle,and lateral distal femoral angle remained unchanged(P>0.05).No significant differences were observed in postoperative radiographic indices between the two groups(P>0.05).Except for valgus correction angle and lateral proximal femoral angle,the preoperative and postoperative changes in other values were not significantly different(P>0.05).(6)The incidence of postoperative complications was not significantly different between groups(P>0.05).(7)These findings suggest that Mako roboticassisted total knee arthroplasty offers superior intraoperative precision in angular alignment,limb axis correction,and soft tissue balancing compared with conventional total knee arthroplasty,enhancing the accuracy and personalization of bone resection and implant placement.Postoperative lower limb alignment and clinical outcomes were non-inferior to conventional total knee arthroplasty,demonstrating promising potential for broader clinical application.
作者
刘浩洋
李宏旭
周宇
岳德波
王佰亮
马金辉
Liu Haoyang;Li Hongxu;Zhou Yu;Yue Debo;Wang Bailiang;Ma Jinhui(China-Japan Friendship School of Clinical Medicine,Peking University,Beijing 100029,China;Department of Orthopedic Surgery,China-Japan Friendship Hospital,Beijing 100029,China)
出处
《中国组织工程研究》
北大核心
2026年第15期3936-3945,共10页
Chinese Journal of Tissue Engineering Research
基金
首都医科大学教育教学改革研究课题(2023JYY388),项目负责人:马金辉
中央高水平医院临床科研业务费,中日友好医院“菁英计划”人才培育工程项目(ZRJY2021-TD01),项目负责人:王佰亮。
关键词
机器人辅助
全膝关节置换
影像学
下肢力线
活动度
膝关节功能
robotic-assisted
total knee arthroplasty
imaging
lower limb alignment
range of motion
knee joint function
