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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 123 -128. doi: 10.3877/cma.j.issn.1674-134X.2023.01.018

临床经验

机器人辅助髓芯减压术治疗股骨头坏死的效果
马瑞1, 杨佩1, 田润1, 王春生1, 王坤正1,†()   
  1. 1. 710004　西安交通大学第二附属医院骨关节外科
  • 收稿日期:2021-12-30 出版日期:2023-02-01
  • 通信作者: 王坤正

Effect of robot-assisted core decompression and bone grafting fornecrosis of femoral head

Rui Ma1, Pei Yang1, Run Tian1, Chunsheng Wang1, Kunzheng Wang1,†()   

  1. 1. Department of Bone and Joint Surgery, the Second Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710004, China
  • Received:2021-12-30 Published:2023-02-01
  • Corresponding author: Kunzheng Wang
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马瑞, 杨佩, 田润, 王春生, 王坤正. 机器人辅助髓芯减压术治疗股骨头坏死的效果[J]. 中华关节外科杂志(电子版), 2023, 17(01): 123-128.

Rui Ma, Pei Yang, Run Tian, Chunsheng Wang, Kunzheng Wang. Effect of robot-assisted core decompression and bone grafting fornecrosis of femoral head[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(01): 123-128.

目的

观察国产骨科手术机器人应用于髓芯减压植骨术治疗早期股骨头缺血性坏死的临床效果。

方法

回顾性分析2020年6月至2021年5月于西安交通大学第二附属医院骨关节外科行髓芯减压植骨术治疗早期股骨头缺血性坏死的病例共36例，国际骨循环研究会(ARCO)分期均为Ⅱ期，其中机器人辅助手术组15例，传统手术组21例，记录手术时间、导针尝试穿刺次数和透线次数，比较术前、术后3、6个月的Harris髋关节评分和视觉模拟评分(VAS)。统计学分析采用两独立样本t检验和重复测量方差分析。

结果

所有患者均成功随访，机器人组患者的手术时间(57.3±18.9)min较传统手术组(71.6±18.2)min明显缩短(t＝2.292，P<0.05)，机器人组患者的导针尝试穿刺次数、总透线次数和置入导针透线次数均较传统组明显减少(t＝6.818、4.871、4.546，均为P<0.05)，而两组在术后3个月和术后6个月的Harris评分和VAS评分差异无统计学意义(F＝0.080、0.069，均为P>0.05)。

结论

应用国产机器人辅助下髓芯减压植骨术治疗早期股骨头坏死是安全有效的，可以节省手术时间并减少医患放射线暴露。

关键词: 股骨头坏死, 骨移植, 机器人手术
Objective

To observe the effect of the domestic orthopedic robot-assisted core decompression and bone grafting surgery for early necrosis of the femoral head.

Methods

A retrospective analysis was performed on 36 cases underwent core decompression and bone grafting for early necrosis of the femoral head treated at Department of Bone and Joint Surgery, the Second Affiliated Hospital of Xi ′an Jiaotong University from June 2020 to May 2021. 15 cases underwent robot-assisted surgery, and 21 cases underwent conventional surgery. All the patients were in Association research circulation osseous (ARCO)stageⅡ. The operating times, the number of guidewire attempts and total number of intraoperative radiation exposure were recorded. The preoperative and postoperative Harris scores and VAS scores in three and six months were compared. The repeated measurements analysis of variances and t test of two independent samples were used for statistical analysis.

Results

All the patients were successfully followed up, and the operation time of the robot-assisted group (57.3±18.9) min was significantly shorter than that of the traditional group (71.6±18.2) min (t=2.292, P<0.05); compared with the traditional group, the number of guidewire attempts, the total number of intraoperative radiation exposure, and the number of radiation exposure during insertion of guidewire were significantly reduced in the robot-assisted group (t=6.818, 4.871, 4.546, all P<0.05), and there were no significant differences between the two groups in Harris score and VAS score at three and six months postoperatively (F=0.080, 0.069, both P>0.05).

Conclusion

It is safe and effective to use the domestic robot-assisted core decompression and bone grafting for the treatment of early femoral head necrosis, which can save the operation time and reduce the radiation exposure.

Key words: Femur head necrosis, Bone transplantation, Robotic surgical procedures
图1 机器人辅助组软件内进行术前规划
Figure 1 Preoperative software planning for the robot-assisted group
图2 机器人辅助组导针置入过程。图A定位，右上角小图为透视图；图B图像多模态融合，右上角为规划骨道示意图；图C置入导针；图D成功置入导针右髋关节正位透视图，右上角为右髋关节蛙式位透视图
Figure 2 The process of guidewire insertion in the robot-assisted group. A is positioning, and the small figure in the upper-right corner is the perspective figure; B is multimodal fusion, and the small figure in the upper-right corner is the schematic diagram of the bone tunnel in the robot-assisted group; C is guidewire insertion; D is the perspective figure of the right hip in the anteroposterior position after successful placement of the guidewire, and the small figure in the upper-right corner is the frog-like perspective figure of the right hip
图3 减压植骨术中用到的器械图片。图A为减压用的铰刀；图B为植骨用的漏斗套筒
Figure 3 Photos of the instruments used in the core decompression and bone grafting surgery. A is the reamer for core decompression; B is the funnel sleeve for bone grafting
表1 患者的一般资料和术中指标
Table 1 General data and intraoperative indicators of the patients
组别Group 例数Case number 年龄Age[岁，(±s)] 性别Gender(男/女)(male/female) 病程Course[个月，(±s)] 手术时间Operation time[min，(±s)] 尝试穿刺次数Number of guidewire attempts(±s) 总透线次数Number of intraoperative radiation exposure(±s) 置入导针透线次数Number of radiation exposure during guidewire insertion (±s) 减压植骨透线次数Number of radiation exposure during decompression(±s)
机器人组Robot group 15 47.7±8.9 9/6 6.0±6.4 57.3±18.9 3.0±1.2 16.1±1.7 6.1±1.6 10.1±1.3
传统组Traditional group 21 44.0±10.8 10/11 7.5±6.2 71.6±18.2 6.7±1.8 22.1±5.2 10.2±3.8 11.2±2.6
统计值   t＝1.097 － t＝0.725 t＝2.292 t＝6.818 t＝4.871 t＝4.546 t＝1.711
P值   >0.05 0.516* >0.05 0.028 <0.001 <0.001 <0.001 >0.05
表2 两组患者治疗前后的Harris评分对比(±s)
Table 2 The Harris scores of the two groups before and after treatment
组别Group 例数Case number 术前Pre-operation 术后3个月Three months after operation 术后6个月Six months after operation F值 P值
机器人组Robot group 15 57±11 77±9 88±6 219.472 <0.001
传统组Traditional group 21 59±12 76±10 87±8    
F值     0.080      
P值     >0.05      
表3 两组患者治疗前后的VAS评分对比(±s)
Table 3 The VAS scores of the two groups before and after treatment
组别Group 例数Case number 术前Pre-operation 术后3个月Three months after operation 术后6个月Six months after operation F值 P值
机器人组Robot group 15 5.2±0.9 2.0±1.1 1.1±0.8 273.261 <0.001
传统组Traditional group 21 5.1±1.3 2.0±1.0 1.4±0.9    
F值     0.069      
P值     >0.05      
图4 典型病例的影像学资料(双髋关节正位X光片，右侧股骨头坏死)。图A为术前，显示坏死病灶位于右侧股骨头；图B为术后3个月，显示右侧骨道精准到达坏死病灶，植骨满意；图C为术后6个月，显示右侧股骨头病灶愈合良好
Figure 4 X rays of typical case(anteroposterior radiographs of both hips, necrosis of the right femoral head). A is the preoperative photo that shows the necrotic lesion is located in the right femoral head; B is the postoperative photo after three months that showed the right bone tunnel reached the necrotic lesion accurately and the bone grafting is satisfactory; C is the postoperative photo after six months that showed good healing of the right femoral head lesion
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