探讨机器人辅助导航技术在重度髋关节脱位前入路全髋关节置换术（THA）的应用策略，并评估其临床治疗的安全性和有效性。

纳入2022年10月至2023年10月南京鼓楼医院运动医学与成人重建外科收治的重度髋关节脱位（Crowe分型Ⅳ型）患者，排除患髋感染且不能耐受手术患者，共计18例，男3例，女15例，年龄23～72岁。术前应用MAKO机器人规划髋臼位置及假体型号与安放角度，股骨假体类型及型号。仰卧位以前入路暴露患髋，机械臂辅助下准备髋臼安装臼杯，手工操作扩髓、安装股骨侧假体。收集术前、术后3、6个月和1年患髋Harris功能评分并采用重复测量方差分析；记录手术时间，双下肢不等长、臼杯前倾角与外展角、手术前后红细胞压积与血红蛋白的比较采用配对t检验；记录术后不良并发症发生情况。

平均手术时间为（162.5±36.3）min，血红蛋白由术前（126.2±12.9）g/L降低至术后（109.0±10.9）g/L，红细胞压积由术前（41.2±12.0）%降至术后（33.1±3.1）%，差异均具有统计学意义（t=5.241、2.791，均为P<0.01）。双下肢不等长由术前平均（35.4±20.4）mm纠正至术后（9.6±6.2）mm。术后测量臼杯前倾角平均（19.6±4.1）°，较术前规划（14.4±1.6）°更大，外展角平均（40.3±5.1）°，较术前规划（43.8±2.6）°更小，差异均具有统计学意义（t=5.130、4.940、2.591，均为P<0.05）。术前术后偏心距差异无明显统计学意义（t=0.897，P>0.05）。股骨柄及臼杯型号术前规划与术中使用一致率100%。Harris功能评分由术前（58.2±10.8）分，术后6个月和1年分别提高至（79.9±15.9）分和（89.5±8.3）分。其中2例（11.1%）发生股骨近端骨裂，2例（11.1%）在术后发生假体后脱位，予切开复位支具固定后无复发，1例术后股神经麻痹，屈髋固定联合营养神经治疗，术后3个月症状缓解。所有患者均无切口感染、愈合不良。

机器人术前规划可个性化地为重度髋关节脱位患者选择恰当的假体类型和型号，术中辅助术者精准安装假体位置及角度。前入路方便充分松解阔筋膜张肌近端止点，利于纠正双下肢不等长。髋部的结构畸形和肌肉废用性萎缩导致的术后康复慢、脱位风险高是机器人所不能克服的问题，需要更精细的围术期软组织管理。

To investigate the application strategy of robot-assisted navigation technology in anterior approach total hip arthroplasty (THA) for severe hip dislocations and to evaluate its clinical safety and effectiveness.

Eighteen patients with severe hip dislocations (Crowe type IV), including three males and 15 females, age range was 23 to 72 years, were enrolled in the department of sports medcine and adult reconstruction, Nanjing Drum Tower Hospital from October 2022 to October 2023. The patients with joint infection on the involved side and those who were intolerant to surgery were excluded. Before surgery, the MAKO robot was used to plan the acetabular position, prosthesis type and size, and implantation angle. The prosthesis type and size were also planned based on the morphology of the proximal femur. The anterior approach was used to expose the hip in the supine position, with the acetabular cup prepared and installed under robotic arm assistance, while manual reaming and femoral prosthesis installation were performed. Data were collected on preoperative and postoperative (three and six months, one year) Harris hip function scores and evaluated by repeated measurement of variance analysis. The data of operative duration, leg length discrepancy, acetabular cup anteversion and abduction angles, preoperative and postoperative hematocrit and hemoglobin levels were analyzed by paired t test; postoperative complications were recorded.

The average operative duration was (162.5±36.3) min. Hemoglobin levels decreased from (126.2±12.9) g/L to (109.0±10.9) g/L after surgery, and hematocrit decreased from (41.2±12.0) % to (33.1±3.1) %, with statistically significant differences (t=5.241, 2.791, both P<0.01). Leg length discrepancy was corrected from an average of (35.4±20.4) mm preoperatively to (9.6±6.2) mm postoperatively. Postoperative measurements showed an average acetabular cup anteversion angle of (19.6±4.1)°, which was larger than the preoperative plan of (14.4±1.6)°, and an average abduction angle of (40.3±5.1)°, which was smaller than the preoperative plan of (43.8±2.6)°, with statistically significant differences (t=5.130, 4.940, 2.591, all P<0.05). There was no statistically significant difference in the eccentricity before and after surgery (t=0.897, P=0.130). The preoperative planning for femoral stem and acetabular cup sizes matched the intraoperative use with 100% consistency. The Harris hip function score increased from an average of (58.2±10.8) preoperatively to (79.9±15.9) at six months postoperatively and (89.5±8.3) at one year postoperatively, indicating significant improvement in hip function. Two patients (11.1%) experienced proximal femoral fractures, and two patients (11.1%) had postoperative prosthesis dislocations. One case of postoperative femoral nerve palsy was treated with hip flexion fixation combined with neurotrophic therapy. The symptoms were relieved three months after the operation. After open reduction and fixation with braces, no recurrences occurred. No patients experienced complications such as wound infection or poor wound healing.

Preoperative robotic planning aids in personalized prosthesis selection for severe hip dislocations, ensuring precise installation. The anterior approach helps release the tensor fascia lata for limb length correction. However, hip deformities and muscle atrophy may delay recovery and increase dislocation risks, necessitating detailed perioperative soft tissue management beyond robotic capabilities.