机器人辅助治疗先天性髋关节发育不良的进展

doi:10.3877/cma.j.issn.1674-134X.2026.02.012

机器人辅助技术近年来在现代医学中发展迅速，尤其在先天性髋关节发育不良（DDH）等复杂疾病的诊疗中显示出较高应用价值。现有研究表明，该技术应用于多种髋关节手术时，能够提高术前规划的精准性，并在一定程度上降低并发症发生风险。在DDH治疗中，机器人辅助技术的主要优势体现在精准定位手术区域、优化假体植入位置、改善术后髋关节活动度、减轻双下肢长度差异、降低翻修率、促进术后康复以及维持较稳定的远期疗效等方面。与此同时，随着该技术逐步推广，其在患者隐私保护、责任界定及社会伦理层面所引发的问题也不容忽视，相关法律法规仍需进一步完善。本文综述了机器人辅助治疗在DDH领域的研究进展，总结其临床应用优势，分析当前面临的技术挑战及法律、伦理问题，并对未来发展方向进行展望，以期为突破关键技术瓶颈、提升临床应用水平及拓展相关研究提供参考，从而为患者提供更加精准、高效的治疗方案。

关键词: 机器人手术, 发育性髋关节发育不良, 临床医学, 伦理学

Robot-assisted technology has developed rapidly in modern medicine in recent years, demonstrating significant clinical value particularly in the diagnosis and treatment of complex conditions such as developmental dysplasia of the hip (DDH). Existing research indicates that when applied to various hip surgeries, this technology can enhance the accuracy of preoperative planning and, to some extent, reduce the risk of complications. In the treatment of DDH, the primary advantages of robot-assisted technology include precise localization of the surgical site, optimization of prosthesis placement, improved postoperative hip range of motion, reduction of lower limb length discrepancy, lower revision rates, promotion of postoperative rehabilitation, and maintenance of stable long-term outcomes. At the same time, as this technology becomes more widely adopted, the issues it raises regarding patient privacy protection, liability determination, and social ethics cannot be overlooked, and relevant laws and regulations still require further refinement. This article reviewed research progress in robot-assisted treatment for DDH, summarized its clinical advantages, analyzed current technical challenges as well as legal and ethical issues, and outlined future development directions. It aimed to provide guidance for overcoming key technical bottlenecks, enhancing clinical application standards, and expanding related research, thereby offering patients more precise and efficient treatment options.

Key words: Robot-assisted surgery, Developmental dysplasia of the hip, Clinical medicine, Ethics, medical

表1 机器人辅助与传统THA的对比

Table 1 Comparison between robotic-assisted and conventional THA

研究比较	机器人辅助THA	传统THA
髋臼杯定位准确性^［21］	96.3%（P<0.001）	37%（P<0.001）
假体位置变异风险（髋关节中心重建精度）^［34］	水平距离：（3.5±2.8）mm 垂直距离：（6.4±4.1）mm	水平距离：（5.4±4.9）mm 垂直距离：（11.7±8.2）mm
患者术后评分（手术时间、术中出血量）^［33］	手术时间较长（126 min）术前术后血红蛋白差异较小（-29.34 g/L）	手术时间较短（108 min）术前术后血红蛋白差异较大（-30.27 g/L）
术后运动功能（Harris评分）^［29］	86分（P<0.001）	29分（P<0.001）
围手术期并发症发生率^［42］	5.71%	56.76%

表1 机器人辅助与传统THA的对比

Table 1 Comparison between robotic-assisted and conventional THA

研究比较	机器人辅助THA	传统THA
髋臼杯定位准确性^［21］	96.3%（P<0.001）	37%（P<0.001）
假体位置变异风险（髋关节中心重建精度）^［34］	水平距离：（3.5±2.8）mm 垂直距离：（6.4±4.1）mm	水平距离：（5.4±4.9）mm 垂直距离：（11.7±8.2）mm
患者术后评分（手术时间、术中出血量）^［33］	手术时间较长（126 min）术前术后血红蛋白差异较小（-29.34 g/L）	手术时间较短（108 min）术前术后血红蛋白差异较大（-30.27 g/L）
术后运动功能（Harris评分）^［29］	86分（P<0.001）	29分（P<0.001）
围手术期并发症发生率^［42］	5.71%	56.76%

［1］	叶灿华, 陈峰, 钱文伟, 等. 成人型髋关节发育不良的分型与治疗［J］. 中华骨与关节外科杂志, 2017, 10（1）: 70-75.
［2］	Nissen T, Douw K, Overgaard S. Patient-reported outcome of hip resurfacing arthroplasty and standard total hip replacement after short-term follow-up［J］. Dan Med Bull, 2011, 58（10）: A4310.
［3］	Peters V AW, Harris TJ, Rinehart DB, et al. Technical trick: traction table–assisted lateral decubitus patient positioning in cephalomedullary nailing of geriatric intertrochanteric femur fractures［J］. J Orthop Trauma, 2024, 38（2）: e71-e77.
［4］	何宜蓁, 耿霄, 田华. 机器人辅助髋膝关节置换术的应用现状及趋势分析［J］. 中华骨与关节外科杂志, 2023, 16（4）: 378-384.
［5］	van Bosse H, Wedge JH, Babyn P. How are dysplastic hips different a three-dimensional CT study［J］. Clin Orthop Relat Res, 2015, 473（5）: 1712-1723.
［6］	Hepinstall M, Mota F, Naylor B, et al. Robotic-assisted total hip arthroplasty in patients who have developmental hip dysplasia［J/OL］. Surg Technol Int, 2021, 39: 338-347. DOI: 10.52198/21.sti.39.os1454.
［7］	Kouyoumdjian P, Mansour J, Assi C, et al. Current concepts in robotic total hip arthroplasty［J/OL］. SICOT J, 2020, 6: 45. DOI: 10.1051/sicotj/2020041.
［8］	Lee Y-K, Biau DJ, Yoon B-H, et al. Learning curve of acetabular cup positioning in total hip arthroplasty using a cumulative summation test for learning curve（LC-CUSUM）［J］. J Arthroplasty, 2014, 29（3）: 586-589.
［9］	Lim S-J, Ko K-R, Park C-W, et al. Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study［J］. Comput Aided Surg, 2015, 20（1）: 41-46.
［10］	孙锡玮, 吴青杰, 管之也, 等. 超声人工智能辅助诊断发育性髋关节发育不良［J］. 中华骨科杂志, 2022, 42（16）: 1084-1092.
［11］	Sicat CS, Buchalter DB, Luthringer TA, et al. Intraoperative technology use improves accuracy of functional safe zone targeting in total hip arthroplasty［J］. J Arthroplasty, 2022, 37（7）: S540-S545.
［12］	许固军, 马明阳, 张帅, 等. Mako机器人辅助人工全髋关节置换术在发育性髋关节发育不良中的应用［J］. 中国修复重建外科杂志, 2021, 35（10）: 1233-1239.
［13］	Wu L, Yang XC, Wu J, et al. Short-term outcome of artificial intelligence-assisted preoperative three-dimensional planning of total hip arthroplasty for developmental dysplasia of the hip compared to traditional surgery［J］. Jt Dis Relat Surg, 2023, 34（3）: 571-582.
［14］	Andrade AO, Pereira AA, Walter S, et al. Bridging the gap between robotic technology and health care［J］. Biomed Signal Process Control, 2014, 10: 65-78.
［15］	张纪, 邵宏翊, 邓旺, 等. 机器人辅助技术在髋臼骨折后全髋关节置换术中的应用研究［J］. 中华骨与关节外科杂志, 2022, 15（8）: 598-604.
［16］	Wen Z, Yang YX, Yu S, et al. KangDuo surgical robot versus da Vinci robotic system in urologic surgery: a systematic review and meta-analysis［J/OL］. J Rob Surg, 2024, 19（1）: 6. DOI: 10.1007/s11701-024-02165-5.
［17］	袁博, 李开南, 贾子善. 不同模式平衡障碍康复机器人训练老年全髋关节置换后的效果比较［J］. 中国组织工程研究, 2022, 26（36）: 5826-5830.
［18］	王章宇, 廖军义, 程强, 等. 加速康复下机器人辅助全髋关节置换术与传统全髋关节置换术的早期临床效果比较［J］. 中华骨与关节外科杂志, 2022, 15（8）: 584-590.
［19］	Hecht CJ, Nedder VJ, Porto JR, et al. Are robotic-assisted and computer-navigated total hip arthroplasty associated with superior outcomes in patients who have hip dysplasia［J］. J Orthop, 2024, 53: 125-132.
［20］	Guo DH, Li XM, Ma SQ, et al. Total hip arthroplasty with robotic arm assistance for precise cup positioning: a case-control study［J］. Orthop Surg, 2022, 14（7）: 1498-1505.
［21］	Chai W, Xu C, Guo RW, et al. Does robotic-assisted computer navigation improve acetabular cup positioning in total hip arthroplasty for Crowe III/IV hip dysplasia A propensity score case-match analysis［J］. Int Orthop, 2022, 46（4）: 769-777.
［22］	Callanan MC, Jarrett B, Bragdon CR, et al. The john charnleyaward: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital［J］. Clin Orthop Relat Res, 2011, 469（2）: 319-329.
［23］	Domb BG, El Bitar YF, Sadik AY, et al. Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study［J］. Clin Orthop Relat Res, 2014, 472（1）: 329-336.
［24］	马鹏程, 张思平, 柴浩, 等. 机器人辅助与传统全髋关节置换术疗效比较的Meta分析［J/OL］. 中华关节外科杂志（电子版）, 2022, 16（3）: 329-336.
［25］	Marcinko M, Sadhwani S, Dahl R, et al. The practicality of the robotic total hip arthroplasty for the treatment of complex bilateral adult hip dysplasia. technology makes it easy［J/OL］. Arthroplasty Today, 2023, 24: 101249. DOI: 10.1016/j.artd.2023.101249.
［26］	廖星宇, 张云峰, 周一新, 等. 手术机器人对关节重建术的重构: 从经验型到解析型［J］. 中华医学杂志, 2025, 105（17）: 1297-1302.
［27］	Nodzo SR, Chang C-C, Carroll KM, et al. Intraoperative placement of total hip arthroplasty components with robotic-arm assisted technology correlates with postoperative implant position: a CT-based study［J］. Bone Jt J, 2018, 100-B（10）: 1303-1309.
［28］	贾健. 骨科定位机器人在骨盆髋臼骨折手术治疗中的应用［J］. 中华骨科杂志, 2023, 43（19）: 1334-1342.
［29］	Vigdorchik JM, Sharma AK, Aggarwal VK, et al. The use of robotic-assisted total hip arthroplasty in developmental dysplasia of the hip［J］. Arthroplasty Today, 2020, 6（4）: 770-776.
［30］	El Bitar YF, Jackson TJ, Lindner D, et al. Predictive value of robotic-assisted total hip arthroplasty［J/OL］. Orthopedics, 2015, 38（1）: e31-7. DOI: 10.3928/01477447-20150105-57.
［31］	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 Jt J, 2018, 100-B（7）: 930-937.
［32］	Kort N, Stirling P, Pilot P, et al. Clinical and surgical outcomes of robot-assisted versus conventional total hip arthroplasty: a systematic overview of meta-analyses［J］. EFORT Open Rev, 2021, 6（12）: 1157-1165.
［33］	Shi H, Yu R, Pu L, et al. Application and exploration of total hip arthroplasty for developmental dysplasia of the hip assisted by full-process robotics［J/OL］. BMC Musculoskelet Disord, 2025, 26（1）: 225. DOI: 10.1186/s12891-025-08460-y.
［34］	Zhang S, Ma M, Kong X, et al. Robotic-assisted total hip arthroplasty in patients with developmental dysplasia of the hip［J］. Int Orthop, 2024, 48（5）: 1189-1199.
［35］	郭人文, 孔祥朋, 宋平, 等. CroweⅣ型髋关节发育不良的机器人辅助全髋关节置换术两例报告［J］. 骨科, 2021, 12（2）: 180-182.
［36］	Kayani B, Konan S, Ayuob A, et al. The current role of robotics in total hip arthroplasty［J］. EFORT Open Rev, 2019, 4（11）: 618-625.
［37］	张帅, 刘成, 孔祥朋, 等. 机器人辅助全髋关节置换术的临床疗效［J］. 中华骨科杂志, 2023, 43（17）: 1137-1145.
［38］	王鑫光, 何宜蓁, 董子漾, 等. 机器人辅助与常规全髋关节置换术早期疗效及患者满意度的比较［J］. 中华骨科杂志, 2023, 43（8）: 492-499.
［39］	Dawod MS, Alswerki MN, Haddad BI, et al. Intraoperative blood loss and haemoglobin drop in patients with developmental dysplasia of the hip in Jordan undergoing total hip arthroplasty［J］. Int Orthop, 2023, 47（12）: 2933-2940.
［40］	Ross D, Erkocak O, Rasouli MR, et al. Operative time directly correlates with blood loss and need for blood transfusion in total joint arthroplasty［J］. Arch Bone Jt Surg, 2019, 7（3）: 229-234.
［41］	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（1）: 19-26.
［42］	Chai W, Kong X, Yang M, et al. Robot-assisted total hip arthroplasty for arthrodesedhips［J］. Ther Clin Risk Manag, 2020, 16: 357-368.
［43］	Griffin J, Davis ET, Parsons H, et al. UK robotic arthroplasty clinical and cost effectiveness randomised controlled trial for hips（RACER-Hip）: a study protocol［J/OL］. BMJ Open, 2023, 13（10）: e079328. DOI: 10.1136/bmjopen-2023-079328.
［44］	Hadley CJ, Grossman EL, Mont MA, et al. Robotic-assisted versus manually implanted total hip arthroplasty: a clinical and radiographic comparison［J］. SurgTechnolInt, 2020, 37: 371-376.
［45］	Khatri C, Metcalfe A, Wall P, et al. Robotic trials in arthroplasty surgery: design of the RACER studies and implications for the future［J］. Bone Joint J, 2024, 106-B（2）: 114-120.
［46］	王磊, 顾慧丽, 张彤, 等. 医疗服务机器人在医院多场景应用SWOT分析［J］. 科学与信息化, 2025（14）: 154-156.
［47］	Chatterjee S, Das S, Ganguly K, et al. Advancements in robotic surgery: innovations, challenges and future prospects［J/OL］. J Rob Surg, 2024, 18（1）: 28. DOI: 10.1007/s11701-023-01801-w.
［48］	Novriansyah R, Respati DRP, Tjandra KC, et al. Robotic vs manual and navigated approaches for total hip arthroplasty in hip dysplasia: a systematic review and network meta-analysis［J］. Asian J Surg, 2026, 49（4）: 1909-1921.
［49］	Aguzzi J, Costa C, Calisti M, et al. Research trends and future perspectives in marine biomimicking robotics［J/OL］. Sensors, 2021, 21（11）: 3778. DOI: 10.3390/s21113778.
［50］	Neitzke CC, O’Donnell JA, Buchalter DB, et al. Robotic-assisted versus manual total hip arthroplasty performed for hip dysplasia［J］. J Am Acad Orthop Surg, 2026, 34（5）: e747-e756.
［51］	Cresswell K, Cunningham-Burley S, Sheikh A. Health care robotics: qualitative exploration of key challenges and future directions［J/OL］. J Med Internet Res, 2018, 20（7）: e10410. DOI: 10.2196/10410.
［52］	Zora H, Bayrak G, Bilgen ÖF. Robotically assisted vs. manual total hip arthroplasty in developmental hip dysplasia: a comparative analysis of radiological and functional outcomes［J/OL］. J Clin Med, 2025, 14（2）: 509. DOI: 10.3390/jcm14020509.
［53］	王硕, 文侃骁, 刘天语, 等. 医疗机器人的伦理风险与治理探析——基于“医−患−机”分析框架［J］. 医学与哲学, 2023, 44（23）: 16-21.
［54］	刘星, 吴影, 李洋, 等. 人工智能医疗器械应用中的伦理问题分析［J］. 中国临床药理学与治疗学, 2021, 26（6）: 695-699.
［55］	谭璐, 刘小红. “人−机”医疗模式下的伦理学问题及应对策略［J］. 中国医学伦理学, 2019, 32（9）: 1127-1131.
［56］	Elendu C, Amaechi DC, Elendu TC, et al. Ethical implications of AI and robotics in healthcare: a review［J/OL］. Medicine, 2023, 102（50）: e36671. DOI: 10.1097/md.0000000000036671.
［57］	Shentu X. A review on legal issues of medicalrobots［J/OL］. Medicine, 2024, 103（21）: e38330. DOI: 10.1097/md.0000000000038330.
［58］	Yang GZ, Cambias J, Cleary K, et al. Medical robotics—regulatory, ethical, and legal considerations for increasing levels of autonomy［J/OL］. Sci Robot, 2017, 2（4）: eaam8638. DOI: 10.1126/scirobotics.aam8638.
［59］	Hamet P, Tremblay J. Artificial intelligence in medicine［J］. Metabolism, 2017, 69: S36-S40.
［60］	Sung J. Artificial intelligence in medicine: Ethical, social and legal perspectives［J］. Ann Acad Med Singap, 2023, 52（12）: 695-699.
［61］	Naik N, Zeeshan Hameed BM, Shetty DK, et al. Legal and ethical consideration in artificial intelligence in healthcare: who takes responsibility［J/OL］. Front Surg, 2022, 9: 862322. DOI: 10.3389/fsurg.2022.862322.
［62］	Boninger ML, Field-Fote EC, Kirshblum SC, et al. Research progress from the SCI Model Systems（SCIMS）: an interactive discussion on future directions［J］. J Spinal Cord Med, 2018, 41（2）: 216-222.
［63］	Chua KSG, Kuah CWK. Innovating with rehabilitation technology in the real world: promises, potentials, and perspectives［J］. Am J Phys Med Rehabil, 2017, 96（10）: S150-S156.
［64］	Huang PC, Hsieh Y-W, Wang C-M, et al. Predictors of motor, daily function, and quality-of-life improvements after upper-extremity robot-assisted rehabilitation in stroke［J］. Am J Occup Ther, 2014, 68（3）: 325-333.
［65］	Alabdulkareem A, Alhakbani N, Al-Nafjan A. A systematic review of research on robot-assisted therapy for children with autism［J/OL］. Sensors, 2022, 22（3）: 944. DOI: 10.3390/s22030944.
［66］	Tate DG, Boninger ML, Jackson AB. Future directions for spinal cord injury research: recent developments and model systems contributions［J］. Arch Phys Med Rehabil, 2011, 92（3）: 509-515.
［67］	White M, Vining Radomski M, Finkelstein M, et al. Assistive/socially assistive robotic platform for therapy and recovery: patient perspectives［J/OL］. Int J Telemed Appl, 2013, 2013: 948087. DOI: 10.1155/2013/948087.

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Advances in robotic-assisted treatment for developmental dysplasia of hip

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Advances in robotic-assisted treatment for developmental dysplasia of hip