机器人辅助下膝关节单髁置换术短期临床疗效

doi:10.3877/cma.j.issn.1674-134X.2019.05.006

目的

评估机器人辅助下膝关节单髁置换术(UKA)的短期临床结果。

方法

随访评估2016年9～12月在上海交通大学附属第六人民医院接受机器人辅助下UKA治疗的10例患者，纳入标准：内侧单间隙骨关节炎；不伴严重膝关节内翻畸形；前后交叉韧带完整。其中男2例，女8例，平均年龄(65±6)岁。均采用MAKO RIO机器人手术系统和RESTORIS MCK单髁膝关节假体(STRYKERMAKO Surgical，美国)进行手术。回顾以上10例患者，对其术前及术后影像学资料，日常活动情况，美国膝关节协会评分(KSS)、遗忘关节评分(FJS)等进行记录分析。采用配对样本t检验进行统计学分析。

结果

10例患者均获得随访，随访时间平均(22.2±1.5)月。患者KSS的临床评分由术前的(58.8±13.7)分提升至末次随访的(96.0±2.8)分，功能评分由术前的(59.5±19.0)分提升至末次随访的(88.5±15.2)分，膝关节活动度由术前的(90.7±6.1)°提升至末次随访的(127.9±7.2)°(t＝－8.588，P<0.01)。FJS评分为(83±24)分，表示患者对手术膝关节的感受接近本体膝关节。10例患者的影像学评估良好，膝关节内翻畸形角度由术前的(8.8±3.5)°纠正至末次随访时的(4.0±2.0)°(t＝7.294，P<0.01)。患者假体对位对线良好，未见透亮线，未出现假体下沉、假体松动等不良事件，所有患者均未继发外侧间室的骨关节炎，关节间隙正常。

结论

机器人辅助下UKA能使假体获得良好的对位对线和软组织平衡，达到功能好、患者主观感受佳的目标，术后短期的临床疗效优异；其远期临床结果及假体生存率需要通过更长期的随访加以证实。

关键词: 骨关节炎, 关节成形术，置换，膝, 机器人手术

Objective

To assess the short-term clinical outcomes of robotic-assisted unicompartmental knee arthroplasty (UKA).

Methods

Ten patients who underwent robotic-assisted UKA treatment in Shanghai Jiao Tong University Affiliated Sixth People’s Hospital from September 2016 to December 2016 were followed up. Inclusion criteria: medial unicompartmental osteoarthritis; without severe varus deformity; integrity of anterior and posterior cruciate ligaments. There were two males and eight females, with a mean age of (65±6) years. All the procedures were performed with MAKO RIO robotic-assisted surgical system and RESTORIS MCK unicompartmental knee prosthesis (STRYKER MAKO Surgical, USA). Relevant clinical data, including patients’ preoperative and postoperative imaging data, daily activities, Knee Society scores, and the forgotten joint score were recorded and analyzed. Statistical analysis was done with paired-samples t test.

Results

All the patients were followed-up at an average time of (22.2±1.5) months. The Knee Society clinical score improved from (58.8±13.7) preoperatively to (96.0±2.8)at the last follow-up, and the functional score improved from (59.5±19.0)preoperatively to (88.5±15.2) at the last follow-up. The range of motion of the knee joint increased from (90.7±6.1) ° preoperatively to (127.9±7.2) °at the last follow-up (t=-8.588, P<0.01). The forgotten joint score was (83±24)at the latest follow-up visit, indicating that patients had feelings close to their native knee joint. The imaging findings of the 10 patients were good. The varus deformity of the knee was corrected from (8.8±3.5) ° before surgery to (4.0±2.0) °at the last follow-up (t=7.294, P<0.01). The alignment of the prosthesis was optimal and there was no radiolucent line. There was no adverse event such as prosthesis subsidence or loosening of the prosthesis. No patient had secondary osteoarthritis in the lateral compartment.

Conclusion

Robotic-assisted UKA can provide optimal prosthesis alignment and soft tissue balance, insuring good functional outcomes and native knee joint feelings for patients, which shows excellent short-term clinical outcomes; further follow-up is needed for the long-term clinical benefits.

Key words: Osteoarthritis, Arthroplasty, replacement, knee, Robotic surgical procedures

表1 患者随访结果(±s)

时间	KSS评分(分)		膝关节ROM(°)
时间	临床评分	功能评分	膝关节ROM(°)
术前	58.8±13.7	59.5±19.0	90.7±6.1
末次随访	96.0±2.8	88.5±15.2	127.9±7.2
t值	－9.095	－5.031	－11.638
P值	<0.01	<0.01	<0.01

表1 患者随访结果(±s)

时间	KSS评分(分)		膝关节ROM(°)
时间	临床评分	功能评分	膝关节ROM(°)
术前	58.8±13.7	59.5±19.0	90.7±6.1
末次随访	96.0±2.8	88.5±15.2	127.9±7.2
t值	－9.095	－5.031	－11.638
P值	<0.01	<0.01	<0.01

图1 患者对各个问题的遗忘关节评分均值示意图

图2 患者的遗忘关节评分总分示意图

图3 患者UKA(膝关节单髁置换术)术前及术后右膝关节双下肢X线片。图A、B　为术前右膝关节站立正侧位X片，图C　为术前双下肢站立位正位全长X片，可见右膝关节内侧胫股关节间隙狭窄，内侧间室退变严重；图D、E　为术后右膝关节站立正侧位X片，可见胫骨与股骨假体在位良好，未见放射透亮线；图F　为术后双下肢站立位正位全长X片，可见右膝关节内翻畸形角度得到纠正(1.94°)。图中线段表示下肢力线的测量，连接股骨头中心(a)与膝关节中心(b)构成股骨机械轴(ab)，连接膝关节中心(b)与踝关节中心(c)构成胫骨机械轴(bc)，180°减去ab和bc之间的内侧夹角即为膝关节内翻畸形角度

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