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

[1]	王斌，邢丹，董圣杰，等．中国膝骨关节炎流行病学和疾病负担的系统评价[J]．中国循证医学杂志，2018，18(2)：134-142.
[2]	Liddle AD, Pandit H, Judge A, et al. Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14076 matched patients from the National Joint Registry for England and Wales[J]. Bone Joint J, 2015, 97B(6): 793-801.
[3]	Shankar S, Tetreault MW, Jegier BJ, et al. A cost comparison of unicompartmental and total knee arthroplasty[J]. Knee, 2016, 23(6): 1016-1019
[4]	Lyons MC, Macdonald SJ, Somerville LE, et al. Unicompartmental versus total knee arthroplasty database analysis: is there a winner？[J]. Clin Orthop Relat Res, 2012, 470(1): 84-90.
[5]	Autorino R, Kaouk JH, Stolzenburg J, et al. Current status and future directions of robotic Single-Site surgery: a systematic review[J]. Eur Urol, 2013, 63(2): 266-280.
[6]	Maeso S, Reza M, Mayol JA, et al. Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis[J]. Ann Surg, 2010, 252(2): 254-262.
[7]	Jacofsky DJ, Allen M. Robotics in arthroplasty: a comprehensive review[J]. J Arthroplasty, 2016, 31(10): 2353-2363.
[8]	Lonner JH, Moretti VM. The evolution of Image-Free robotic assistance in unicompartmental knee arthroplasty[J]. Am J Orthop (Belle Mead NJ), 2016, 45(4): 249-254.
[9]	Lonner JH. Robotically assisted unicompartmental knee arthroplasty with a handheld image-free sculpting tool[J]. Orthop Clin North Am, 2016, 47(1): 29-40.
[10]	王俏杰，柴伟，王琦．机器人辅助下膝关节单髁置换术初步临床结果[J]．中华解剖与临床杂志，2017，22(2)：108-115.
[11]	Odum SM, Fehring TK, Knee Soc Crosswalk Writing Grp. Can original knee society scores be used to estimate new 2011 knee society scores？[J]. Clin Orthop Relat Res, 2017, 475(1): 160-167.
[12]	Behrend H, Giesinger K, Giesinger JM, et al. The "forgotten joint" as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure[J]. J Arthroplasty, 2012, 27(3): 430-436.e1.
[13]	王一鸣，王琦，张先龙．膝关节单髁置换术的适应证及远期疗效综述[J/CD]．中华关节外科杂志(电子版)，2016，10(3)：341-346.
[14]	Siman H, Kamath AF, Carrillo N, et al. Unicompartmental knee arthroplasty vs total knee arthroplasty for medial compartment arthritis in patients older than 75 years: comparable reoperation, revision, and complication rates[J]. J Arthroplasty, 2017, 32(6): 1792-1797.
[15]	Heller S, Fenichel I, Salai M, et al. The Oxford unicompartmental knee prosthesis for the treatment of medial compartment knee disease: 2 to 5 year follow-up[J]. Isr Med Assoc J, 2009, 11(5): 266-268.
[16]	Koskinen E, Eskelinen A, Paavolainen P, et al. Comparison of survival and cost-effectiveness between unicondylar arthroplasty and total knee arthroplasty in patients with primary osteoarthritis: a follow-up study of 50，493 knee replacements from the Finnish Arthroplasty Register[J]. Acta Orthop, 2008, 79(4): 499-507.
[17]	Robertsson O, Knutson K, Lewold S, et al. The routine of surgical management reduces failure after unicompartmental knee arthroplasty[J]. J Bone Joint Surg Br, 2001, 83(1): 45-49.
[18]	Batailler C, White N, Ranaldi FM, et al. Improved implant position and lower revision rate with robotic-assisted unicompartmental knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1232-1240.
[19]	Pearle AD, Van Der List JP, Lee L, et al. Survivorship and patient satisfaction of robotic-assisted medial unicompartmental knee arthroplasty at a minimum two-year follow-up[J]. Knee, 2017, 24(2): 419-428.
[20]	Baker PN, Jameson SS, Deehan DJ, et al. Mid-term equivalent survival of medial and lateral unicondylar knee replacement: an analysis of data from a National Joint Registry[J]. J Bone Joint Surg Br, 2012, 94(12): 1641-1648.
[21]	Hamilton WG, Ammeen DJ, Hopper RH. Mid-term survivorship of minimally invasive unicompartmental arthroplasty with a fixed-bearing implant: revision rate and mechanisms of failure[J]. J Arthroplasty, 2014, 29(5): 989-992.
[22]	Liebs TR, Herzberg W. Better quality of life after medial versus lateral unicondylar knee arthroplasty[J]. Clin Orthop Relat Res, 2013, 471(8): 2629-2640.
[23]	Lim HC, Bae JH, Song SH, et al. Oxford phase 3 unicompartmental knee replacement in Korean patients[J]. J Bone Joint Surg Br, 2012, 94(8): 1071-1076.
[24]	Pandit H, Jenkins C, Gill HS, et al. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases[J]. J Bone Joint Surg Br, 2011, 93(2): 198-204.
[25]	付君，柴伟，倪明，等．机器人与牛津单髁膝关节置换术的学习曲线对比研究[J/CD]．中华关节外科杂志(电子版)，2017，11(6)：575-581.
[26]	Kang KT, Son J, Koh YG, et al. Effect of femoral component position on biomechanical outcomes of unicompartmental knee arthroplasty[J]. Knee, 2018, 25(3): 491-498.
[27]	Dossett HG, Estrada NA, Swartz GJ, et al. A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results[J]. Bone Joint J, 2014, 96-b (7): 907-913.
[28]	Tsukada S, Fujii T, Wakui M. Impact of soft tissue imbalance on knee flexion angle after posterior stabilized total knee arthroplasty[J]. J Arthroplasty, 2017, 32(8): 2399-2403.
[29]	Canetti R, Batailler C, Bankhead C, et al. Faster return to sport after robotic-assisted lateral unicompartmental knee arthroplasty: a comparative study[J]. Arch Orthop Trauma Surg, 2018, 138(12): 1765-1771.
[30]	Carlson VR, Post ZD, Orozco FR, et al. When does the knee feel normal again: a cross-sectional study assessing the forgotten joint score in patients after total knee arthroplasty[J]. J Arthroplasty, 2018, 33(3): 700-703.
[31]	Zuiderbaan HA, Van Der List JP, Khamaisy S, et al. Unicompartmental knee arthroplasty versus total knee arthroplasty: which type of artificial joint do patients forget？[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 681-686.
[32]	郭万首．单髁关节置换术影像学评价[J/CD]．中华关节外科杂志(电子版)，2015，9(5)：640-643.
[33]	Schilcher J, Palm L, Ivarsson I, et al. Local bisphosphonate reduces migration and formation of radiolucent lines adjacent to cemented acetabular components[J]. Bone Joint J, 2017, 99B(3): 317-324.
[34]	Voss F, Sheinkop MB, Galante JO, et al. Miller-Galante unicompartmental knee arthroplasty at 2-to 5-year follow-up evaluations[J]. J Arthroplasty, 1995, 10(6): 764-771.
[35]	Lisowski LA, Van DM, Pilot P, et al. Oxford phase 3 unicompartmental knee arthroplasty：medium-term results of a minimally invasive surgical procedure[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(2): 277-284.

[1]	许银峰, 盛璞义, 余世明, 张阳春. 偏心性髋臼旋转截骨术治疗发育性髋关节发育不良[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 568-574.
[2]	刘鹏, 罗天, 许珂媛, 邓红美, 李瑄, 唐翠萍. 八段锦对膝关节炎疗效的初步步态分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 590-595.
[3]	苏介茂, 齐岩松, 王永祥, 魏宝刚, 马秉贤, 张鹏飞, 魏兴华, 徐永胜. 关节镜手术在早中期膝骨关节炎治疗的应用进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 646-652.
[4]	谢佳乐, 李琦, 芦升升, 姜劲松. 内侧膝骨关节炎伴胫股关节冠状半脱位的手术治疗[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 653-657.
[5]	任俊筱, 浦路桥, 王志豪, 施洪鑫, 刘爱峰, 齐保闯, 徐永清, 李川. 机器人辅助全膝关节置换术的临床疗效对照研究[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 469-476.
[6]	李志文, 李远志, 李华, 方志远. 糖皮质激素治疗膝骨关节炎疗效的网状Meta分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 484-496.
[7]	许亚龙, 巩栋, 陈晓涛. 超前镇痛在全膝关节置换术中的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 517-523.
[8]	王振宇, 张洪美, 荆琳, 何名江, 闫奇. 膝骨关节炎相关炎症因子与血浆代谢物间的因果关系及中介效应[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 467-473.
[9]	王振宁, 杨康, 王得晨, 邹敏, 归明彬, 王雅楠, 徐明. 机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 437-442.
[10]	嵇晋, 吴胜文, 姜明瑞, 汪刘华, 王伟, 任俊, 王道荣, 马从超. 三种方式关闭盆底联合改良造口在直肠癌腹会阴联合切除术的对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 406-410.
[11]	孙昭, 刘琪, 王殿琛, 姜建武, 符洋. 机器人对比腹腔镜及开放式腹股沟疝修补术的Meta 分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 588-598.
[12]	刘明昊, 李晨, 王冰, 万政, 田文. 机器人与腹腔镜食管裂孔疝修补术对比研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(04): 376-382.
[13]	魏孔源, 仵正, 王铮, 黎韡. 机器人胰腺中段切除后远端胰腺消化道不同重建方式初探[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(05): 295-300.
[14]	曾纪晓, 徐晓钢, 王欣星, 刘斐, 兰梦龙, 陶波圆, 梁子建, 叶志华, 罗媛圆. 达芬奇机器人辅助Swenson-like巨结肠根治术[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(04): 239-243.
[15]	高广涵, 张耀南, 石磊, 王林, 王飞, 郑子天, 王鸿禹, 郭民政, 薛庆云. 膝骨关节炎患者前交叉韧带功能影像学影响因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 301-307.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Short-term clinical outcomes of robotic-assisted unicompartmentalknee arthroplasty

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Short-term clinical outcomes of robotic-assisted unicompartmentalknee arthroplasty