机器人辅助全膝关节置换术治疗严重内翻畸形膝骨关节炎的疗效研究

作者	单位	邮编
祁师亮^*	华中科技大学同济医学院附属武汉普爱医院（武汉市第四医院）关节外科，湖北武汉，430033	430033
韩乐奇	江汉大学医学部，湖北武汉，430056	430056
杨开祥	华中科技大学同济医学院附属武汉普爱医院（武汉市第四医院）关节外科，湖北武汉，430033	430033
王俊文^*	华中科技大学同济医学院附属武汉普爱医院（武汉市第四医院）关节外科，湖北武汉，430033	430033

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中文摘要:

目的探讨机器人辅助全膝关节置换术（robotic-assisted total knee arthroplasty, RATKA）在治疗严重内翻畸形膝骨关节炎中的应用价值，评估其术后效果及对下肢力线恢复的影响。方法回顾性分析2023年2月至2024年10月在华中科技大学同济医学院附属武汉普爱医院接受膝关节置换术的58例患者，其中机器人组31例，传统组27例。机器人组采用天玑机器人辅助进行全膝关节置换术（total knee arthroplasty, TKA），传统组接受传统TKA。比较两组患者术后住院天数、手术时间、切口长度、术中出血量、引流量、血红蛋白差值等围术期指标，比较两组术前及术后髋-膝-踝角（hip-knee-ankle, HKA）偏移、股骨机械轴远端外侧角（mechanical lateral distal femur angle, mLDFA）、胫骨机械轴近端内侧角（mechanical medial proximal tibial angle, mMPTA）、胫骨平台后倾角（lateral tibia component, LTC），比较两组术前及术后末次随访膝关节协会评分（knee society score, KSS）、视觉模拟量表（visual analogue score, VAS）、遗忘关节评分（forgotten joint score, FJS）及膝关节活动度（range of motion, ROM）。结果本研究所有患者随访时间3 ～ 26个月，平均随访时间（12.6±6.5）个月。机器人组手术时间显著长于传统组，且切口长度更大（P＜0.05）；但术中出血量、术后住院天数及引流量等其他围术期指标比较，差异无统计学意义（P＞0.05）。机器人组术后HKA偏移显著低于传统组（P＜0.05），且术后HKA偏移、mLDFA和mMPTA评价为“优”的比例明显高于传统组（P＜0.05），“差”的比例显著低于传统组（P＜0.05）。机器人组的术后LTC角度更接近理想值3°，与传统组相比差异有统计学意义（P＜0.05）。两组术后KSS评分、VAS评分及ROM均较术前改善，但组间差异无统计学意义（P＞0.05）。结论 RATKA在严重内翻畸形膝关节患者的治疗中能够显著提高下肢对线的精准度，获得更好的影像学结果。此外，RATKA在术前规划和术中操作方面能够减轻术者的负担，提高手术精度与稳定性，具备较高的临床应用价值。

英文摘要:

Objective To explore the application value of robotic-assisted total knee arthroplasty (RATKA) in the treatment of severe varus deformity in osteoarthritis of the knee and to evaluate its postoperative effects and impact on lower limb alignment.Methods A retrospective analysis was performed on 58 patients who underwent knee arthroplasty at Wuhan Pu'ai Hospital, Tongji Medical College, between February 2023 and October 2024. Among them, 31 patients underwent robotic-assisted total knee arthroplasty (RATKA) using the TiRobot system, and 27 patients underwent conventional TKA. Perioperative outcomes, including postoperative hospital stay, operative time, incision length, intraoperative blood loss, drainage volume, and hemoglobin changes were compared. Preoperative and postoperative evaluations of hip-knee-ankle angle (HKA), mechanical lateral distal femur angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and lateral tibial component angle (LTC) were analyzed. Additionally, Knee Society Score (KSS), visual analogue scale (VAS), forgotten joint score (FJS), and range of motion (ROM) were assessed preoperatively and at the final follow-up.Results All patients in this study were followed up for 3 to 26 months, with a mean follow-up of (12.6±6.5) months. The surgical duration in the robotic group was significantly longer than that in the conventional group, and the incision length was longer (P<0.05). However, there were no significant differences in intraoperative blood loss, postoperative hospital stay, or drainage volume between the two groups (P>0.05). Postoperative HKA was significantly lower in the robotic group than in the conventional group (P<0.05). The proportion of patients rated as "excellent" for postoperative HKA deviation, mLDFA, and mMPTA was significantly higher in the robotic group (P<0.05), while the proportion rated as "poor" was significantly lower (P<0.05). The postoperative LTC angle in the robotic group was closer to the ideal value of 3°, with a statistically significant difference compared to the conventional group (P<0.05). Postoperative KSS scores, VAS scores and ROM improved in both groups compared to the preoperative period, but there were no significant differences between the groups (P>0.05).Conclusion RATKA can significantly improve the accuracy of lower limb alignment and achieve better imaging results in the treatment of patients with severe varus deformity of the knee. Additionally, RATKA can reduce the surgeon's workload in preoperative planning and intraoperative procedures, improve the precision and stability of the surgery, and demonstrate high clinical application value.

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