机器人辅助小切口后路全髋关节置换术治疗股骨头坏死的临床效果

Clinical efficacy of robot-assisted mini-incision posterior tatal hip arthroplasty in the treatment of osteonecrosis of the femoral head

摘要

目的 比较小切口后路MAKO机器人辅助人工全髋关节置换术（THA）与传统手工小切口后路THA治疗股骨头坏死（ONFH）患者中的短期疗效并分析MAKO机器人在小切口THA手术的注册特点及学习曲线和优势。方法 收集2025年1月至2025年6月在首都医科大学附属北京积水潭医院矫形骨科接受后路小切口THA治疗的ONFH 112例患者资料；其中MAKO组47例，手工组65例。最低随访时间为3个月。比较两组的手术时间、术中失血量、切口长度、术后并发症发生率；评估MAKO组的注册时间、注册成功率及学习曲线；并比较术前与末次随访时的Harris髋关节评分（HHS）及影像学参数（髋臼杯外展角与前倾角）。结果 两组患者基线资料差异无统计学意义。MAKO组骨骼示踪器注册成功率为100%；平均注册时间为（17.5±10.2）min。MAKO组手术时间随经验积累逐渐缩短，学习曲线平台期出现在约第11例手术。MAKO组平均手术时间较手工组延长[（66.1±12.7）min比（50.2±8.9）min，P<0.01]。两组在术中失血量、切口长度等方面差异无统计学意义。MAKO组的臼杯外展角与前倾角均较手工组更接近术前设定的目标值，且分布更为集中。MAKO组臼杯置入于安全区内的比例为100%，显著高于手工组的83.1%（P<0.01）。两组末次随访时HHS均较术前显著提高，组间差异无统计学意义。随访期间未发生脱位、感染或其他严重并发症。结论 在小切口后路THA中，MAKO机器人辅助能够实现顺利注册并显著提高髋臼假体安放精度。尽管手术时间略有延长，但随学习曲线完成后可控制在可接受范围内。短期随访中未见两组临床疗效及严重并发症发生率有差异。MAKO机器人辅助小切口后路THA在假体定位精度方面显示出较传统手工技术的优势，但其长期临床价值仍需大样本、长期随访研究进一步验证。

Abstract

Objective To compare the short-term clinical and radiological outcomes between MAKO robotic-assisted and conventional manual mini-incision posterior total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH), and to evaluate registration feasibility and the learning curve of robotic-assisted surgery under mini-incision conditions. Methods From January 2025 to June 2025, 112 patients with ONFH (47 MAKO, 65 manual) underwent mini-incision posterior THA in Department of Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University. Minimum follow-up was 3 months. Operative time, intraoperative blood loss, incision length, and complications were compared. Registration time, success rate, and learning curve were analyzed in the MAKO group. Harris hip scores (HHS) and radiographic parameters, including acetabular cup inclination and anteversion, were assessed preoperatively and at final follow-up. Results Baseline characteristics were comparable between groups. The MAKO group achieved a 100% tracker registration success rate, with a mean registration time of (17.5±10.2) min. Operative time was significantly longer in the MAKO group (66.1±12.7) min than the manual group (50.2±8.9) min (P<0.01), whereas intraoperative blood loss and incision length did not differ significantly. In the MAKO group, cup inclination and anteversion were significantly closer to target values and exhibited a more concentrated distribution. All cups in the MAKO group were within the Lewinnek safe zone, compared with 83.1% in the manual group (P<0.01). Both groups showed significant and comparable improvements in HHS at final follow-up. No postoperative dislocation, infection, or other major complications were observed during follow-up. Conclusions In mini-incision posterior THA, MAKO robotic-assisted surgery enables reliable registration and significantly improves the accuracy and consistency of acetabular component positioning. Although operative time is modestly increased, it can be reduced to an acceptable level with completion of the learning curve. No differences in clinical efficacy and in the incidence of severe complications were observed between the two groups during short-term follow-up. Although MAKO robotic-assisted mini-incision posterior-approach THA shows advantages over conventional manual technique in implant positioning accuracy, further studies with larger sample sizes and longer follow-up are required to determine the long-term clinical benefits.

关键词

关节成形术，置换，髋 / 股骨头坏死 / 机器人手术 / 小切口后路

Key words

Arthroplasty, replacement, hip / Femoral head necrosis / Robotic surgical procedures / Mini-incision posterior approach

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