摘要
目的介绍应用骨科机器人辅助游离腓骨移植治疗股骨头缺血性坏死(ANFH)手术流程,并报告早期治疗结果。方法2016年9月至2018年11月,采用骨科机器人辅助游离腓骨移植治疗17例(21髋)ANFH患者,其中男14例,女3例;右侧8例,左侧5例,双侧4例。平均年龄35(17~55)岁;特发性7例,创伤术后4例,4例有饮酒史,1例曾服用激素6个月治疗肾炎,1例既有饮酒史也有服用激素病史;Ficat II期17髋,Ficat III期4髋。术中使用骨科机器人辅助确定腓骨置入方向及所需腓骨长度,打入导针,开通骨隧道,打磨坏死区。切取腓骨,修整后将其插入骨隧道内,术中透视确认腓骨位置并吻合血管。术后电话和门诊复查随访,影像学评估术区情况,采用Harris评分评价最终髋关节功能。结果21髋手术顺利,导针和腓骨均按机器人规划准确置入,经机器人工作站融合图像后计算,入点误差1.23 mm,靶点误差1.90 mm。腓骨顶端均位于股骨头外上象限负重区中央。术后3个月内免负重,3~6个月间拄拐部分负重。10例(12髋)术后随访1年以上,平均15(12~24)个月。9例髋关节功能恢复顺利,经正、侧位X线片和CT检查,腓骨顶端位于负重区中央。1例患者为双侧ANFH,右侧恢复顺利,左侧髋关节活动受限、疼痛,术后1个月经关节镜探查,关节内没有感染和腓骨头穿出等问题,处理髋臼侧骨赘后,症状缓解。术前和术后最后一次随访Harris评分分别为(62.4±13.6)分和(84.5±4.5)分,差异有统计学意义(P<0.05)。结论骨科机器人辅助手术可以更精准地放置腓骨,是一种在理论上完成腓骨移植治疗ANFH的最佳选择,早期治疗效果良好。
Objective To introduce the surgical procedure of orthopaedic robot-assisted vascularised fibular grafting for the treatment of ANFH and report the short-term result.Methods From September,2016 to November,2018,17 patients(21 hips)with ANFH had undergone robot-assisted free fibular grafting.There were 14 males and 3 females,of which,8 cases were associated with the right side,5 cases the left side,and 4 cases with both sides.The average age was 35(ranged from 17 to 55)years.There were 7 patients suffered from idiopathic ischemic necrosis of femoral head,4 patients who had cannulated screws fixed after a femoral neck fracture,4 patients who had a history of alcohol consumption,1 patient who had taken corticosteroids for 6 months to treat nephritis,and 1 patient who had a history of alcohol consumption and had also taken corticosteroids.Seventeen hips were in Ficat stage II,and 4 hips were in Ficat stage III.The orthopaedic surgical robot workstation was used to plan the entry point and target of the guide pin during the operation,to place a cannula in the optimal position.Then a bone window was created and the fibula was placed into the bone tunnel.Using fluoroscopy to monitor each step of the procedure and verify the position of the fibula.Finally,the vessels were anastomosed.The patient remain in bed completely for a week with the use of vasodilator.The follow-up was accomplished with phone call and outpatient clinic,and Harris score was evaluated.Results All 21 surgical procedures were successful.The guide pins and fibula were accurately placed according to the robot’s plan,and the tips of the fibula were placed at the centre of the load-bearing region of the femoral heads,4 to 6 mm from the articular surface.Conventional anticoagulant,anti-infective therapy was performed after the procedure.Ten patients were followed-up postoperatively more than 1 year,with an average of 15(from 12 to 24)months.The function of the hip joint recovered smoothly for 9 patients.Frontal and lateral X-ray and CT scans showed that the tips of the fibula were placed at the centre of the load-bearing region,4 to 6 mm from the articular surface.One patient suffered from bilateral femoral head necrosis and the right side recovered smoothly after operation.However,joint movement was restricted for the left hip and the pain was significant.An arthroscopic examination was performed 1 month after the operation and did not identify any problems such as intraarticular incular infection or articular surface of the femoral head was protruded by the tip of the fibula.The symptoms were alleviated after removing the osteophytes at the rim of the acetabulum.The Harris score was 62.4±13.6 before operation,and 84.5±4.5 at the last time of followed-up after operation.The difference in Harris scores was statisticly significant(P<0.05).Conclusion With the assistance of an orthopaedic robot system,the guide pin can be accurately positioned,thereby allowing the tip of the fibula to be inserted into the optimal anatomical position and maximising its mechanical efficacy.In theory,it is the best choice for performing fibular bone transplantation in ANFH.And the early effect of treatment is good.
作者
陈山林
荣艳波
苗荷佳
刘路
薛云皓
栗鹏程
武竞衡
童德迪
王志新
Chen Shanlin;Rong Yanbo;Miao Hejia;Liu Lu;Xue Yunhao;Li Pengcheng;Wu Jingheng;Tong Dedi;Wang Zhixin(Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2019年第5期423-428,共6页
Chinese Journal of Microsurgery
基金
北京215人才培养计划(2014-3-029)
首都临床特色基金资助项目(Z171100001017132)。
关键词
股骨头缺血性坏死
骨科机器人
腓骨移植
显微外科技术
Avascular necrosis of femoral head
Orthopaedic robot
Fibula grafting
Microsurgical technique
