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首页> 外文期刊>Clinical Orthopaedics and Related Research >Comparison of robotic-assisted and conventional acetabular cup placement in THA: A matched-pair controlled study hip
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Comparison of robotic-assisted and conventional acetabular cup placement in THA: A matched-pair controlled study hip

机译：THA中机器人辅助和常规髋臼杯放置的比较：匹配对照研究髋关节

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Background: Improper acetabular component orientation in THA has been associated with increased dislocation rates, component impingement, bearing surface wear, and a greater likelihood of revision. Therefore, any reasonable steps to improve acetabular component orientation should be considered and explored. Questions/purposes: We therefore sought to compare THA with a robotic-assisted posterior approach with manual alignment techniques through a posterior approach, using a matched-pair controlled study design, to assess whether the use of the robot made it more likely for the acetabular cup to be positioned in the safe zones described by Lewinnek et al. and Callanan et al. Methods: Between September 2008 and September 2012, 160 THAs were performed by the senior surgeon. Sixty-two patients (38.8%) underwent THA using a conventional posterior approach, 69 (43.1%) underwent robotic-assisted THA using the posterior approach, and 29 (18.1%) underwent radiographic-guided anterior-approach THAs. From September 2008 to June 2011, all patients were offered anterior or posterior approaches regardless of BMI and anatomy. Since introduction of the robot in June 2011, all THAs were performed using the robotic technique through the posterior approach, unless a patient specifically requested otherwise. The radiographic cup positioning of the robotic-assisted THAs was compared with a matched-pair control group of conventional THAs performed by the same surgeon through the same posterior approach. The safe zone (inclination, 30 -50; anteversion, 5 -25) described by Lewinnek et al. and the modified safe zone (inclination, 30 -45; anteversion, 5 -25) of Callanan et al. were used for cup placement assessment. Matching criteria were gender, age ± 5 years, and (BMI) ± 7 units. After exclusions, a total of 50 THAs were included in each group. Strong interobserver and intraobserver correlations were found for all radiographic measurements (r > 0.82; p < 0.001). Results: One hundred percent (50/50) of the robotic-assisted THAs were within the safe zone described by Lewinnek et al. compared with 80% (40/50) of the conventional THAs (p = 0.001). Ninety-two percent (46/50) of robotic-assisted THAs were within the modified safe zone described by Callanan et al. compared with 62% (31/50) of conventional THAs p (p = 0.001). The odds ratios for an implanted cup out of the safe zones of Lewinnek et al. and Callanan et al. were zero and 0.142, respectively (95% CI, 0.044, 0.457). Conclusions: Use of the robot allowed for improvement in placement of the cup in both safe zones, an important parameter that plays a significant role in long-term success of THA. However, whether the radiographic improvements we observed will translate into clinical benefits for patients - such as reductions in component impingement, acetabular wear, and prosthetic dislocations, or in terms of improved longevity - remains unproven. Level of Evidence: Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
机译：背景技术：THA中的髋臼组分取​​向不正确，与脱位率增加，部件冲击，轴承表面磨损以及更大的修订可能性有关。因此，应考虑和探索改善髋臼成分取向的任何合理步骤。如问题/目的：我们试图通过匹配对控制的研究设计，通过后路进行手动对准技术，通过匹配对控制设计来评估机器人是否使机器人的使用更有可能对髋臼更有可能进行手动对准技术杯子以Lewinnek等人描述的安全区定位。和callanan等。方法：2008年9月至2012年9月，160个THA由高级外科医生进行。六十二名患者（38.8％）使用常规的后近方法进行了接受了69（43.1％）使用后方法进行机器人辅助THA，29例（18.1％）接受了射线照相引导的前近方法。从2008年9月到2011年6月，无论BMI和解剖学如何，所有患者都被提供前后或后近方法。自2011年6月引入机器人以来，除非另有要求的患者，否则使用后方法使用机器人技术进行所有THA。将机器人辅助THA的射线照相杯定位与通过相同外科医生通过相同的后近方法进行的常规传统THA的匹配对照组进行比较。安全区（倾斜，30 -50; levinsion，5 -25）由Lewinnek等人描述。和修改的安全区（倾向，30 -45; anteversion，5 -25）的Callanan等。用于杯形安置评估。匹配标准是性别，年龄±5年，（BMI）±7个单位。排除后，每组共包含共有50个THA。发现所有射线照相测量（R> 0.82; P <0.001）发现强的interobserver和腹腔通道相关性。结果：百分之百（50/50）的机器人辅助THA在Lewinnek等人描述的安全区内。与常规THA的80％（40/50）相比（P = 0.001）。百分之九十二（46/50）的机器人辅助THA在Callanan等人描述的修改安全区内。与62％（31/50）的常规p（p = 0.001）相比。 Lewinnek等人的安全区域中植入杯的几率比。和callanan等。分别为零0.142（95％CI，0.044,0.457）。结论：使用机器人在安全区中使用杯子的放置，这是一个重要的参数，在长期成功中起着重要作用。然而，我们观察到的射线照相改善是否会转化为患者的临床益处 - 例如减少组分撞击，髋臼磨损和假脱臼，或者在改善的长寿方面 - 仍然是未经证实的。证据水平：第三级，治疗研究。有关作者的说明，以获得证据级别的完整描述。

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  • 作者

    DombB.G.; ElBitarY.F.; SadikA.Y.; StakeC.E.; BotserI.B.;

  • 作者单位

    American Hip Institute in Chicago Hinsdale Orthopedics 1010 Executive Court Westmont IL 60559;

    American Hip Institute in Chicago Hinsdale Orthopedics 1010 Executive Court Westmont IL 60559;

    American Hip Institute in Chicago Hinsdale Orthopedics 1010 Executive Court Westmont IL 60559;

    American Hip Institute in Chicago Hinsdale Orthopedics 1010 Executive Court Westmont IL 60559;

    American Hip Institute in Chicago Hinsdale Orthopedics 1010 Executive Court Westmont IL 60559;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 骨科学（运动系疾病、矫形外科学）;
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