北京生物医学工程

骨科机器人辅助腓骨移植治疗股骨头缺血性坏死的临床疗效观察

Clinical effects of orthopaedic robot-assisted free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head

作者：刘莹沈杰韩巍刘路

单位：北京积水潭医院手外科（北京 100035）<br />通讯作者：刘莹。E-mail：13401105320@163.com 

关键词：骨科机器人；腓骨移植；股骨头缺血性坏死；护理

分类号：R318.04

出版年·卷·期（页码）：2022·41·5（477-482）

摘要：

目的比较骨科机器人辅助腓骨移植治疗和传统腓骨移植治疗股骨头缺血性坏死（osteonecrosis of the femoral head，ONFH）的早期临床结果和护理效果差异，从术后护理角度对患者术后早期功能锻炼和减轻术后疼痛进行探讨。方法纳入2019年6月至2020年9月北京积水潭医院手外科因股骨头缺血性坏死行腓骨移植的患者共31例，其中采用骨科机器人辅助腓骨移植患者18例，采用传统腓骨移植患者13例。机器人辅助组在术后6 h进行下肢股四头肌等长收缩和踝泵运动，而传统组患者在术后24 h进行下肢功能锻炼。比较两组患者的病因、髋部Steinberg分期、手术时间、术中出血量、围手术期疼痛评分、护理满意度、治疗前后Harris评分和术后并发症等指标。结果 31例（31髋）均顺利完成手术，其中女性患者9例（29%）,两组患者性别、年龄、病因、Steinberg分期等基线数据无显著性差异。机器人辅助腓骨移植组在手术时间、术中出血量以及末次随访时Harris评分（89.0±5.5 vs. 80.5±6.2，P＜0.05）方面显著优于传统腓骨移植组。在围手术期护理方面，机器人辅助腓骨移植组术后4 h及术后24 h的视觉模拟评分（visual analog scale，VAS）均低于传统组，且具有较高的患者满意度。结论骨科机器人辅助腓骨移植治疗股骨头缺血性坏死，能够保留患者股骨头，提高腓骨植入的精准性。在护理方面，帮助患者实现术后早期床上功能锻炼，减轻患者髋关节术后疼痛，提高患者围手术期满意度，同时不增加术后并发症发生率。

Objective To compare the short-term clinical outcomes and perioperative nursing effects between robotic-assisted free vascularized fibular grafting and conventional fibula grafting for the treatment of osteonecrosis of the femoral head (ONFH), and to explore the early postoperative functional exercise time and pain relief from the viewpoint of postoperative nursing. Methods This retrospective cohort study included 31 patients who underwent fibula grafting for the treatment of ONFH in the Department of Hand Surgery, Beijing Jishuitan Hospital between June 2019 and September 2020, of which 18 patients with ONFH had undergone orthopaedic robot-assisted fibula grafting while 13 conventional fibula grafting. The robot-assisted group performed isometric quadriceps and ankle pump exercise at 6 hours after surgery, while the patients in the traditional group performed lower extremity functional exercise at 24 hours after surgery. The etiology, hip Steinberg stage, operation time, intraoperative blood loss, perioperative pain score, nursing satisfaction, preoperative and postoperative Harris score, and postoperative complications were compared between two groups. Results All 31 patients (31 hips) completed the procedures successfully, of which 9(29%) were female. There were no statistical differences in baseline data between these two groups such as gender, age, etiology, and Steinberg staging. The operation time, intraoperative blood loss and Harris score at last follow-up (89.0±5.5 vs. 80.5±6.2, P<0.05) of the robotic-assisted fibula grafting group were significantly better than those of the conventional fibular grafting group. In terms of perioperative care, the pain scores of the robot-assisted fibula grafting group at 4 hours and 24 hours after surgery were superior to the conventional group, and the patient satisfaction was higher. Conclusions Orthopaedic robot-assisted fibula grafting in the treatment of ONFH can save the patient's femoral head and improve the accuracy of fibular grafting. Early functional exercise in bed and less pain can improve patient's satisfaction without increasing incidence of complications.

参考文献：

[1] Yamaguchi R, Yamamoto T, Motomura G, et al. Incidence of nontraumatic osteonecrosis of the femoral head in the Japanese population[J]. Arthritis & Rheumatism,2011,63(10):3169-3173.
[2] Wu W, He W, Wei Q S, et al. Prognostic analysis of different morphology of the necrotic-viable interface in osteonecrosis of the femoral head[J]. International Orthopaedics,2018,42(1):133-139.
[3] 郭晓忠. 股骨头缺血坏死早期微创保头手术的疗效观察[J]. 骨科临床与研究杂志,2019,4(4):225-231.
Guo XZ. Minimally invasive head preservation surgery in the early stage of osteonecrosis necrosis of femoral head: a clinical report of 216 cases of 296 hips[J]. Journal of Clinical Orthopedics and Research, 2019,4(4):225-231.
[4] 郭晓忠，李兵，岳聚安，等. 髓芯减压植骨加异体腓骨支撑治疗早期股骨头缺血性坏死的单中心长期临床疗效研究[J]. 中华骨与关节外科杂志,2018,11(12):904-909.
Guo XZ, Li B, Yue JA , et al. Long-term efficacy of core decompressionwith allogeneic peroneal transplantation in treatment of osteonecrosis of the femoral head in single center[J]. Chinese Journal of Bone and Joint Surgery, 2018,11(12):904-909.
[5] Unal M B, Cansu E, Parmaksizoglu F, et al. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting: Results of 7.6-year follow-up[J]. Acta Orthopaedica Et Traumatologica Turcica,2016,50(5):501-506.
[6] Unal M B, Cansu E, Parmaksizoglu F, et al. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting: results of 7.6-year follow-up[J]. Acta Orthopaedica Et Traumatologica Turcica,2016,50(3):323-329.
[7] 孙明曜，王俊博，曾羿，等. 腓骨移植治疗不同股骨头坏死面积患者的随访研究[J]. 华西医学,2015,30(8):1430-1434.
Sun MY, Wang JB, Zeng Y, et al. Follow-up Study on Allogeneic Nonvascularized Fibular Graft ing in Treating Patients with Diff erent Femoral Head Necrotic Area[J]. West China Medical Journal, 2015,30(8):1430-1434.
[8] 许本柯，徐达传，王兵，等. 股骨头血供特点及临床意义[J]. 解剖学杂志,2007，30(3):371-373.
Xu BK, Xu DC, Wang B, et al. Characteristics and clinical significance of blood supply to the femoral head[J]. Chinese Journal of Anatomy,2007,30(3):371-373.
?[9] Malizos KN, Quarles LD, Dailiana ZH, et al. Analysis of failures after vascularized fibular grafting in femoral head necrosis[J]. Orthopedic Clinics of North America,2004,35(3):305-314.
[10] Gonzalez D V A, Bates J, Di Carlo E, et al. Failure of free vascularized fibular graft for osteonecrosis of the femoral head: a histopathologic study of 6 cases[J]. Journal of Arthroplasty,2005,20(3):331-336.
[11] 李爽，李文菁，范明星，等. 骨科手术机器人培训效果的横断面调查[J]. 北京生物医学工程,2020,39(5):523-528.
Li S, Li WJ, Fan MX, et al. Training effect for orthopaedic surgery robots: a cross-sectional survey [J]. Beijing Biomedical Engineering, 2020, 39(5):523-528.
[12] 田伟. 骨科机器人研究进展[J]. 骨科临床与研究杂志,2016,1(1):55-57.
Tian W. Research progress of orthopedic robots[J]. Journal of Clinical Orthopedics and Reserarch， 2016,1(1):55-57.
[13] 赵燕鹏，唐佩福. 骨科机器人及导航技术研究进展[J]. 中国矫形外科杂志,2016,24(3):242-246.
Zhao YP, Tang PF. A review of robot system and its navigational system in orthpaedic surgery[J]. Orthopedic Journal of China, 2016,24(3):242-246.
[14] 陈山林，荣艳波，苗荷佳，等. 骨科机器人辅助游离腓骨移植治疗股骨头缺血性坏死[J]. 中华显微外科杂志,2019，42(5):423-424.
Chen SL, Rong YB, Miao HJ, et al. Orthopaedic robot-assisted free vascularised fibular grafting for the treatment of avascular necrosis of the femoral head[J]. Chinese Journal of Microsurgery, 2019，42(5):423-424.

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