摘要全髋关节置换术(total hip arthroplasty，THA)是目前治疗终末期髋关节疾病最普遍、最有效的治疗方式，但传统THA常因不可避免的人工因素而使置入假体位置偏离预期，造成假体翻修率的增加及患者满意度低等问题，同时也带来了巨大的社会经济负担。如何提高THA治疗晚期髋关节疾病的临床疗效、提高患者生活质量是关节外科医生关注的重点问题。机器人辅助全髋关节置换术(robotassisted total hip arthroplasty，RTHA)是一种通过整合多学科技术行术前规划，并在术中通过机械臂来辅助术者完成髋关节假体的置入，从而重建髋关节正常功能的一种手术方式。经过几十年的发展，传统THA在基础解剖、手术技术等方面都取得了巨大进展，但传统手术技术的精度不能够有效解决术后相关并发症的问题。从首个机器人的问世到现今的各型机器人，都有一个共同的特点即“高精准度”，这为解决术后相关并发症的问题提供了新视野。近5年与机器人辅助关节置换的相关研究更是呈现出直线增长的趋势，美国在该领域活跃的研究文献和机器人公司数量最多，其次是中国。本文通过简述机器人辅助技术的发展背景，并就关节机器人的技术原理和手术治疗效果作一综述。
［1］Li C，Wang L，Perka C，et al.Clinical application of robotic orthopedic surgery：A bibliometric study［J］.BMC Musculoskelet Disord，2021，22(1)：968.
［2］Haaker R.Evolution of total knee arthroplasty.From robotics and navigation to patientspecific instruments［J］.Orthopade，2016，45(4)：280-285.
［3］Perets I，Mu BH，Mont MA，et al.Current topics in roboticassisted total hip arthroplasty：A review［J］.Hip Int，2020，30(2)：118-124.
［4］Mazoochian F，Pellengahr C，Huber A，et al.Low accuracy of stem implantation in THR using the CASPARsystem：Anteversion measurements in 10 hips［J］.Acta Orthop Scand，2004，75(3)：261-264.
［5］Shatrov J，Parker D.Computer and robotic-assisted total knee arthroplasty：A review of outcomes［J］.J Exp Orthop，2020，7(1)：70.
［6］Bargar WL，Bauer A，Brner M.Primary and revision total hip replacement using the Robodoc system［J］.Clin Orthop Relat Res，1998 (354)：82-91.
［7］Woerner M，Sendtner E，Springorum R，et al.Visual intraoperative estimation of cup and stem position is not reliable in minimally invasive hip arthroplasty［J］.Acta Orthop，2016，87(3)：225-230.
［8］SuarezAhedo C，Gui C，Martin TJ，et al.Roboticarm assisted total hip arthroplasty results in smaller acetabular cup size in relation to the femoral head size：A matchedpair controlled study［J］.Hip Int，2017，27(2)：147-152.
［9］Raj JJ，Thompson M，Whitehouse SL，et al.Downsizing and minimising medialisation of the acetabular component：Novel technique to preserve bone in THA［J］.Proc Inst Mech Eng H，2023，237(3)：368-374.
［10］Lewinnek GE，Lewis JL，Tarr R，et al.Dislocations after total hipreplacement arthroplasties［J］.J Bone Joint Surg(Am)，1978，60(2)：217-220.
［11］Callanan MC，Jarrett B，Bragdon CR，et al.The John Charnley award：Risk factors for cup malpositioning：Quality improvement through a joint registry at a tertiary hospital［J］.Clin Orthop Relat Res，2011，469(2)：319-329.
［12］Ando W，Takao M，Hamada H，et al.Comparison of the accuracy ofthe cup position and orientation in total hip arthroplasty for osteoarthritis secondary todevelopmental dysplasia of the hip between the Mako robotic armassisted system andcomputed tomographybased navigation［J］.Int Orthop，2021，45(7)：1719-1725.
［13］Kong X，Yang M，Jerabek S，et al.A retrospective study comparing a single surgeon’s experience on manual versus robotassisted total hip arthroplasty after the learning curve of the latter procedureA cohort study［J］.Int J Surg，2020 (77)：174-180.
［14］Chai W，Xu C，Guo RW，et al.Does roboticassisted computer navigation improve acetabular cup positioning in total hip arthroplasty for Crowe Ⅲ/Ⅳ hip dysplasia?A propensity score casematch analysis［J］.Int Orthop，2022，46(4)：769-777.
［15］李俊成，倪明，冀全博，等.机器人辅助与传统方法行全髋关节置换术后下肢长度差异比较［J］.中华骨科杂志，2021，41(8)：480-487.
［16］Kort N，Stirling P，Pilot P，et al.Clinical and surgical outcomes of robotassisted versus conventional total hip arthroplasty：A systematic overview of metaanalyses［J］.EFORT Open Rev，2021，6(12)：1157-1165.
［17］Emara AK，Samuel LT，Acuna AJ，et al.Roboticarm assisted versus manual total hip arthroplasty：Systematic review and meta-analysis of radiographic accuracy［J］.Int J Med Robot，2021，17(6)：e2332.
［18］Guo DH，Li XM，Ma SQ，et al.Total hip arthroplasty with robotic arm assistance for precise cup positioning：A casecontrol study［J］.Orthop Surg，2022，14(7)：1498-1505.
［19］El Bitar YF，Jackson TJ，Lindner D，et al.Predictive valueof roboticassisted total hip arthroplasty［J］.Orthopaedics，2015，38(1)：e31-e37.
［20］Foissey C，Batailler C，Coulomb R，et al.Image-based robotic-assisted total hip arthroplasty through direct anterior approach allows a better orientation of the acetabular cup and a better restitution of the centre of rotation than a conventional procedure［J］.Int Orthop，2023，47(3)：691-699.
［21］Kayani B，Konan S，Thakrar RR，et al.Assuring the longterm total joint arthroplasty：A triad of variables［J］.Bone Joint J，2019，101(1 Supple A)：11-18.
［22］Kayani B，Konan S，Huq SS，et al.The learning curve of roboticarm assisted acetabular cup positioning during total hip arthroplasty［J］.Hip Int，2021，31(3)：311-319.
［23］Ng N，Gaston P，Simpson PM，et al.Robotic arm-assisted versus manual total hip arthroplasty：A systematic review and metaanalysis［J］.Bone Joint J，2021，103 (6)：1009-1020.
［24］Patel K，Judd H，Harm RG，et al.Robotic-assisted total knee arthroplasty：Is there a maximum level of efficiency for the operating surgeon?［J］.J Orthop，2022(31)：13-16.
［25］Brinkman JC，Christopher ZK，Moore ML，et al.Patient interest in robotic total joint arthroplasty is exponential：A 10-year google trends analysis［J］.Arthroplast Today，2022(15)：13-18.
［26］Bendich I，Vigdorchik JM，Sharma AK，et al.Robotic assistance for posterior approach total hip arthroplasty is associated with lower risk of revision for dislocation when compared to manual techniques［J］.J Arthroplasty，2022，37(6)：1124-1129.
［27］Shibanuma N，Ishida K，Matsumoto T，et al.Early postoperative clinical recovery of robotic arm-assisted vs.image-based navigated total hip arthroplasty［J］.BMC Musculoskelet Disord，2021，22(1)：314.
［28］Clement ND，Gaston P，Bell A，et al.Robotic armassisted versus manual total hip arthroplasty［J］.Bone Joint Res，2021，10(1)：22-30.
［29］郭人文，柴伟，李想，等.机器人辅助在股骨头坏死全髋关节置换术中的应用［J］.中华骨科杂志，2020，40(13)：819-827.
［30］Domb BG，Chen JW，Lall AC，et al.Minimum 5-year outcomes of robotic-assisted primary total hip arthroplasty with a nested comparison againstmanual primary total hip arthroplasty：A propensity scorematched study［J］.J Am Acad Orthop Surg，2020，28(20)：847-856.
［31］Kirchner GJ，Lieber AM，Haislup B，et al.The cost of robotassisted total hip arthroplasty：Comparing safety and hospital charges to conventional total hip arthroplasty［J］.J Am Acad Orthop Surg，2021，29(14)：609-615.
［32］Kayani B，Konan S，Tahmassebi J，et al.Roboticarm assisted total knee arthroplasty is associated with improved early functional recovery and reducedtime to hospital discharge compared with conventional jig-based total knee arthroplasty：A prospective cohort study［J］.Bone Joint J，2018，100 (7)：930-937.
［33］H-necke T，Schwarze M，Wangenheim M，et al.Noise exposure during robotassisted total knee arthroplasty［J］.Arch Orthop Trauma Surg，2023，143(6)：2813-2819.
［34］Singh A，Telagareddy K，Kumar P，et al.Robotic total hip arthroplasty for fused hips in ankylosing spondylitis patients：Our experience with robotic arm technology［J］.SICOT J，2022(8)：30.
［35］Sato K，Sato A，Okuda N，et al.A propensity score-matched comparison between Mako robotic armassisted system and conventional technique in total hip arthroplasty for patients with osteoarthritis secondary to developmental dysplasia of the hip［J］.Arch Orthop Trauma Surg，2023，143(5)：2755-2761.
晋公网安备 14010702070875号