摘要老年人髋部骨折的发病率正在上升,这可能是由于人口老龄化加重和生活方式更积极等多方面原因所致 。由于创伤后缺血性坏死和继发性髋关节骨关节炎的发生,老年髋部骨折患者的切开复位内固定术疗效较差,并发症发生率高,尤其是髋臼移位性骨折和股骨头粉碎性骨折的患者。全髋关节置换术(total hip arthroplasty,THA)是老年髋部骨折的最佳治疗方案之一,该术式可以使髋关节快速实现全负重,避免因长期卧床而产生并发症,并且有可靠的临床预后结果 ,但其面临的挑战是实现髋臼假体的稳定置入和髋臼骨缺损的修复。髋臼骨折使得在THA中正确识别解剖标志和准确置入髋臼假体变得困难。近年来,机器人辅助THA得到了广泛应用,其目的是提高髋关节置换术中假体定位的精度,恢复髋关节原有的生物力学。研究表明,机器人辅助THA与传统THA相比具有显著优势,包括更小的肢体长度差异,更接近术前的偏心距恢复,更准确的假体定位和更好的临床结果。然而,没有研究报告机器人辅助THA在老年髋部骨折患者中的结局。
[1]Ferguson TA,Patel R,Bhandari M,et al.Fractures of the acetabulum in patients aged 60 years and older:An epidemiological and radiological study[J].J Bone Joint Surg Br,2010,92(2):250-257.
[2]Bhandari M,Swiontkowski M.Management of acute hip fracture[J].New Engl J Med,2017,377(21):2053-2062.
[3]Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:Treatment by mold arthroplasty:An end-result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,51(4):737-755.
[4]Mears DC,Velyvis JH.Acute total hip arthroplasty for selected displaced acetabular fractures:Two to twelve-year results[J].J Bone Joint Surg Am,2002,84(1):1-9.
[5]Kennedy JG,Rogers WB,Soffe KE,et al.Effect of acetabular component orientation on recurrent dislocation,pelvic osteolysis,polyethylene wear,and component migration[J].J Arthroplasty,1998,13(5):530-534.
[6]Chen AF,Kazarian GS,Jessop GW,et al.Robotic technology in orthopaedic surgery[J].J Bone Joint Surg Am,2018,100(22):1984-1992.
[7]Domb BG,el Bitar YF,Sadik AY,et al.Comparison of robotic-assisted and conventional acetabular cup placement in THA:A matched-pair controlled study[J].Clin Orthop Relat Res,2014,472(1):329-336.
[8]Perets I,Walsh JP,Close MR,et al.Robot-assisted total hip arthroplasty:Clinical outcomes and complication rate[J].Int J Med Robot,2018,14(4):e1912.
[9]Zhou Y,Shao H,Huang Y,et al.Does robotic assisted technology improve the accuracy of acetabular component positioning in patients with DDH?[J].J Orthop Surg(HK),2021,29(2):23094990211025325.〖JP〗
[10]Pipkin G.Treatment of grade IV fracture-dislocation of the hip[J].J Bone Joint Surg Am,1957,39-A(5):1027-1042 passim.
[11]Yang SH,Zhang YK,Xu WH,et al.Early total hip arthroplasty for severe displaced acetabular fractures[J].Chin J Traumatol,2006,9(6):329-333.
[12]Ando W,Takao M,Hamada H,et al.Comparison of the accuracy of the cup position and orientation in total hip arthroplasty for osteoarthritis secondary to developmental dysplasia of the hip between the mako robotic arm-assisted system and computed tomography-based navigation[J].Int Orthop,2021,45(7):1719-1725.
[13]Elmallah RK,Cherian JJ,Jauregui JJ,et al.Robotic-arm assisted surgery in total hip arthroplasty[J].Surg Technol Int,2015(26):283-288.
[14]Zhang S,Liu YB,Ma MY,et al.Revision total hip arthroplasty with severe acetabular defect:A preliminary exploration and attempt of robotic-assisted technology[J].Orthop Surg,2022,14(8):1912-1917.
[15]Solomon LB,Studer P,Abrahams JM,et al.Does cup-cage reconstruction with oversized cups provide initial stability in THA for osteoporotic acetabular fractures?[J].Clin Orthop Relat Research,2015,473(12):3811-3819.
[16]Sarantis M,Stasi S,Milaras C,et al.Acute total hip arthroplasty for the treatment of acetabular fractures:A retrospective study with a six-year follow-up[J].Cureus,2020,12(8):e10139.
[17]Lin C,Caron J,Schmidt AH,et al.Functional outcomes after total hip arthroplasty for the acute management of acetabular fractures:1-to 14-year follow-up[J].J Orthop Trauma,2015,29(3):151-159.
[18]Tidermark J,Blomfeldt R,Ponzer S,et al.Primary total hip arthroplasty with a Burch-Schneider antiprotrusion cage and autologous bone grafting for acetabular fractures in elderly patients[J].J Orthop Trauma,2003,17(3):193-197.
[19]Lchel J,Janz V,Hipfl C,et al.Reconstruction of acetabular defects with porous tantalum shells and augments in revision total hip arthroplasty at ten-year follow-up[J].Bone Joint J,2019,101-b(3):311-316.
[20]Abolghasemian M,Tangsataporn S,Sternheim A,et al.Combined trabecular metal acetabular shell and augment for acetabular revision with substantial bone loss:A midterm review[J].Bone Joint J,2013,95-b(2):166-172.
[21]Wang Y,Wang M,Li C,et al.Biomechanical effect of metal augment and bone graft on cup stability for acetabular reconstruction of total hip arthroplasty in hip dysplasia:A finite element analysis[J].BMC Musculoskelet Disord,2022,23(1):277.
[22]Bobyn JD,Stackpool GJ,Hacking SA,et al.Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial[J].J Bone Joint Surg Br,1999,81(5):907-914.