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骨科機器人輔助腓骨移植治療股骨頭缺血性壞死的臨床療效觀察 Clinical effects of orthopaedic robot-assisted free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head |
| 作者： 劉瑩 沈杰 韓巍 劉路 |
| 單位：北京積水潭醫(yī)院手外科（北京 100035）<br />通訊作者：劉瑩。E-mail：[email protected] |
| 關(guān)鍵詞： 骨科機器人；腓骨移植；股骨頭缺血性壞死；護理 |
| 分類號：R318.04 |
| 出版年·卷·期（頁碼）：2022·41·5（477-482） |
| 摘要： |
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目的 比較骨科機器人輔助腓骨移植治療和傳統(tǒng)腓骨移植治療股骨頭缺血性壞死（osteonecrosis of the femoral head，ONFH）的早期臨床結(jié)果和護理效果差異，從術(shù)后護理角度對患者術(shù)后早期功能鍛煉和減輕術(shù)后疼痛進行探討。 方法 納入2019年6月至2020年9月北京積水潭醫(yī)院手外科因股骨頭缺血性壞死行腓骨移植的患者共31例，其中采用骨科機器人輔助腓骨移植患者18例，采用傳統(tǒng)腓骨移植患者13例。 機器人輔助組在術(shù)后6 h進行下肢股四頭肌等長收縮和踝泵運動，而傳統(tǒng)組患者在術(shù)后24 h進行下肢功能鍛煉。比較兩組患者的病因、髖部Steinberg分期、手術(shù)時間、術(shù)中出血量、圍手術(shù)期疼痛評分、護理滿意度、治療前后Harris評分和術(shù)后并發(fā)癥等指標。 結(jié)果 31例（31髖）均順利完成手術(shù)，其中女性患者9例（29%）,兩組患者性別、年齡、病因、Steinberg分期等基線數(shù)據(jù)無顯著性差異。機器人輔助腓骨移植組在手術(shù)時間、術(shù)中出血量以及末次隨訪時Harris評分（89.0±5.5 vs. 80.5±6.2，P＜0.05）方面顯著優(yōu)于傳統(tǒng)腓骨移植組。在圍手術(shù)期護理方面，機器人輔助腓骨移植組術(shù)后4 h及術(shù)后24 h的視覺模擬評分（visual analog scale，VAS）均低于傳統(tǒng)組，且具有較高的患者滿意度。 結(jié)論 骨科機器人輔助腓骨移植治療股骨頭缺血性壞死，能夠保留患者股骨頭，提高腓骨植入的精準性。在護理方面，幫助患者實現(xiàn)術(shù)后早期床上功能鍛煉，減輕患者髖關(guān)節(jié)術(shù)后疼痛，提高患者圍手術(shù)期滿意度，同時不增加術(shù)后并發(fā)癥發(fā)生率。 |
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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. |
| 參考文獻： |
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[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. |
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地址：北京安定門外安貞醫(yī)院內(nèi)北京生物醫(yī)學(xué)工程編輯部 電話：010-64456508 傳真：010-64456661 電子郵箱：[email protected] |