机器人髋关节和膝关节手术

这是一份完整的机器人关节置换指南。
在本指南中，你将了解到以下所有内容：

• 矫形外科机器人技术的历史
• 机器人技术的益处和优势
• 不同的矫形机器人
• 机器人手术背后的证据
• 所需培训
• 如何为手术做准备

因此，如果你想确保你能从髋关节或膝关节手术中获得最大的收益，那么今天的指南将给你带来无穷的价值。

Hip and Knee replacement surgeries are incredibly successful operations. In fact, the Lancet named total hip replacements “the operation of the century.”

However, hip replacements are known to have problems with dislocations and limb length discrepancies. In patients with hip dysplasia or other deformities in their hips often have distorted anatomy. While anterior hip replacements have improved some of these problems, there is still room for improvement.

Knee replacements are considered an incredibly successful surgery. However, 20% of patients are still dissatisfied with their surgery. In studies of total knees performed on patients in Hawaii by excellent orthopedic surgeons using mechanical jigs, only 86% of these implants are placed in the appropriate position.

Keep reading to learn how robotics improves our surgical techniques.

了解过去有助于理解未来。
了解我们从哪里来，对改善我们的手术效果非常重要。

Traditionally, orthopedic surgeons replace joints manually using special tools. These tools are rigid in their placement of knees and do not allow for easy personalization of placement of the implant.

外科医生必须通过自己的判断和视觉来选择和定位植入物。
许多外科医生使用这种手动方法成功地改善了患者的疼痛和整体功能，但仍有一些人担心会出现误差。

在短时间内，许多骨科公司展示了计算机导航膝关节置换术。
计算机导航膝关节和髋关节置换术使用钉在病人身上的标记来确定植入物的对准位置。
事实证明，与机械夹具相比，导航技术能更准确地定位植入物。
遗憾的是，这项技术较难使用，也未能证明患者的治疗效果有所改善。

最近，随着技术的进步，机器人辅助手术越来越受欢迎。
与使用计算机导航或机械夹具进行的关节置换手术相比，机器人手术是一项重大改进。
手术机器人更加精确，这为整个手术带来了多重益处。
机器人主要有三种类型：主动式、触觉式和被动式。
主动式系统试图在外科医生输入最少的情况下完成整个手术。
研究表明，这些系统并不比导航好多少。
被动和半主动系统，即外科医生完成大部分工作，机器人起辅助作用，这种系统很受欢迎。
机器人会对骨骼的重塑和植入物的定位提供反馈。
这比人眼的精确度更高。

Dr. Morton is fellowship-trained in robotic-assisted joint replacements and one of the few surgeons in Hawaii to perform this procedure.

手术前，一些机器人系统需要使用先进的成像技术，如长腿立位片或 CT 扫描。
这种成像可以

• 手术前精确确定植入物的尺寸
  • 减少之前对尺寸的猜测
  • 更短的运行周期
• 术前测量患者的畸形程度

罗莎膝关节置换术使用带有特殊校准标记的 X 射线，可准确确定术前对齐和尺寸。
获得这些 X 光片后，在手术开始前就会为每位患者制定个性化的术前计划。

使用机器人进行手术有一些很大的不同。
以下是机器人膝关节手术的具体步骤。
请继续关注视频演示。

通过导航针可以正确使用机器人。

这种方法与普通膝关节或髋关节置换术的方法基本相同。
通常情况下进行的软组织松解术无需进行。

莫顿医生将追踪膝关节置换手术的骨骼标志，获取实时信息，绘制膝关节解剖图。

机器人关节手术中获得的软组织间隙平衡信息提供了膝关节置换术中通常无法评估的信息。
这种评估可提醒外科医生注意您的特殊软组织解剖结构，并帮助指导髋关节或膝关节的定制化、针对患者的植入手术。

然后，在实际植入之前，会在电脑屏幕上对您的手术进行规划。

然后，机器人通过切割导轨引导切割。
机器人提高了人眼无法比拟的精确度。
切割完成后，将确认切割的准确性。

切骨完成后，莫顿医生会将新的髋关节或膝关节放置在正确的位置。

Robotic-arm assisted surgery is used partial knee replacements, total knee replacements, and total hip replacements. This technology has made a tremendous improvement in the treatment of patients with arthritis. There are several differences between manual joint replacement and robotic joint replacement.

Follow the links below to see the evidence-based medicine behind these claims.

There are two main ways to approach knee replacements: partial knee replacements and total knee replacements. Patients who undergo robotic-assisted partial knee replacements have improved outcomes compared to conventional methods. These implants were implanted with better positioning, limb alignment, and sizing.

Patients who underwent robotic-assisted joint replacement have less pain and stiffness than their conventional counterparts. Additionally, these patients are less likely to need a revision, their implants last longer and patients are more satisfied with their knee function.

Read more about partial knee replacements here…

Patients who undergo a total knee replacement with robotic assistance also have better outcomes. Implants positioned with a robot similarly have improved positioning with better balance with less invasive soft-tissue surgical intervention. Less soft tissue releases lead to a decrease in swelling and pain. This means that they needed less pain medication after the surgery. Patients undergoing a robotic total knee replacement also report better function and movement compared to those who undergo conventional surgery.

These patients are overall more satisfied than their conventional counterparts. Australian registry data evaluating younger patients undergoing total knee replacements may have a lower requirement for revision if their knee is placed more accurately using robotic assistance.

Read more about total knee replacements here…

Robot-assisted total hip replacements also have several benefits. Hip implants are placed with more precision with robotic assistance.

Better implant position leads to a lower likelihood of hip dislocation and limb length discrepancy postoperatively In the short term, both robot-assisted and conventional hip replacements had similar functional scores. Based on these short-term benefits, surgeons believe that these joints may last longer with fewer revisions.

Read more about total hip replacements here…

机器人系统有多种类型。
它们各有优缺点。
外科医生或医院系统可以选择最适合自己和病人的系统。
市场上的三种主要系统都具有可比的导航、肢体对齐计算和校准技术，可对髋关节或膝关节置换术进行个性化安置。

史赛克 Mako 机器人系统是美国第一个大规模生产的机器人。
手术前，Mako 机器人使用计算机断层扫描，也称为 CT 扫描。
通过 CT 扫描，可以在术前准确定位植入物。
术中韧带平衡检查允许对每个髋关节或膝关节植入物进行个性化定位。
这样就能实现精确的植入物定位和对齐。
Mako 是一种触觉系统，这意味着器械在使用时由外科医生引导，在手术过程中提供手动反馈，如果机器人被放置在不安全区域，则会停止工作。

Dr. Morton is an expert in robotic hip and knee replacements. He has certifications in Rosa, MAKO, and CORI robotics. Understanding robotic technology is a paradigm shift from traditional hip and knee replacements and requires specialist training. This is because robotic surgery requires three-dimensional spatial thinking, understanding where implants need to be placed – without the use of mechanical jigs. This facilitates the perfect placement of the implants.

Many orthopedic surgeons may not be comfortable with this newer surgery because they did not undergo this training and would have to undergo a learning curve on their patients. Few patients would like to undergo surgery by someone who is still learning the technology. Dr. Morton is an expert in performing robotic joint replacements from experts in the field during his fellowship training and is comfortable with the technology.

Early results of several scientific studies have demonstrated that robotic-assisted surgery has increased precision and better outcomes than manual orthopedic surgery for certain joint replacement procedures. Patients who undergo robot-assisted surgeries have less pain, less swelling, and stiffness, and improved function compared to the patients who had conventional surgery. There are benefits to each robotic system available. Ask Dr. Morton about your options in regards to having a robotic-assisted joint replacement surgery.

Dr. Morton is certified in MAKO, CORI, and Rosa robotic-assisted hip and knee replacement surgery. Schedule an appointment in Honolulu or on the Big Island to talk with him about the advantages of robotics.