RESUMO
Objective:To evaluate the accuracy of the domestic "Skywalker" surgical robot in implementing personalized lower limb alignment reconstruction scheme in total knee arthroplasty (TKA) and the short-term clinical outcome of robotic assisted TKA.Methods:From September 2020 to January 2021, the data of patients who received surgical robot assisted TKA in 5 clinical centers in China (Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Southwest Hospital affiliated to Third Military Medical University, The Affiliated Hospital of Qingdao University, The First Affiliated Hospital of Chongqing Medical University and Yantai Yuhuangding Hospital, and Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine was the group leader) were prospectively collected and retrospectively analyzed. There were 24 males and 82 females with an average age of 67.6±7.3 years, (range 45-80 years); Average body mass index 26.42±4.31 kg/m 2, all the operation were performed by "Skywalker" surgical robot system according to preoperative design based on CT. The operation time, intraoperative blood loss, hospitalization days and postoperative complications were recorded, and the imaging indexes including hip-knee-ankle (HKA), lateral distal angle of femur (LDFA) and medial proximal angle of tibia (MPTA) measured before and after the operation, implant model indexes (preoperative planning implant model and postoperative implant model) and short-term clinical efficacy indexes [Western Ontario and McMaster Universities (WOMAC) osteoarthritis index] pain score, stiffness score, joint function score, total score and SF-12 score before and 3 months after the operation) were compared. Results:The average follow-up period was 109.60±9.80 d, (range 95-143 d). The average operation time of 106 patients was 105.30±23.22 min; The average intraoperative blood loss was 141.70±58.33 ml; The average length of hospitalization was 5.82±2.80 d. One patient had ischemic stroke after operation, and one patient had abnormal liver function after operation. According to the judgment of the investigator, all of them were not related to the operation. The actual angle error is the difference between the preoperative planning angle and the postoperative measurement angle. The absolute error of 99.1% (105/106) of the HKA angle was within 3°, 90.8% (69/76) of LDFA, 98.7% (75/76) of the MPTA. In 45 patients in one center where data were available, the actual implant models used in all patients were consistent with the preoperative planning size, and there were only differences in version selection such as Asian condyle. WOMAC pain score, joint function score, total score was improved from 7.34±2.85, 25.10±9.85, 34.75±13.02 to 3.34±2.66, 14.68±9.64, 18.66±13.49 before and after operation, respectively, which were statistically significant ( P<0.001) and SF-12 physiological score and psychological score were improved form 27.24±6.42, 30.68±8.26 to 38.83±5.74, 39.36±7.85 before and after operation, respectively, which were statistically significant ( t=7.33, P<0.001; t=4.53, P=0.043). Conclusion:Domestic surgical robot system "Skywalker" can assist the surgeon to achieve accurate and personalized reconstruction of lower limb alignment and achieve satisfactory short-term clinical outcomes. The long-term clinical outcomes of personalized reconstruction and survival rate of implant still need to be further studied.
RESUMO
BACKGROUND: Low power laser irradiation has positive effects on fracture healing, including shortening the time of bone union and enhancement of bone formation. OBJECTIVE: To evaluate the effects of different wave lengths in low power laser on eedy fracture healing. DESIGN, TIME AND SETTING: Randomized, controlled, animal experiment. The study was performed at the Laser Center of Dankook University Medical Center between May 2005 and May 2006. MATERIALS: A total of 60 female English Hartley guinea pigs, 9 weeks old, weighing (300～30) g, were used for this experiment. They were randomly divided into three groups control, 632, and 830 nm groups (n=20). METHODS: The right femoral middle shaft fractures were made with a bone cutter and fixed with intramedullary nails (1.4 mm diameter K-wire). The frequencies of 632 nm and 830 nm semi-conductor laser machines were used. The laser irradiations were started 48 hours after operation vertically at the fracture sites and were applied every two days, at 100 J/cm<'2> of the same irradiation doses and 2.52 cm<'2> of the same irradiation areas in different irradiation groups. Finally, 46 guinea pigs survived, including 14 in control group, 16 in 632 nm group and 16 in 830 nm group. MAIN OUTCOME MEASURES: Guinea pigs were sacdficed at 3 and 6 weeks separately. The bone healing was assessed by the Modified Zorlu Scoring System, including gross, radiologic and histologic examinations. RESULTS: In the gross and radiologic findings, both 632 nm and 830 nm irradiation groups shown a significantly greater rate of callus formation at postoperatively 3 weeks compared to the control group (P< 0.01). Quantity of callus formation in 830 nm group was more than 632 nm group, but there was no significant difference (P > 0.05). The result of histological findings showed a significant increase of osteoblastic proliferation in two irradiation groups than the control group at 3 weeks postoperatively (P < 0.01). Enhancement of osteoblastic proliferation was more obvious in 830 nm group than in 632 nm group at 3 and 6 weeks, but there was no significant difference (P > 0.05).CONCLUSION: Both 632 nm and 830 nm wave lengths are considered to be optimal irradiation wave lengths for eady fracture healing. Moreover, 830 nm irradiation is better than 632 nm irradiation for eady fracture healing.