機器人髖關節和膝關節手術

這是一份關於機器人關節置換的完整指南。
在本指南中，您將瞭解以下所有資訊：

• 機器人技術在骨科中的歷史
• 機器人技術的好處和優勢
• 不同的骨科機器人
• 機器人手術背後的證據
• 所需培訓
• 如何為手術做準備

因此，如果您想確保從髖關節或膝關節手術中獲得最大收益，您將從今天的指南中獲得大量價值。

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.

了解過去有助於了解未來。
重要的是要了解我們從哪裡來改善我們的手術結果。

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.

外科醫生必須根據他或她自己的判斷和可視化來選擇和定位植入物。
許多外科醫生使用這種手動方法成功地改善了患者的疼痛和整體功能，但仍有一些人擔心存在出錯的餘地。

在很短的時間內，許多骨科公司都在展示計算機導航膝關節置換術。
計算機引導的膝關節和髖關節置換術使用固定在患者身上的標記來確定植入物的對齊位置。
事實證明，與機械夾具相比，種植體定位的導航更準確。
不幸的是，這項技術更難使用，並且無法證明患者的預後有所改善。

最近，隨著技術的進步，機器人輔助手術變得越來越流行。
與使用計算機導航或機械夾具進行的關節置換相比，機器人手術是一項巨大的改進。
手術機器人更精確，在整個手術過程中提供了多種好處。
機器人主要有三種類型：主動機器人、觸覺機器人和被動機器人。
主動系統試圖以外科醫生最少的投入執行整個手術。
研究尚未證明這些系統比導航好得多。
被動和半主動系統很受歡迎，其中外科醫生完成大部分工作，機器人起到支援作用。
機器人提供有關重塑骨骼和植入物定位的反饋。
這導致比人眼更精確。

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

在手術之前，一些機器人系統需要使用先進的成像技術，例如長腿站立膠片或 CT 掃描。
這種成像允許：

• 手術前準確確定植入物的尺寸
  • 以前減少對尺寸的猜測
  • 更短的運行週期
• 術前對患者畸形的術前測量

Rosa 膝關節置換術使用帶有特殊校准標記的 X 射線，可以準確確定術前對齊和尺寸。
在獲得這些 X 光片后，甚至在進行手術之前，都會為每位患者制定個人化的術前計劃。

使用機器人進行手術時，存在一些很大的差異。
以下是如何執行機器人膝蓋的分步過程。
請繼續關注視頻演示。

導航銷允許正確使用機器人。

這與正常膝關節或髖關節置換術期間的執行方式大致相同。
通常進行的軟組織釋放 – 不必進行。

Morton 博士將追蹤出膝關節置換術上的骨骼標誌，獲取實時資訊以繪製出您的膝關節解剖結構。

在機器人關節過程中獲得的軟組織間隙平衡資訊提供了在膝關節置換過程中通常不會評估的資訊。
該評估會提醒外科醫生注意您的特定軟組織解剖結構，並有助於指導針對患者定製的髖關節或膝關節植入術。

然後，在實際植入之前，將在計算機螢幕上計劃您的手術。

然後，機器人通過切割導軌引導切割。
該機器人提供了人眼無法比擬的更高精度。
這些切割在進行后被確認是準確的。

一旦進行骨頭切割，Morton 醫生會將您的新髖關節或膝蓋放置在正確的位置。

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…

有多種類型的機器人系統。
它們各有各的優點和缺點。
外科醫生或醫院系統可以選擇最適合他們和他們的患者的系統。
市場上的三個主要系統具有可比的導航、肢體對準計算和校准技術，可以個人化放置您的髖關節或膝關節置換術。

Stryker Mako機器人系統是第一款在美國大規模生產的機器人。
手術前，Mako機器人使用計算機斷層掃描，也稱為CT掃描。
CT 掃描可以在術前準確定位種植體。
術中韌帶平衡檢查允許對每個髖關節或膝關節植入物進行個人化定位。
這樣可以精確地定位和對準植入物。
Mako是一種觸覺系統，這意味著這些器械在使用時由外科醫生指導，在手術過程中提供手動反饋，如果機器人被放置在不安全的區域，這些器械將停止運行。

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.