机器人辅助下的骶髂螺钉置入精准性的临床分析  

Study on the precision of the robot-assisted sacroiliac screw placement

作　　者：赵勇[1] 姜传强 孙涛[1] 辛大江[1] 曲文庆 王振海[1] 王丹[1] 张树栋[1] Zhao Yong;Jiang Chuanqiang;Sun Tao;Xin Dajiang;Qu Wenqing;Wang Zhenhai;Wang Dan;Zhang Shudong(Department of Orthopedics,Yantai Shan Hospital,Yantai 264008,China)

机构地区：[1]烟台市烟台山医院骨创伤科,烟台264008

出　　处：《中华医学杂志》2020年第35期2763-2767,共5页National Medical Journal of China

基　　金：国家重点研发计划(2017YFC0110602);国家自然科学基金(81301553、81641171);山东省重点研发计划项目(2018GSF118064);山东省医药卫生科技发展计划项目(2017WS169)。

摘　　要：目的:探讨机器人辅助骶髂螺钉置入治疗骨盆后环损伤的精准性及其影响因素。方法:回顾性分析2016年8月至2018年5月烟台市烟台山医院收治的24例骨盆骨折患者的病例资料,男17例,女7例;年龄17~71岁,平均44.1岁。骨盆骨折按AO分型:B型17例(B1型9例,B2型8例),C型7例(C1型3例,C2型2例,C3型2例)。骨盆后环损伤均采用机器人辅助经皮骶髂螺钉(AO直径7.3 mm的空心钉)治疗。S 1共26钉,S 2共18钉,单独S 1节段固定8例,单独S 2节段固定3例,S 1/S 2双节段联合固定13例,S 1单向单侧固定18例,S 1双向双侧固定3例,S 2单向单侧固定14例,S 2双向双侧固定2例,S 1单向两枚螺钉固定2例。后X线平片和CT观察骶髂螺钉置钉效果。术前及术后1周应用视觉模拟评分(VAS)进行疼痛评估。结果:所有骶髂螺钉均为使用机器人辅助下按规划一次性顺利置入。术后X线片和CT显示,所有骶髂螺钉均没有穿破骶骨体及对侧骶骨翼前缘皮质,也没有进入骶管、椎间隙。3例出现了螺钉紧贴髂骨内缘高密度线前缘和骶1的骶骨翼斜坡穿出,并最终再次进入骶骨体,3例螺钉与骶神经根管相切,但未突破骶神经根管。VAS评分由术前平均7.1分(4~10分)降至术后的平均1.9分(0~3分)。结论:采用机器人辅助骶髂螺钉置入的精准度高,值得推广,但术者的主导作用不容替代。Objective To evaluate the precision of the robot-assisted sacroiliac screw placement for posterior pelvis injury and the impacting factors.Methods The clinical data of twenty-four cases of posterior pelvic fractures treated by percutaneous sacroiliac screw placement in Yantai shan Hospital from August 2016 to May 2018 were studied retrospectively.There were 17 males and 7 females with a mean age of 44.1 years(ranged from 17 to 71 years).According to AO classification,17 cases were type B fractures(9 cases of type B1 and 8 type B2),and 7 cases were type C factures(3 cases of type C1,2 type C2 and 2 type C3).All cases were treated by robot-assisted percutaneous sacroiliac screw placement(AO cannulated screws with a diameter of 7.3 mm).In the posterior pelvic surgeries for the 24 cases,26 S1 sacroiliac screws fixations and 18 S2 sacroiliac screw fixations were placed in total,with single S1 segmental fixation in 8 cases,single S2 segmental fixation in 3 cases,S1 and S2 combined fixation in 13 cases,S1 unidirectional one-sided fixation in 18 cases,S1 bidirectional two-sided fixation in 3 cases,S2 unidirectional one-sided fixation in 14 cases,S2 bidirectional two-sided fixation in 2 cases and S1 unidirectional double screws fixation in 2 cases.X-ray and CT examinations were taken for all 24 cases after operation.The visual analogue scale(VAS)of pain were performed before and after the operation.Results All the sacroiliac screws were successfully implanted at once as planned with the assistance of the robot.The postoperative X-ray films and CT showed that none of the sacroiliac screws broke through the sacral body and the contralateral sacral wing′s frontal cortex nor did they stray into the sacral canal and the intervertebral space.In 3 cases,the sacroiliac screws went closely against and wore out the front edge of iliac cortical density line and sacral alar slope and finally re-entered the sacral body.In 3 cases,sacroiliac screws touched upon the sacral nerve canals but did not break through the nerve canals.The me

关 键 词：骨盆 机器人 骶髂螺钉 微创 精准 

分 类 号：R687.3[医药卫生—骨科学] TP242[医药卫生—外科学]