骨科机器人辅助髋臼骨折微创手术的临床研究  

Robot-assisted minimally invasive surgery for acetabular fracture

作　　者：赵春鹏[1] 肖鸿鹄 汪凯文 韩巍[1] 苏永刚[1] 周力[1] 马若飞 王军强[1] 吴新宝[1] Zhao Chunpeng;Xiao Honghu;Wang Kaiwen;Han Wei;Su Yonggang;Zhou Li;Ma Ruofei;Wang Junqiang;Wu Xinbao(Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopaedics,The First Hospital of Qiqihar,Qiqihar 161000,China)

机构地区：[1]北京积水潭医院创伤骨科,100035 [2]齐齐哈尔市第一医院骨科,161000

出　　处：《中华创伤骨科杂志》2020年第12期1021-1028,共8页Chinese Journal of Orthopaedic Trauma

基　　金：北京自然科学基金(L192011)。

摘　　要：目的探讨骨科机器人辅助治疗髋臼骨折的临床效果。方法回顾性分析2015年1月至2019年12月期间北京积水潭医院创伤骨科采用"天玑"机器人辅助治疗的31例髋臼骨折患者资料。男27例,女4例;平均年龄为42.3岁(17~71岁)。骨折Letournel-Judet分型:前柱骨折5例,横形骨折12例,横形伴后壁骨折2例,T形骨折8例,前方伴后半横形骨折2例,双柱骨折2例。受伤至手术时间平均为9.0 d(2~21 d)。23例患者采用经皮内固定术,8例患者采用有限切开复位内固定术。记录患者的螺钉固定数量、手术时间、术中出血量、输血量、ICU使用率、住院时间及相关并发症的发生情况等。结果31例患者平均置入螺钉1.9枚(1~5枚),手术时间平均为3.3 h(1.0~8.5 h),术中出血量平均为298.7 mL(20~2000 mL),异体输血量平均为77.4 mL(0~800 mL),自体输血量平均为56.5 mL(0~800 mL),并发症发生率为9.7%(3/31),ICU使用率为29.0%(9/31)。住院时间平均为6.0 d(1~23 d)。29例患者术后获平均34.2个月(6~65个月)随访,2例失访。末次随访时改良Merle d'Aubigne&Postel评分平均为16.7分(12~18分);Majeed评分平均为85.4分(60~100分),其中优18例,良7例,可4例,优良率为86.2%(25/29)。结论骨科机器人可以帮助临床医生准确定位髋臼螺钉的安全通道,并辅助安全置入通道螺钉,实现髋臼骨折的微创固定,效果良好。Objective To evaluate the clinical outcomes of robot-assisted minimally invasive surgery for acetabular fracture.Methods From January 2015 to December 2019,31 patients with acetabular fracture underwent TiRobot-assisted minimally invasive surgery at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital.They were 27 males and 4 females,with an average age of 42.3 years(from 17 to 71 years).By the Letournel-Judet classification,there were 5 anterior column fractures,12 transverse fractures,2 transverse+posterior wall fractures,8 T-shaped fractures,2 anterior+posterior hemitransverse fractures and 2 associated both column fractures.The time from injury to surgery averaged 9.0 d(from 2 to 21 d).Of the 31 patients,23 underwent robot-assisted percuta neous internal fixation and 8 robot-assisted limited open reduction and internal fixation.Recorded were number of screws,operation time,intraoperative bleeding,blood transfusion,ICU use,hospital stay and related complications.Results For the 31 patients,on average,screw number was 1.9(from 1 to 5),operation time 3.3 h(from 1.0 to 8.5 h),intraoperative bleeding 298.7 mL(from 20 to 2,000 mL),allogenic transfusion 77.4 mL(from 0 to 800 mL),autologous transfusion 56.5 mL(from 0 to 800 mL),rate of complications 9.7%(3/31),rate of ICU use 29.0%(9/31),and hospital stay 6.0 d(from 1 to 23 d).In this cohort,29 patients were followed up for an average time of 34.2 months(from 6 to 65 months)and 2 lost to the follow-up.At the final follow-up,the modified Merle d'Aubignéscores averaged 16.7 points(from 12 to 18 points);the Majeed scores averaged 85.4 points(from 60 to 100 points),giving 18 excellent,7 good and 4 fair cases and a good to excellent rate of 86.2%(25/29).Conclusion Orthopaedic robots can help clinicians accurately locate a safe pathway and assist safe placement of acetabular screws to fulfill minimally invasive fixation of acetabular fracture,leading to fine clinical outcomes.

关 键 词：手术机器人 髋臼 骨折 骨折固定术 内 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]