机器人辅助下跟骨骨折内固定与传统切开复位内固定对比研究  

A comparative study on internal fixation of calcaneal fractures assisted by robot and traditional open reduction internal fixation

作　　者：袁心伟[1] 张斌[1] 胡豇[1] 卢冰[1] 唐智 YUAN Xinwei;ZHANG Bin;HU Jiang;LU Bing;TANG Zhi(Department of Orthopedics,Sichuan Provincial People's Hospital,Sichuan Academy of Medical Sciences,Chengdu Sichuan,610072,P.R.China)

机构地区：[1]四川省医学科学院·四川省人民医院骨科,成都610072

出　　处：《中国修复重建外科杂志》2021年第6期729-733,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省科技厅科技支撑项目(2019YFS0268)。

摘　　要：目的比较机器人辅助下跟骨骨折内固定与传统切开复位内固定疗效差异。方法回顾分析2017年10月—2018年12月收治且符合选择标准的44例44足跟骨骨折患者临床资料,根据术式不同分为研究组(19例,行机器人辅助下跗骨窦切口经皮复位空心螺钉内固定术治疗)和对照组(25例,行传统C臂X线机透视下跗骨窦切口切开复位内固定术治疗)。两组患者性别、年龄、受伤侧别、致伤原因、骨折分型、受伤至手术时间以及术前Bohler角、Gissane角、跟骨宽度、美国矫形足踝协会(AOFAS)评分等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中C臂X线机透视次数、骨折愈合时间;术前及术后6个月于侧位X线片上测量Bohler角、Gissane角和跟骨轴位X线片上测量跟骨宽度,评价手术治疗对畸形及塌陷的恢复情况;术前及术后6个月采用AOFAS评分评价患足踝关节功能。结果研究组患者手术时间显著长于对照组,但术中C臂X线机透视次数显著少于对照组,差异均有统计学意义(P<0.05)。术后对照组1例出现皮缘坏死,1例出现切口少许渗液;两组其余患者无皮肤及切口相关并发症发生。两组患者均获随访,随访时间6~12个月,平均9.5个月。术后6个月,两组B?hler角、Gissane角和跟骨宽度均较术前显著改善(P<0.05),两组间比较差异无统计学意义(P>0.05);两组骨折均愈合,愈合时间比较差异无统计学意义(t=-1.890,P=0.066);两组AOFAS评分均较术前显著提高(P<0.05),研究组AOFAS评分显著高于对照组(t=-3.135,P=0.003)。结论与传统C臂X线机透视下内固定治疗跟骨骨折相比,机器人辅助跗骨窦切口内固定治疗跟骨骨折能有效维持骨折复位后植钉精度,减少术中透视次数,骨折愈合良好,促进患足功能恢复。Objective To compare the effectiveness of robot assisted internal fixation and traditional open reduction and internal fixation for calcaneal fractures. Methods The clinical data of 44 patients(44 feets) with calcaneal fracture admitted between October 2017 and December 2018 who met the selection criteria were retrospectively analyzed.According to different operation methods, they were divided into trial group(19 cases, treated with robot assisted percutaneous reduction and cannulated screw fixation through tarsal sinus incision) and control group(25 cases, treated with open reduction and internal fixation via traditional tarsal sinus incision). There was no significant difference in gender, age, injured side, cause of injury, fracture type, time from injury to operation, and preoperative B?hler angle,Gissane angle, calcaneus width, American Orthopedic Foot and Ankle Association(AOFAS) score, and other general data between the two groups(P>0.05). The operation time, intraoperative fluoroscopy frequency, and fracture healing time were recorded and compared between the two groups. Before operation and at 6 months after operation, the B?hler angle and Gissane angle were measured on the lateral X-ray film, and the calcaneal width was measured on the axial X-ray film of the calcaneus to evaluate the recovery of the deformity and collapse after surgical treatment;the AOFAS score was used to evaluate the function of the affected foot and ankle joint. Results The operation time of the trial group was significantly longer than that of the control group(P<0.05), but the intraoperative fluoroscopy frequency was significantly less than that of the control group(P<0.05). In the control group, 1 case had skin necrosis, and 1 case had a little leakage from the incision;the rest of the two groups had no skin-and incision-related complications. Patients in both groups were followed up 6-12 months, with an average of 9.5 months. At 6 months after operation, the B?hler angle, Gissane angle, and calcaneal width in the two groups wer

关 键 词：机器人 跟骨骨折 内固定 跗骨窦切口 

分 类 号：R687.3[医药卫生—骨科学]