机器人辅助双侧三角固定治疗创伤性脊柱骨盆分离  

Robot-assisted bilateral triangular fixation for the treatment of traumatic spinopelvic dissociation

作　　者：戚浩天 葛振新 田维[1] 刘兆杰[1] 孙玉玺 金鑫[1] 王宏川[1] 贾健[1] Qi Haotian;Ge Zhenxin;Tian Wei;Liu Zhaojie;Sun Yuxi;Jin Xin;Wang Hongchuan;Jia Jian(Department of Plevic Trauma,Tianjin Hospital,Tianjin 300211,China;The First Ward of Department of Trauma and Orthopaedics of Juxian People's Hospital,Rizhao 276500,China)

机构地区：[1]天津市天津医院骨盆科,300211 [2]山东省莒县人民医院创伤骨科一病区,日照276500

出　　处：《中华骨科杂志》2021年第15期1001-1009,共9页Chinese Journal of Orthopaedics

基　　金：天津市卫生健康委科技人才培育项目(RC20203)。

摘　　要：目的探讨机器人辅助双侧三角固定治疗创伤性脊柱骨盆分离的临床疗效。方法回顾性分析2016年3月至2020年3月治疗30例创伤性脊柱骨盆分离患者,根据手术及固定方式分为机器人辅助微创双侧三角固定组(简称机器人三角固定组)和传统切开复位髂腰固定组(简称髂腰固定组)。其中机器人三角固定组16例,男4例,女12例;年龄(35.7±13.3)岁(范围16~58岁);骶骨骨折形状分型,"U"型10例,"H"型4例,"Y"型2例;创伤性脊柱骨盆分离ROY-Camille分型,Ⅰ型4例,Ⅱ型9例,Ⅲ型3例;13例合并骶神经损伤,GibbonsⅡ级10例,Ⅲ级3例。髂腰固定组14例,男4例,女10例;年龄(37.4±15.1)岁(范围18~66岁);骶骨骨折形状分型,"U"型10例,"H"型3例,"Y"型1例;创伤性脊柱骨盆分离ROY-Camille分型,Ⅰ型1例,Ⅱ型10例,Ⅲ型3例;10例合并骶神经损伤,GibbonsⅡ级7例,Ⅲ级3例。比较两组患者年龄、手术时间、术中出血量、Majeed评分、性别、骶骨骨折分类、ROY-Camille分型、骨折复位质量、术后伤口感染、骶神经恢复与否。结果两组患者均获得随访,随访时间12~54个月,平均23.6个月。机器人三角固定组:手术时间(95.3±27.5)min(范围70~180 min),术中出血量(98.7±47.5)ml(范围50~250 ml)。根据Mears和Velyvis影像学评价标准,6例解剖复位,9例复位满意,1例复位不满意;Majeed评分(85.5±7.7)分。术前10例GibbonsⅡ级骶神经损伤者,术后8例恢复为Ⅰ级;术前3例Ⅲ级骶神经损伤者,术后1例恢复为Ⅰ级,1例恢复为Ⅱ级。髂腰固定组:手术时间(148.6±59.1)min(范围90~240 min),术中出血量(582.1±244.6)ml(范围300~1200 ml)。术后7例解剖复位,6例复位满意,1例复位不满意;Majeed评分(77.6±7.7)分;术前7例GibbonsⅡ级骶神经损伤者,术后5例恢复为Ⅰ级;术前3例Ⅲ级骶神经损伤者,术后2例恢复为Ⅰ级。与髂腰固定组比较,机器人三角固定组手术时间短、出血量少、术后功能恢复Majeed评分高,以上各指标�Objective To evaluate the clinical outcomes of traumatic spinopelvic dissociation treated with robot-assisted bilateral triangular fixation.Methods From March 2016 to March 2020,30 patients with traumatic spinopelvic dissociation were retrospectively analyzed.According to operation and fixation methods,the patients were divided into robot-assisted minimally invasive bilateral triangular fixation group(Robot triangular group)and traditional open reduction lumbopelvic fixation group(Lumbopelvic group).There were 16 patients in the Robot triangular group,4 males and 12 females,average age 35.7±13.3 years(range,16-58 years).There were 10 cases of U-shaped,4 cases of H-shaped,2 cases of Y-shaped sacral fractures according to shape classification of sacral fractures.According to ROY-Camille classification,there were 4 cases of type I,9 cases of type II,3 cases of type III.There were 13 cases with sacral nerve injuries,including 10 cases of Gibbons grade II,3 cases of grade III.There were 14 patients in the Lumbopelvic group,4 males and 10 females,average age 37.4±15.1 years(range,18-66 years),there were 10 cases of U-shaped,3 cases of H-shaped,1 case of Y-shaped sacral fractures according to shape classification of sacral fractures.According to ROY-Camille classification,there were 1 case of type I,10 cases of type II,3 cases of type III.There were 10 cases with sacral nerve injuries,7 cases of Gibbons grade II,3 cases of grade III.The patients'age,operation time,intraoperative blood loss,and Majeed score of the two groups were compared by independent sample t-test;gender,sacral fracture classification,ROY-Camille classification,fracture reduction quality,postoperative wound infection,and sacral nerve recovery were compared by Chi-square test.Results All patients were followed up for 23.6 months(range,12-54 months).In the Robot triangular group,the operation time was 95.3±27.5 min(range,70-180 min),and intraoperative blood loss was 98.7±47.5 ml(range,50-250 ml).According to Mears and Velyvis imaging evaluation crit

关 键 词：骶骨 骨折 骨折固定术 机器人 

分 类 号：R687.3[医药卫生—骨科学]