急诊骨科手术机器人辅助经皮固定骶髂关节螺钉治疗不稳定型骨盆后环骨折的临床研究  

Emergency iliosacral screw fixation assisted by TiRobot for unstable posterior pelvic ring fracture

作　　者：李宇能[1] 刘昊楠 赵春鹏[1] 吴宏华[1] 孙旭[1] 谭哲伦 王满宜[1] 吴新宝[1] Li Yuneng;Liu Haonan;Zhao Chunpeng;Wu Honghua;Sun Xu;Tan Zhelun;Wang Manyi;Wu Xinbao(Department of Orthopedics&Traumatology,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopaedics,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]北京积水潭医院创伤骨科,北京100035 [2]国家儿童医学中心,首都医科大学附属北京儿童医院骨科,北京100045

出　　处：《中华创伤骨科杂志》2022年第3期194-199,共6页Chinese Journal of Orthopaedic Trauma

基　　金：北京市属医院科研培育计划(PX2019016)。

摘　　要：目的探讨急诊骨科手术机器人辅助经皮固定骶髂关节螺钉治疗不稳定型骨盆后环骨折的临床疗效。方法回顾性分析2018年6月至2020年12月期间北京积水潭医院创伤骨科急诊接受经皮骶髂关节螺钉固定的26例骨盆骨折患者资料。根据术中是否应用骨科手术机器人辅助置钉分为两组:观察组14例,男10例,女4例;年龄为(45.9±10.1)岁;利用天玑®(TiRobot)骨科手术机器人辅助置钉。对照组12例,男9例,女3例;年龄为(49.2±11.3)岁;按传统方式在X线透视下徒手置钉。所有患者均于伤后24 h内完成手术。比较两组患者的螺钉置入时间、导针置入次数、术中出血量、透视时间、术后骶髂关节螺钉位置、骨折复位质量及末次随访时髋关节Harris评分等。结果两组患者术前一般资料及随访时间的比较差异均无统计学意义(P>0.05),具有可比性。观察组和对照组分别置入20、18枚螺钉。观察组患者的螺钉置入时间[(16.1±3.4)min]和透视时间[(8.1±3.3)s]显著短于对照组患者[(26.4±5.4)min、(25.2±7.4)s],导针置入次数[1(1,2)次]显著少于对照组患者[6(3,8)次],术中出血量[(10.5±6.4)mL]显著少于对照组患者[(24.8±6.7)mL],差异均有统计学意义(P<0.05)。术后骶髂关节螺钉位置:观察组优18枚,良2枚;对照组优14枚,良2枚,差2枚;术后骨折复位质量:观察组优12例,良1例,可1例;对照组优10例,良1例,可1例,以上项目两组比较差异均无统计学意义(P>0.05)。两组患者末次随访时髋关节Harris评分比较差异无统计学意义(P>0.05)。结论与传统徒手置钉比较,急诊骨科手术机器人辅助经皮固定骶髂关节螺钉治疗不稳定型骨盆后环骨折能够有效缩短手术时间、减少手术创伤,且置钉准确率高。Objective To evaluate the emergency iliosacral screw fixation assisted by TiRobot for unstable posterior pelvic ring fracture.Methods The 26 patients with unstable pelvic fracture were analyzed retrospectively who had undergone emergency iliosacral screw fixation at Department of Orthopedics&Traumatology,Beijing Jishuitan Hospital from June 2018 to December 2020.They were divided into 2 groups depending on whether orthopaedic TiRobot was used to assist screw insertion.In the observation group of 14 cases subjected to TiRobot-assisted insertion of iliosacral screws,there were 10 males and 4 females with an age of(45.9±10.1)years;in the control group of 12 cases subjected to conventional manual insertion of iliosacral screws,there were 9 males and 3 females with an age of(49.2±11.3)years.All the surgeries were conducted within 24 hours after injury.The 2 groups were compared in terms of screw insertion time,pin insertion,intraoperative blood loss,fluoroscopy time,postoperative screw position,fracture reduction and Harris hip score at the final follow-up.Results The 2 groups were comparable because there was no significant difference between them in their preoperative general clinical data or follow-up time(P>0.05).The screw insertion time[(16.1±3.4)min]and fluoroscopy time[(8.1±3.3)s]in the observation group were significantly shorter than those in the control group[(26.4±5.4)min and(25.2±7.4)s],and the pin insertions[1(1,2)times]and intraoperative blood loss[(10.5±6.4)mL]in the former were significantly less than those in the latter[6(3,8)times and(24.8±6.7)mL](all P<0.05).Postoperatively,the sacroiliac screw position was excellent in 18 cases and good in 2 in the observation group while excellent in 14 cases,good in 2 and poor in 2 in the control group;the fracture reduction was excellent in 12 cases,good in one and fair in one in the observation group while excellent in 10 cases,good in one and fair in one in the control group,showing insignificant differences in the above comparisons(P>0.05).There was n

关 键 词：骨盆 骨折 骨折固定术 内 骨钉 外科手术 微创性 手术机器人 急诊 

分 类 号：R687.3[医药卫生—骨科学]