机器人辅助骨盆后环通道螺钉内固定治疗青少年不稳定型骨盆骨折  

Robot-assisted pelvic posterior channel screws in the treatment of unstable pelvic fractures in adolescents

作　　者：戚浩天 田维[1] 刘兆杰[1] 王宏川[1] 贾健[1] Qi Haotian;Tian Wei;Liu Zhaojie;Wang Hongchuan;Jia Jian(Department of Plevic Trauma,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院骨盆科,天津300211

出　　处：《中华骨科杂志》2022年第10期635-643,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骨盆后环通道螺钉内固定治疗青少年不稳定型骨盆骨折的临床疗效。方法回顾性分析2016年10月至2020年10月采用机器人辅助骨盆后环通道螺钉内固定治疗14例青少年不稳定型骨盆骨折患者资料,男8例、女6例;年龄(14.57±1.69)岁(范围12~17岁);骨盆骨折Tile分型,B1型2例、B2型3例、B3型1例、C1型2例、C2型5例、C3型1例;Torode-Zieg分型,Ⅲb型2例、Ⅳ型12例;Young-Burgess分型,APCⅡ型1例、APCⅢ型1例、LCⅠ型2例、LCⅢ型2例、VS型8例。记录骶髂螺钉通道直径、手术时间、术中出血量,评价骨折复位质量、骨盆不对称性、疼痛视觉模拟评分(visual analogue scale,VAS)、Majeed评分、螺钉置入准确率及术后并发症。对术前、术后1周及末次随访时的骨盆不对称性和VAS评分进行统计学分析。结果机器人辅助置入骶髂螺钉8例、辅助行三角固定6例。患者均获得随访,随访时间(24.85±10.26)个月(范围12~51个月)。S1骶髂螺钉通道高度(14.85±3.59)mm(范围8~22 mm),宽度(13.78±2.64)mm(范围9~19 mm);S2骶髂螺钉通道高度(14.07±3.08)mm(范围8~21 mm),宽度(12.64±2.84)mm(范围7~19 mm)。手术时间(63.57±21.61)min(范围20~120 min),术中出血量(65.71±41.83)ml(范围20~200 ml)。根据Mears和Velyvis影像学评价标准,7例解剖复位、6例复位满意、1例复位不满意,复位满意率为93%(13/14)。骨盆不对称性,术前(18.14±6.07)mm(范围9~33 mm),术后1周(5.43±2.44)mm(范围3~13 mm),末次随访时(4.64±2.27)mm(范围3~12 mm),差异有统计学意义(F=50.21,P<0.001)。VAS评分,术前(6.93±1.21)分(范围5~9分)、术后1周(3.93±0.99)分(范围3~6分)、末次随访时(1.21±0.97)分(范围0~3分),差异有统计学意义(F=100.89,P<0.001)。末次随访时Majeed评分为(86.14±7.35)分(范围70~95分),其中优11例、良2例、可1例,优良率为93%(13/14)。机器人辅助骨盆后环通道螺钉置入均位于骨质内,螺钉置入准确率100%。术后无一�Objective To investigate the clinical outcomes of unstable pelvic fractures in adolescents treated with robot-assisted posterior pelvic channel screw.Methods From October 2016 to October 2020,14 adolescent patients with unstable pelvic fractures were retrospectively analyzed.There were 8 males and 6 females,average age of 14.57±1.69 years(range,12-17 years).Pelvic fracture classification:according to Tile classification,2 cases of B1,3 cases of B2,1 case of B3,2 cases of C1,5 cases of C2,1 case of type C3.According to Torode-Zieg classification,2 cases of type IIIb,12 cases of type IV.According to Young-Burgess classification,1 case of APC II,1 case of APC III,2 cases of LC I,2 cases of LC III,8 cases of VS type.The diameter of the sacroiliac screw channel,operation time,intraoperative blood loss,fracture reduction quality,pelvic asymmetry,pain visual analogue scale(VAS),Majeed score,screw placement accuracy,postoperative complications were analyzed.The pelvic asymmetry and VAS at presurgery,one week after surgery and the last follow-up were statistically analyzed.Results There were 8 cases of robot-assisted sacroiliac screw placement and 6 cases of robot-assisted triangular fixation.All patients were followed up for 24.85±10.26 months(range,12-51 months).The average height of S1 sacroiliac screw channel was 14.85±3.59 mm(range,8-22 mm).The average width was 13.78±2.64 mm(range,9-19 mm).The average height of S2 sacroiliac screw channel was 14.07±3.08 mm(range,8-21 mm),and the average width was 12.64±2.84 mm(range,7-19 mm).The operation time was 63.57±21.61 min(range,20-120 min),and the intraoperative blood loss was 65.71±41.83 ml(range,20-200 ml).According to Mears and Velyvis imaging evaluation criteria,7 cases were anatomically reduced,6 cases were satisfactory,and 1 case was unsatisfactory,and the satisfactory reduction rate was 93%(13/14).The pelvic asymmetry was 18.14±6.07 mm(range,9-33 mm)before surgery,while one week after surgery,it was 5.43±2.44 mm(range,3-13 mm),and it was 4.64±2.27 mm(range,

关 键 词：青少年 骨盆 骨折 骨折固定术 内 机器人 

分 类 号：R687.3[医药卫生—骨科学]