机器人联合提拉钉复位空心钉固定难复性股骨颈骨折  

Robot combined with lifting pin for reduction and cannulated screw internal fixation of refractory femoral neck fracture

作　　者：杜公文 申才良[1] 张复文[1] 张琦[1] 王刚[1] 尹宗生[1] DU Gong wen;SHEN Cai-liang;ZHANG Fu-wen;ZHANG Qi;WANG Gang;YIN Zong-sheng(Department of Orthopedics,The First Affiliated Hospital,Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院骨科,安徽合肥230022

出　　处：《中国矫形外科杂志》2022年第14期1299-1302,共4页Orthopedic Journal of China

基　　金：国家重点研发计划资助项目(编号:2018YFC0114708)。

摘　　要：[目的]介绍机器人联合辅助提拉闭合复位治疗难复性股骨颈骨折的手术技术和临床效果。[方法] 2018年1月—2020年12月采用上述技术治疗难复位性股骨颈骨折15例。首先机器人引导下置入3枚空心钉导针,不穿过骨折线,股骨头置入1枚拉杆钉,透视下拉杆钉和手法施加复位力,使骨折达到满意复位,将3根空心钉导针穿过骨折线至股骨头下,最后空心钉固定。[结果] 15例患者均顺利完成手术,术中无神经、血管损伤等严重并发症,术后1年髋关节Harris评分平均(88.67±14.04)分。1例因过早下地致固定失败,其余患者末次随访时均恢复伤前运动水平。影像方面,所有患者术后均达到Garden对线I级复位,除上述1例患者,所有患者均骨折愈合,无股骨头坏死。[结论]机器人联合辅助提拉复位可有效治疗难复性股骨颈骨折,具有放射损害低、骨折复位质量高、内固定精准的优点。[Objective] To introduce the surgical technique and preliminary clinical outcomes of robot combined with lifting pin for reduction and cannulated screw internal fixation of refractory femoral neck fracture. [Methods] From January 2018 to December 2020, 15 patients were treated with the above techniques for refractory femoral neck fracture. First of all, 3 cannulated screw guide pins were placed under the guidance of robot, without passing through the fracture line, and a lifting pin was placed into the femoral head. The reduction force was applied by the lifting pin and manipulations to achieve satisfactory reduction of the fracture. Subsequently, the guide pin for cannulated screw guide were driven to pass through the fracture line into the femoral head, and finally the cannulated screws was inserted to finish the internal fixation. [Results] All the 15 patients had operation completed successfully, without neurovascular injury and other serious complications, and were marked Harris score of(88.67±14.04) one year postoperatively. Except a patient who failed fixation due to premature walking, all the patients returned to their pre-injury activity level at the latest follow-up. In terms of imaging, all patients achieved grade I reduction based on Garden alignment scale after surgery. Except the patient abovementioned, all patients achieved fracture healing without femoral head necrosis. [Conclusion] The robot combined with lifting pin for reduction and cannulated screw internal fixation does effectively treat the refractory femoral neck fracture, with advantages of low radiation exposure, high fracture reduction quality and accurate internal fixation placement.

关 键 词：股骨颈骨折 难复性骨折 机器人 辅助提拉复位 空心钉 

分 类 号：R683.42[医药卫生—骨科学]