机器人辅助骶髂螺钉固定治疗老年脆性骶骨骨折  

Robot-assisted sacroiliac screw fixation to treat fragility fractures of the sacrum in the elderly

作　　者：白树财 刘兆杰[1] 田维[1] 戚浩天 李鹏飞[1] 孙玉玺 王宏川[1] 肖湘[1] 刘柱娜 孔蒙娟 贾健[1] Bai Shucai;Liu Zhaojie;Tian Wei;Qi Haotian;Li Pengfei;Sun Yuxi;Wang Hongchuan;Xiao Xiang;Liu Zhuna;Kong Mengjuan;Jia Jian(Department of Plevic Trauma,Tianjin Hospital,Tianjin 300211,China;Department of Radiology,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院创伤骨盆科,天津300211 [2]天津市天津医院放射一科,天津300211

出　　处：《中华骨科杂志》2023年第12期789-796,共8页Chinese Journal of Orthopaedics

基　　金：天津市应用基础研究多元投入项目(21JCQNJC01360)。

摘　　要：目的探讨机器人辅助骶髂螺钉固定治疗老年脆性骶骨骨折的疗效。方法回顾性分析2016年3月至2022年6月天津市天津医院创伤骨盆科采用机器人辅助骶髂螺钉固定治疗30例老年脆性骶骨骨折患者资料,男12例、女18例,年龄(71.03±8.25)岁(范围60~89岁)。根据老年脆性骨盆骨折(fragility fractures of the pelvis,FFP)分型,Ⅱ型22例、Ⅲ型2例、Ⅳ型6例。术前根据S1通道的平均CT值及是否具备贯穿通道规划手术,术中采用机器人辅助置入骶髂螺钉。采用视觉模拟评分(visual analogue scale,VAS)评估疼痛,通过Gras分级评估骶髂螺钉位置,采用Majeed功能评分评估骨盆骨折后功能恢复程度。结果30例患者均顺利完成手术,手术时间(27.00±6.68)min(范围18~35 min),透视次数(27.13±5.16)次(范围18~34次),出血量(30.53±6.61)ml(范围23~38 ml)。所有患者均获得随访,随访时间(19.03±7.80)个月(范围8~25个月)。术前、术后1周、术后2个月和术后6个月患者VAS评分分别为5(5,6)分、4(3,4)分、3(2,3)分和0(0,1)分,差异有统计学意义(H=103.26,P<0.001);术后2个月、6个月和末次随访Majeed功能评分分别为88(83,90)分、91(87,92)分和92(90,93)分,差异有统计学意义(H=19.59,P<0.001);术后第3天根据Gras分级评估骶髂螺钉位置,其中Ⅰ级28例、Ⅱ级2例,无一枚螺钉穿透皮质骨或进入骶管、骶孔。术中均未发生血管及神经损伤。28例患者骨折愈合,愈合时间(4.54±1.57)个月(范围3~7个月)。2例患者骨折未愈合,其中1例因骨盆前环伤口感染而取出骨盆前环钢板,1个月后骨盆CT扫描提示骶髂螺钉松动;另1例考虑与患者过早的负重有关。结论对老年脆性骶骨骨折,机器人辅助骶髂螺钉固定是一种有效的微创治疗方法,置钉准确率高,可有效减轻疼痛,骨折愈合率高,近期临床疗效满意。Objective To evaluate the clinical outcome of Robot-assisted sacroiliac screw fixation in the treatment of fragility fracture of the sacrum in the elderly.Methods From March 2016 to June 2022,a retrospective analysis was performed on 30 patients with fragility fractures of the sacrum in the elderly who accepted robot-assisted sacroiliac screw to treat fragility fractures of the sacrum in our hospital.There were 12 males and 18 females with average age 71.03±8.25 years(range,60-89 years).According to the classification of fragility fractures of the pelvis(FFP)in the elderly,there were 22 patients with FFP II,2 patients with FFP III,and 6 patients with FFP IV.Surgical planning was based on the average CT value of S1 channel and whether there is a transsacral screw channel.Robot-assisted sacroiliac screw fixation was performed during surgery.The pain of pre-operation and post-operation was evaluated using the visual analogue scale(VAS),the position of sacroiliac screws was evaluated by Gras grading,and the degree of functional recovery after surgery was evaluated using the Majeed function score.Results All 30 patients successfully completed the operation.The mean operation time was 27.00±6.68 min(range,18-35 min),the mean fluoroscopy times were 27.13±5.16(range,18-34),and the mean blood loss was 30.53±6.61 ml(range,23-38 ml).All patients were followed up,and the mean follow-up time was 19.03±7.8 months(range,8-25 months).The VAS was 5(5,6),4(3,4),3(2,3),0(0,1)points before surgery,1 week,2 months and 6 months after surgery,respectively,and the difference was statistically significant(H=103.26,P<0.001).After the surgery of 2 months,6 months and the last follow-up time,the Majeed function scores were 88(83,90),91(87,92),92(90,93)points,respectively,and the difference was statistically significant(H=19.59,P<0.001).Screw position was evaluated according to Gras grading at 3 days after surgery,including 28 cases of level I,2 cases of level II,and no screw penetrated the cortical bone or entered the sacral canal or s

关 键 词：骶骨 骨折 骨质疏松 机器人手术 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]