机器人辅助螺钉固定治疗老年脆性骨盆骨折  

Robot-assisted screws fixation for the treatment of fragility fractures of the pelvis

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

机构地区：[1]天津市天津医院创伤骨盆科,天津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》2023年第12期813-820,共8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：目的探讨基于骨性通道复位标准的机器人辅助螺钉固定治疗老年脆性骨盆骨折的临床疗效。方法回顾性分析2016年3月至2021年10月天津市天津医院创伤骨盆科治疗的50例老年脆性骨盆骨折患者资料,根据固定方式分为机器人辅助螺钉固定组(简称机器人组)和切开复位钢板固定组(简称切开组)。其中机器人组30例,男6例、女24例,年龄(75.03±7.32)岁(范围60~90岁),脆性骨盆骨折(fragility fractures of the pelvis,FFP)分型:Ⅱc型4例、Ⅲa型8例、Ⅲb型1例、Ⅲc型12例、Ⅳa型3例、Ⅳb型2例;切开组20例,男5例、女15例,年龄(71.90±5.51)岁(范围62~85岁),FFP分型:Ⅱc型2例、Ⅲa型6例、Ⅲc型9例、Ⅳa型3例。比较两组患者年龄、骨盆骨折分型、手术时间、术中出血量、骨折复位质量、骨盆部位疼痛视觉模拟评分(visual analogue scale,VAS)、Majeed评分、伤口愈合与否。结果两组患者均获得随访,随访时间6~24个月,平均12.72个月。机器人组手术时间(50.17±19.32)min(范围30~120 min)、术中出血量(55.50±28.60)ml(范围10~150 ml),切开组分别为(92.25±27.55)min(范围60~180 min)、(217.50±67.20)ml(范围150~400 ml),两组比较差异均有统计学意义(t=6.36,P<0.001;t=11.72,P<0.001)。根据Mears和Velyvis影像学评价标准,机器人组10例解剖复位、20例复位满意,切开组14例解剖复位、6例复位满意,两组比较差异有统计学意义(χ^(2)=6.46,P=0.011)。机器人组骨盆部位疼痛VAS评分术前为(7.33±1.32)分(范围4~9分)、术后1周为(4.13±1.07)分(范围3~8分)、末次随访时为(2.30±0.84)分(范围1~5分),切开组分别为(7.45±1.23)分(范围5~9分)、(5.25±1.25)分(范围3~8分)、(2.80±1.24)分(范围1~6分),两组组内差异均有统计学意义(F=162.18,P<0.001;F=70.18,P<0.001),术后1周两组比较差异有统计学意义(t=3.37,P=0.001)、术前和末次随访比较差异均无统计学意义(P>0.05)。末次随访时机器人组Majeed评分为(82.10±4.80)�Objective To investigate the clinical outcomes of fragility fractures of the pelvis(FFP)treated with robot-assisted screws,minimally reduction according to the pelvic osseous pathways.Methods A retrospective analysis was performed on the data of 50 elderly patients with FFP treated by the Department of Trauma and Pelvic Trauma of Tianjin Hospital from March 2016 to October 2021,and the 50 patients with FFP were divided into robotic-assisted screw fixation group(robot group)and open reduction steel plate fixation group(open group)according to the fixation method.There were 30 patients in the Robot group,6 males and 24 females,average age 75.03±7.32 years(range,60-90 years).According to Rommens and Hofmann FFP classification,there were 4 cases ofⅡc type,8 cases ofⅢa type,1 case ofⅢb type,12 cases ofⅢc type,3 cases ofⅣa type,2 cases ofⅣb type.There were 20 patients in the open group,5 males and 15 females,average age 71.90±5.51 years(range,62-85 years).According to Rommens and Hofmann FFP classification,there were 2 cases ofⅡc type,6 cases ofⅢa type,9 cases ofⅢc type,3 cases ofⅣa type.The two groups were compared with age,pelvic fracture classification,operation time,intraoperative blood loss,fracture reduction quality,visual analogue scale(VAS),Majeed score,and wound healing or not.Results All patients were followed up for 12.72 months(range,6-24 months).In the robot group,the operation time was 50.17±19.32 min(range,30-120 min),and intraoperative blood loss was 55.50±28.60 ml(range,10-150 ml);in the open group,the operation time was 92.25±27.55 min(range,60-180 min),and intraoperative blood loss was 217.50±67.20 ml(range,150-400 ml),there were statistical differences(t=6.36,P<0.001;t=11.72,P<0.001).According to Mears and Velyvis imaging evaluation criteria,in the robot group,anatomical reduction were achieved in 10 cases,satifactory reduction were achieved in 20 cases;in the open group,anatomical reduction were achieved in 14 cases,satifactory reduction were achieved in 6 cases,there were

关 键 词：老年人 骨盆 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]