骨科机器人辅助与徒手经皮骶髂螺钉固定治疗骨盆后环骨折比较的Meta分析  

Meta-analysis of efficacy of orthopedic robot-assisted versus freehand percutaneous sacroiliac screw fixation for posterior pelvic ring fractures

作　　者：张国旭 曾剑波 李静[1] 谢骐骏 周冠斌 管建豪 陈文创 陈海云 Zhang Guoxu;Zeng Jianbo;Li Jing;Xie Qijun;Zhou Guanbin;Guan Jianhao;Chen Wenchuang;Chen Haiyun(Second Clinical College of Guangzhou University of Chinese Medicine,Guangzhou 510120,Guangdong Province,China;Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510000,Guangdong Province,China)

机构地区：[1]广州中医药大学第二临床医学院,广东省广州市510120 [2]广州中医药大学第二附属医院/广东省中医院,广东省广州市510000

出　　处：《中国组织工程研究》2024年第18期2932-2938,共7页Chinese Journal of Tissue Engineering Research

基　　金：珠海市科技创新局重点项目(2220004000372),项目负责人:陈海云。

摘　　要：目的:经皮骶髂螺钉内固定已经成为治疗骨盆后环骨折的主要手术方式,然而徒手闭合操作对术者经验要求较高,且反复透视增加患者和医务人员辐射危害。文章通过Meta分析方法比较机器人辅助与徒手经皮骶髂螺钉置入治疗骨盆后环骨折临床疗效的差异。方法:计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase、Cochrane Library及ClinicalTrials.gov等数据库,检索时限均从各数据库建库到2022年12月。搜集国内外关于对比研究机器人辅助与徒手经皮骶髂螺钉置入治疗骨盆后环骨折临床疗效的文献,由2名研究者分别根据纳入和排除标准独立筛选并提取文献数据。采用Cochrane风险评估标准评价随机对照试验质量,采用纽卡斯尔-渥太华量表对纳入队列研究的质量进行评估。使用RevMan 5.4软件对纳入指标进行Meta分析,结局指标包括手术时间、术中出血量、透视时间、透视频率、钻孔次数、Majeed术后功能评分、Matta骨折复位优良率、Gras螺钉位置优良率、骨折愈合时间及术后并发症。结果:①共纳入13篇文献,2篇为随机对照试验,均提及随机方法;11篇为非随机对照研究,根据纽卡斯尔-渥太华量表进行文献质量评价,1篇8分,9篇7分,1篇6分,文献质量较好;共纳入748例患者,其中机器人组430例,徒手组318例。②Meta分析结果显示,机器人辅助组手术时间(MD=-28.30,95%CI:-40.20至-16.40)、术中出血量(MD=-6.36,95%CI:-10.06至-2.66)、术中透视时间(MD=-12.13,95%CI:-19.54至-4.72)、术中透视频率(MD=-17.39,95%CI:-29.00至-5.78)、术中导针钻孔次数(SMD=-9.50,95%CI:-14.27至-4.73)和Gras螺钉位置优良率(OR=8.65,95%CI:3.26-22.92)均明显优于徒手组(P<0.05);③机器人辅助组可显著降低术后总体并发症发生率(OR=0.10,95%CI:0.02-0.48,P<0.05);④两组骨折愈合时间(MD=-0.08,95%CI:-0.21,0.06)、Matta骨折复位优良率(OR=2.06OBJECTIVE:Percutaneous sacroiliac screw internal fixation has become the main surgical procedure for the treatment of posterior pelvic ring fractures;however,the unassisted closure operation requires high operator experience and repeated fluoroscopy increases the radiation hazard for patients and medical personnel.This article compares the clinical efficacy of robot-assisted versus unassisted percutaneous sacroiliac screw placement for posterior pelvic ring fractures by meta-analysis.METHODS:Computer searches of CNKI,WanFang,VIP,CBM,PubMed,Embase,Cochrane Library and ClinicalTrials.gov were conducted from the time of database inception to December 2022.The literature on the clinical efficacy of robot-assisted versus freehand percutaneous sacroiliac screw placement in the treatment of posterior pelvic ring fractures was collected in and outside China.The data were independently screened and extracted by two investigators according to the inclusion and exclusion criteria,respectively.The quality of randomized controlled trials was evaluated using Cochrane risk assessment criteria.The quality of included cohort studies was assessed using the Newcastle-Ottawa Scale.Meta-analysis was performed using RevMan 5.4 software for inclusion metrics.Outcome metrics included operative time,intraoperative bleeding,fluoroscopy time,fluoroscopy frequency,number of holes drilled,Majeed postoperative function score,the excellent and good rates of Matta fracture reduction,the excellent and good rates of Gras screw position,fracture healing time and complications.RESULTS:(1)A total of 13 publications were included,2 were randomized controlled trials both referring to randomized methods,11 non-randomized controlled studies were evaluated for quality of literature according to the Newcastle-Ottawa Scale,1 scored 8,9 scored 7;and 1 scored 6;the quality of literature was good.A total of 748 patients were included,including 430 in the robot-assisted group and 318 in the freehand group.(2)The results of the metaanalysis showed that the oper

关 键 词：骨盆 骨折 骨盆后环 机器人 机器人手术 骶髂关节螺钉 螺钉 META分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R608