机器人辅助治疗老年骨盆骨折的疗效分析  

Therapeutic effect analysis of orthopedic robot assisted treatment of elderly pelvic fractures

作　　者：姚林林 张明磊[1] 朱彤彤[1] 刘化龙 徐泉泉 郑海明 刘光耀[1] Yao Linlin;Zhang Minglei;Zhu Tongtong;Liu Hualong;Xu Quanquan;Zheng Haiming;Liu Guangyao(Truma Orthopaedics,China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院创伤骨科,长春130033

出　　处：《中华骨科杂志》2023年第19期1277-1284,共8页Chinese Journal of Orthopaedics

基　　金：吉林省医学创伤工程研究中心自主创新能力建设项目(2023C012)。

摘　　要：目的探讨机器人辅助治疗老年骨盆骨折的手术方法及其疗效。方法回顾性分析吉林大学中日联谊医院创伤骨科2019年9月至2022年12月采用机器人辅助治疗24例老年(≥60周岁)骨盆骨折患者的病历资料。男6例、女18例, 年龄(66.1±4.9)岁(范围60~77岁)。高能量损伤(车祸伤、高处坠落伤等)14例, 低能量损伤(平地摔倒、坐空等)10例。骨盆脆性骨折(fragility fractures of the pelvis, FFP)分型Ⅱ型20例, 男5例、女15例, Ⅱa型4例、Ⅱb型12例、Ⅱc型4例;Ⅲ型4例, 男1例、女3例, 均为Ⅲa型。根据Matta复位标准对骨盆骨折复位质量进行评定, 根据Gras分类对应用骨科手术机器人辅助置入螺钉的位置进行评估, 参考Majeed提出的骨盆骨折量化评估系统从患者的疼痛程度、就座、站立与行走、日常生活四个方面对患者术后功能进行量化评估。对骨盆脆性骨折Ⅱ型骨折患者于术前和术后72 h采用疼痛视觉模拟评分(visual analogue scale, VAS)评估疼痛缓解情况。结果按照Matta复位标准评估复位质量为优18例、良4例、中2例, 优良率为92%(22/24)。骨科手术机器人辅助置入螺钉59枚(骶髂螺钉44枚、前柱螺钉15枚), 根据Gras分类评估螺钉位置优52枚、良7枚, 优良率为100%。采用Majeed改良功能评估系统评估术后功能为优19例、良5例。所有患者住院期间一般状态稳定, 无严重内科疾病急性发作, 无神经损害的相关症状, 无术中大出血及术后感染等情况。所有患者骨折愈合均良好, 骨折愈合时间为(3.5±0.7)个月(范围3~5个月)。20例Ⅱ型骨折患者术前VAS评分为(6.3±2.0)分, 术后72 h降低至(4.1±1.4)分(t=6.14, P=0.003)。结论老年骨盆脆性骨折采用机器人辅助进行骨折复位内固定手术可减少术中出血量, 有利于术后早期恢复, 对FFPⅡ型骨折可以实现通道螺钉的固定。Objective To investigate the surgical techniques and advantages of Ti-Robot-assisted surgery for pelvic fragility fractures in the elderly.Methods A retrospective review was performed on geriatric patients presenting with pelvic fractures at the Orthopedics Department of Trauma,China-Japan Union Hospital of Jilin University from September 2019 to December 2022.Minimally invasive procedures were executed with the assistance of the Ti-Robot,and the therapeutic outcomes were appraised.The cohort comprised 24 patients aged≥60 years,consisting of 6 men and 18 women,with a mean age of 66.1±4.9 years(range,60-77 years).Fourteen patients sustained high-energy trauma,while 10 encountered low-energy trauma.Fracture classification utilized the FFP system proposed by Rommens and Hofmann.The cohort included 20 patients with FFP II fractures(5 males,15 females;4 of type IIa,12 of type IIb,and 4 of type IIc)and 4 patients with FFP III fractures(1 male,3 females;all type IIIa).The Matta standard assessment scale gauged fracture reduction,while the Gras classification,with Ti-Robot assistance,assessed screw positioning.Postoperative functionality was holistically assessed based on the Majeed quantitative evaluation system,focusing on pain intensity,sitting,standing,walking,and daily activities.The visual analogue scale(VAS)gauged pain levels in patients with type II fractures,pre and 72 hours post-surgery.Results According to the Matta standard assessment scale,postoperative fracture reduction quality in 24 elderly patients showed 18 as excellent,4 as good,and 2 as fair,yielding a 92%(22/24)combined excellent and good rate.Based on the Gras classification,52 screws were rated as excellent and 7 as good,achieving a 100%positive rate.Utilizing Majeed's modified pelvic fracture evaluation system,postoperative functional recuperation revealed 19 patients as excellent and 5 as good.There were no reports of severe internal disease exacerbations,neurological manifestations,infections,or intraoperative extensive hemorrhaging,with all

关 键 词：老年人 骨盆 骨质疏松性骨折 机器人手术 最小侵入性外科手术 

分 类 号：R683.3[医药卫生—骨科学]