智能化骨盆骨折复位手术导航定位系统在骨盆骨折治疗中的初步应用  

Preliminary application of the intelligent robot-assisted fracture reduction system in pelvic fractures

作　　者：曹奇勇[1] 赵春鹏[1] 卑明健 肖鸿鹄 陈依民 孙旭[1] 李宇能[1] 吴新宝[1] Cao Qiyong;Zhao Chunpeng;Bei Mingjian;Xiao Honghu;Chen Yimin;Sun Xu;Li Yuneng;Wu Xinbao(Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院创伤骨科,北京100035

出　　处：《中华骨科杂志》2023年第19期1293-1299,共7页Chinese Journal of Orthopaedics

基　　金：北京市科技计划项目(Z201100005420033);国家重点研发计划项目(2022YFC2504304)。

摘　　要：目的探讨智能化骨盆骨折复位手术导航定位系统辅助治疗骨盆骨折的近期疗效。方法回顾性分析2021年3月至2022年12月在北京积水潭医院创伤骨科接受智能化骨盆骨折复位手术导航定位系统辅助治疗的49例骨盆骨折患者病历资料。男30例、女19例;年龄(51.51±18.71)岁(范围20~92岁)。骨盆骨折Tile分型:B1型2例、B2型7例、B3型3例、C1型30例、C2型7例。受伤至手术时间为6(5, 10) d(范围2~22 d)。患者均在智能化骨盆骨折复位手术导航定位系统辅助下完成骨盆骨折复位内固定手术, 术前、术后均行骨盆正位、入口位、出口位X线及骨盆CT检查, 根据X线图像测量骨折移位及复位情况, 采用Matta复位标准评估骨折复位质量。记录手术时间、术中出血量、骨折固定方式及术后随访时间, 功能评价采用Majeed评分系统。结果 48例患者在智能化骨盆骨折复位手术导航定位系统辅助下完成微创骨盆骨折复位内固定手术, 另1例因复位失败改行切开复位内固定手术。手术时间为(206.5±7.1) min(范围105~420 min), 术中出血量为100(20, 100) ml(范围10~600 ml)。根据Matta复位标准评估术后骨盆后环移位的骨折复位质量:优30例、良8例, 优良率为93%(38/41);骨盆前环分离移位的复位质量:优45例、良3例, 优良率为100%(48/48)。48例患者获得11.0(3.0, 18.8)个月随访(范围3~23个月), 末次随访时Majeed功能评分为(81.9±17.0)分(范围42~100分), 其中优27例、良11例, 优良率为79%(38/48)。结论智能化骨盆骨折复位手术导航定位系统辅助治疗骨盆骨折具有精确完成复位及内固定的优势, 可以获得良好的骨折复位质量和近期疗效。Objective To elucidate the recent therapeutic efficacy of the intelligent fracture reduction robotic system in managing pelvic fractures.Methods A retrospective evaluation of 49 pelvic fracture patients treated using the intelligent fracture reduction robotic system at Beijing Jishuitan Hospital's trauma orthopedics department between March 2021 and December 2022 was conducted.The cohort included 30 males and 19 females,with a mean age of 51.51±18.71 years(20-92 years range).Fractures were classified according to the Tile system:B1 type in 2 cases,B2 in 7,B3 in 3,C1 in 30,and C2 in 3.The median interval between injury and surgery was 6 days,with a range of 2-22 days.The robotic system assisted in pelvic fracture reduction and stabilization surgeries.Preoperative and postoperative evaluations involved pelvic CT scans,anteroposterior,inlet,and outlet radiographic images.Fracture displacement and reduction outcomes were assessed via X-ray imagery.Data captured included intraoperative blood loss,duration of surgery,fracture stabilization techniques,and postoperative monitoring period.The Majeed scoring system gauged functional outcomes.Results Of the patients,48 underwent minimally invasive interventions with robotic assistance,while one case necessitated open reduction and internal fixation due to an unsuccessful reduction.The duration between injury and operation ranged from 2 to 22 days.Average surgical time stood at 206.5±7.1 minutes(105-440 min range),and median intraoperative blood loss was 100ml(10-600 ml range).Using the Matta reduction criteria,30 postoperative cases exhibited excellent and 9 good outcomes for posterior pelvic ring displacement,translating to a 93%(38/41)positive rate.For anterior pelvic ring shifts,45 showed excellent and 3 good outcomes,culminating in a 100%(48/48)success rate.Follow-up for the 48 cases lasted 11.0 months(3-23 months range),with the Majeed functional score averaging 81.9±17.0 points(42-100 point range).27 cases scored excellent,and 11 good,yielding a combined positive o

关 键 词：骨盆 骨折固定术 机器人手术 最小侵入性外科手术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]