智能可视化系统辅助复位及固定治疗高龄骨盆脆性骨折  

Treatment of pelvic fragility fractures in the elderly assisted by minimally invasive intelligent visualization system

作　　者：樊仕才 廖奕岚 麦奇光 李涛 朱振华 廖坚文 向海波 Fan Shicai;Liao Yilan;Mai Qiguang;Li Tao;Zhu Zhenhua;Liao Jianwen;Xiang Haibo(Department of Traumatic Surgery,Center for Orthopaedic Surgery,Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China)

机构地区：[1]南方医科大学第三附属医院骨科医学中心创伤骨科,广州510630

出　　处：《中华骨科杂志》2023年第19期1300-1307,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82072411);国家重点研发计划(2022YFC2504303)。

摘　　要：目的探讨智能可视化系统辅助复位及螺钉固定治疗高龄骨盆脆性骨折的疗效。方法回顾性分析2016年1月至2022年10月治疗的年龄>75岁的高龄骨盆脆性骨折患者18例, 分别采用闭合复位徒手置入通道螺钉固定骨盆后环(徒手置钉组)和HoloSight智能可视化系统辅助复位及置入螺钉固定骨盆后环(可视化组)。徒手置钉组11例, 男3例、女8例, 年龄(82±12)岁(范围75~94岁), 骨盆骨折FFP分型Ⅲa型5例、Ⅲb型2例、Ⅲc型3例、Ⅳ型1例;可视化组7例, 男1例、女6例, 年龄(83±14)岁(范围76~100岁), 骨盆骨折FFP分型Ⅲa型4例、Ⅲc型2例、Ⅳ型1例。记录两组的手术时间、术中出血量及有效透视次数, 评价骨折Matta复位标准、视觉模拟评分(visual analogue scale, VAS)、Majeed评分及术后并发症。结果 18例患者均顺利完成手术并获得随访, 随访时间6~36个月, 平均12个月, 骨盆骨折均愈合。可视化组7例置入通道螺钉共13枚, 每枚通道螺钉导针的调整次数为(3±1)次(范围1~5次);徒手置钉组11例置入通道螺钉导针18枚, 每枚通道螺钉导针的调整次数为(7±2)次(范围4~10次), 两组比较差异有统计学意义(t=6.99, P<0.001)。可视化组复位及固定骨盆后环的手术时间[(63±12) min]较徒手置钉组[(88±23) min]短、术中有效透视次数[(9±3)次]较徒手置钉组[(35±7)次]少, 差异均有统计学意义(t=2.69, P=0.016;t=9.22, P<0.001)。可视化组术中出血量为(38±12) ml, 徒手置钉组为(55±26) ml, 差异无统计学意义(t=1.61, P=0.127)。Matta标准评估:可视化组优4例、良2例、可1例;徒手置钉组优5例、良3例、可2例、差1例。末次随访时Majeed评分, 可视化组为(84±11)分, 其中优3例、良2例、可2例;徒手置钉组为(79±17)分, 其中优5例、良3例、可3例;两组Majeed评分比较, 差异无统计学意义(t=0.69, P=0.501)。可视化组术前骨盆环骨折处的VAS评分为(6.4±2.6)分, 末次随访时为(2.4±0.Objective To investigate the efficacy of intelligent visualization system(HoloSight Intelligent Visualization System)assisted reduction and screw fixation in the treatment of elderly pelvic fragility fracture.Methods From January 2016 to December 2022,clinical data of 18 elderly patients aged over 75 years with pelvic fragility fractures surgically treated by our team were retrospectively analyzed.Among them,11 cases were treated with closed reduction and hand-inserted percutaneous screw fixation to fix the posterior pelvic ring(control group),and 7 cases were treated with the assistance of the HoloSight intelligent visualization system for reduction and minimally invasive fixation(experimental group).In the control group,there were 3 males and 8 females with an age range of 75-94 years(mean age,82±12 years).The pelvic fractures were classified as FFP type IIIa in 5 cases,IIIb in 2 cases,IIIc in 3 cases,and IV in 1 case.In the experimental group,there were 1 male and 6 females with an age range of 76-100 years(mean age.83±14 years).The pelvic fractures were classified as FFP type IIIa in 4 cases,IIIc in 2 cases,and IV in 1 case.The surgical time,blood loss,effective intraoperative fluoroscopy times,fracture reduction quality(according to Matta standards),visual analogue scale(VAS),limb function rehabilitation(Majeed score)and postoperative complications were recorded and evaluated in both groups.Results All patients underwent surgery successfully and were followed up for 6 months to 3 years(12 months on average),all pelvic fractures healed.Among the 7 cases of experimental group,a total of 13 screws were placed,and the adjustment times of guide pin for each screw were 3±1 times(range,1-5 times),while 18 screws of the control group with the adjustment times of 7±2 times(range,4-10 times),statistical difference was present(t=6.99,P<0.001).The surgical time in experimental group(63±12 min)was shorter than that in control group 88±23 min,while effective intraoperative fluoroscopy times in experimental group(9±

关 键 词：骨盆 骨折 老年人 人工智能 

分 类 号：R683.3[医药卫生—骨科学]