电磁导航机器人辅助与C形臂引导经皮微创空心钉内固定治疗Tile C型骨盆骨折的疗效比较  

Comparison of therapeutic effects of internal fixation with percutaneous minimally invasive hollow nail assisted by electromagnetic navigation robot and guided by C‑arm in the treatment of Tile type C pelvic fracture

作　　者：王海涛 余志平 李奇威 胡鹏宇 黄健 丛志超 董桂鑫 孙炳龙 丛海波 Wang Haitao;Yu Zhiping;Li Qiwei;Hu Pengyu;Huang Jian;Cong Zhichao;Dong Guixin;Sun Binglong;Cong Haibo(Department of Trauma Orthopedics,Weihai Central Hospital,Weihai 264400,China;Department of Orthopedics,Limin Hospital of High‑tech Zone of Weihai,Weihai 264299,China)

机构地区：[1]威海市中心医院创伤骨科,威海264400 [2]威海高区利民医院骨科,威海264299

出　　处：《中华创伤杂志》2023年第11期991-998,共8页Chinese Journal of Trauma

基　　金：泰山学者工程专项经费资助项目(ts201511110);山东省医药卫生科技发展计划项目(202104070389);威海市中医药科技项目(2021N‑17)。

摘　　要：目的比较电磁导航机器人辅助与C形臂引导经皮微创空心钉内固定治疗Tile C型骨盆骨折的早期疗效。方法采用回顾性队列研究分析2020年1月至2022年3月威海市中心医院收治的32例Tile C型骨盆骨折患者的临床资料,其中男18例,女14例;年龄36~60岁[(44.1±3.9)岁]。17例采用电磁导航机器人辅助经皮微创空心钉内固定治疗(电磁导航组),15例采用C形臂引导经皮微创空心钉内固定治疗(C形臂引导组)。比较两组手术时间、术中出血量、骶髂螺钉置入时间、耻骨支螺钉置入时间、下床活动时间、骨折愈合时间;术后1 d、6个月、12个月及末次随访时视觉模拟评分(VAS)和Majeed功能评分;术后并发症发生率。结果患者均获随访12~24个月[(15.4±0.5)个月]。电磁导航组手术时间和术中出血量分别为(42.0±2.5)min、(10.9±2.6)ml,短于或少于C形臂引导组的(50.0±3.5)min、(14.9±3.1)ml(P均<0.01)。电磁导航组骶髂螺钉置入时间和耻骨支螺钉置入时间分别为(12.4±0.2)min、(10.1±0.3)min,短于C形臂引导组的(15.3±0.3)min、(13.2±0.3)min(P均<0.01)。电磁导航组下床活动时间为(3.2±0.4)周,早于C形臂引导组的(3.5±0.4)周(P<0.05)。两组骨折愈合时间差异无统计学意义(P>0.05)。电磁导航组术后1 d、6个月VAS分别为(4.4±0.3)分、(1.1±0.1)分,低于C形臂引导组的(4.8±0.4)分、(1.2±0.3)分(P<0.05或0.01);电磁导航组术后1 d、6个月Majeed功能评分分别为(37.3±1.1)分、(88.5±1.4)分,高于C形臂引导组的(30.7±4.2)分、(82.6±1.8)分(P均<0.01)。两组术后12个月、末次随访时VAS和Majeed功能评分差异无统计学意义(P均>0.05)。两组术后并发症发生率差异无统计学意义(P>0.05)。结论与C形臂引导相比,电磁导航机器人辅助经皮微创空心钉内固定治疗Tile C型骨盆骨折,可减少手术时间、术中出血量及螺钉置入时间,利于患者更早下床活动、早期缓解疼痛并促进功能恢复。Objective To compare the early therapeutic effects of internal fixation with percutaneous minimally invasive hollow nail assisted by electromagnetic navigation robot and guided by C‑arm in the treatment of Tile type C pelvic fracture.Methods A retrospective cohort study was conducted to analyze the clinical data of 32 patients with Tile type C pelvic fracture admitted to Weihai Central Hospital from January 2020 to March 2022,including 18 males and 14 females;aged 36‑60 years[(44.1±3.9)years].Among them,17 patients were treated with internal fixation with percutaneous minimally invasive hollow nail assisted by electromagnetic navigation robot(electromagnetic navigation group),and 15 with internal fixation with percutaneous minimally invasive hollow nail guided by C‑arm(C‑arm guidance group).Operative time,intraoperative blood loss,sacroiliac screw placement time,pubic branch screw placement time,ambulation time and fracture healing time were compared between the two groups.Visual analog scale(VAS),Majeed function score and complication rate at 1 day,6 months,12 months after surgery and at the last follow‑up were compared between the two groups.Results All the patients were followed up for 12‑24 months[(15.4±0.5)months].The operative time and intraoperative blood loss in the electromagnetic navigation group were(42.0±2.5)minutes and(10.9±2.6)ml,shorter or less than(50.0±3.5)minutes and(14.9±3.1)ml in the C‑arm guidance group(all P<0.01).The placement time of sacroiliac screw and pubic branch screw in the electromagnetic navigation group was(12.4±0.2)minutes and(10.1±0.3)minutes,shorter than(15.3±0.3)minutes and(13.2±0.3)minutes in the C‑arm guidance group(all P<0.01).The ambulation time was(3.2±0.4)weeks in the electromagnetic navigation group,earlier than(3.5±0.4)weeks in the C‑arm guidance group(P<0.05).There was no significant difference in fracture healing time between the two groups(P>0.05).VAS scores of the electromagnetic navigation group were(4.4±0.3)points and(1.1±0.1)point

关 键 词：骨盆 骨折固定术 内 机器人手术 空心钉 

分 类 号：R687.3[医药卫生—骨科学]