机器人与传统经皮骶髂螺钉固定骨盆后环损伤  

Robotic-assisted versus traditional freehand percutaneous sacroiliac screw fixation of posterior pelvic ring injury

作　　者：聂涛[1] 王卓 于小龙[1] 戴闽[1] NIE Tao;WANG Zhuo;YU Xiao-long;DAI Min(Department of Orthopedics,The First Affiliated Hospital,Nanchang University,Nanchang 330000,China)

机构地区：[1]南昌大学第一附属医院骨科医院,江西南昌330000

出　　处：《中国矫形外科杂志》2023年第24期2226-2231,共6页Orthopedic Journal of China

基　　金：省中医药科技计划项目(编号:2021Z020);省卫健委资助项目(编号:202130235)。

摘　　要：[目的]比较天玑骨科机器人辅助与传统徒手经皮骶髂空心螺钉固定术骨盆后环损伤的临床疗效。[方法]回顾性分析2019年3月—2021年3月手术治疗的骨盆后环损伤患者74例,依据术前医患沟通结果决定的置钉方式,其中,机器初期组16例,机器后期组16例,传统组42例。比较三组间围手术期、随访和影像资料。[结果]三组患者均顺利手术,无严重并发症。与传统组相比,机器初期组置钉时间延长,但机器后期组置钉时间明显缩短,组间差异有统计学意义[(78.6±4.8) min vs(66.4±7.1) min vs (70.3±6.5) min,P<0.001]。机器初期组和机器后期组术中出血量[(14.8±2.4) ml vs (13.7±1.7) ml vs (18.5±2.9) ml,P<0.001]、术中透视次数[(10.4±1.3)次vs (9.5±0.7)次vs (12.5±1.4)次,P<0.001]及置钉调整次数[(0.6±0.6)次vs (0.3±0.5)次vs (1.1±0.7)次,P<0.001]均明显优于传统组。三组间切口愈合、下地行走时间及住院时间无明显差异(P>0.05)。所有患者均获随访12个月以上,机器初期组与机器后期组恢复完全负重活动均显著早于传统组[(90.5±4.8) d vs (89.1±6.0) d vs (95.8±6.4) d,P<0.001]。随时间推移,三组的VAS评分均显著减少,而Majeed评分显著增加(P<0.05),术后3个月机器初期组与机器后期组的Majeed评分均显著优于传统组[(85.4±5.2) vs (85.7±3.9) vs (80.5±6.1),P<0.001]。影像方面,机器初期组与机器后期组置钉评级明显优于传统组[优/良/差,(14/2/0) vs (15/1/0) vs (28/13/1),P=0.048],但是,三组间骨折复位Matta评级差异无统计学意义(P>0.05)。至末次随访时,所有患者骨折均愈合,未发生内固定断裂。[结论]天玑机器人辅助经皮骶髂空心螺钉内固定术治疗具有准确性高、安全、微创等优点。也有一定的学习曲线。[Objective] To compare the clinical efficacy of Tianji Orthopedics robot-assisted sacroiliac cannulated screw fixation versus traditional freehand counterpart for posterior pelvic ring injury.[Methods] A retrospective study was done on a total of 74 patients who underwent surgical treatment for the posterior pelvic ring injury from March 2019 to March 2021.According to preoperative doctor-patient communication,the surgical techniques used of percutaneous sacroiliac cannulated screw placement was selected,including 16 patients in the robotic-assistance in the early-stage(RAE) group,16 cases in the robotic-assistance in the late-stage group(RAL),and 42 cases in the traditional group.Perioperative,follow-up and imaging data were compared among the three groups.[Results] All patients in the three groups were successfully operated on without serious complications.Compared with that in the traditional group,the RAE group consumed significantly longer time for screw placement,while the RAL group took significantly shorter time with statistically significant difference among the 3 groups [(78.6±4.8) min vs(66.4±7.1) min vs(70.3±6.5) min,P<0.001].In addition,the RAE group and RAL group proved significantly superior to the traditional group in terms of intraoperative blood loss [(14.8±2.4) ml vs(13.7±1.7) ml vs(18.5±2.9) ml,P<0.001],intraoperative fluoroscopy times [(10.4±1.3) times vs(9.5±0.7) times vs(12.5±1.4) times,P<0.001] and the number of screw setting adjustments [(0.6±0.6) times vs(0.3±0.5) times vs(1.1±0.7) times,P<0.001].However,there were no significant differences in incision healing grade,postoperative ambulation time and hospital stay among the three groups(P>0.05).All patients were followed up for more than 12months,and the RAE group and RAL group resumed full weight-bearing activities significantly earlier than the traditional group [(90.5±4.8) days vs(89.1±6.0) days vs(95.8±6.4) days,P<0.001].The VAS score for pain decreased significantly,while Majeed scores increased significantly in all t

关 键 词：骨盆骨折 骶髂关节分离 经皮骶髂螺钉固定 机器人辅助 精确性 

分 类 号：R683.3[医药卫生—骨科学]