机器人辅助及计算机导航辅助关节置换手术的不良事件  

Adverse events of robot and computer navigation assisted joint arthroplsty surgery

作　　者：李海峰[1] 安浩铭 柴伟[1] Li Haifeng;An Haoming;Chai Wei(Senior Department of Orthopaedics,the Fourth Medical Center of PLA General Hospital,Beijing 100142,China)

机构地区：[1]解放军总医院第四医学中心骨科医学部,北京100142

出　　处：《中华骨科杂志》2024年第2期114-118,共5页Chinese Journal of Orthopaedics

摘　　要：机器人辅助及计算机导航辅助关节置换手术具有操作可重复性高、稳定性好、精确度高的优点,近十年来在临床中的应用越来越广泛。但机器人辅助及计算机导航辅助关节置换手术可能出现一些特有的不良事件。机器人及导航设备或流程环节出现问题,如注册失败、存储光盘损坏、建模错误、控制程序损坏等,导致机器人辅助手术被迫停止而改为徒手手术。文献报道这类不良事件导致机器人辅助手术终止的发生率高达22%。跟踪器固定针周围可出现皮肤软组织感染,甚至发生骨髓炎。针道周围软组织感染多数症状较轻,经局部换药等处理可以治愈。经针道骨折发生率低,文献多为个案报告。经检索目前文献报道中经针道骨折29例,发生在股骨骨干17例(59%)、股骨干骺端3例(10%)、胫骨骨干7例(24%)、胫骨干骺端2例(7%)。10例(34%)为无移位或隐匿性骨折,采用非手术治疗获得治愈;19例(66%)骨折发生移位,其中4例(14%)采用切开复位内固定、14例(48%)采用髓内钉固定、1例(3%)最终行全膝关节翻修术。固定针导致的神经、血管损伤也有个案报告。机器人辅助关节置换手术特有的不良事件发生率很低,其中多数比较容易处理。但术者要保持警惕,规范手术操作,如安装固定针时应仔细,尽可能避免此类特殊事件的发生。Robot and computer navigation assisted joint replacement surgery have the advantages of high operational repeatability,good stability,and high accuracy.In the past decade,its application in clinical practice has become increasingly widespread.However,there may be some special adverse events during robot and computer navigation assisted joint arthroplasty surgery.If there are problems with robots,navigation equipment,or process links,it can cause robot assisted surgery to be forced to abortion and switch to manual surgery.There are reports that the incidence of abortion of robotic surgery due to such reasons is as high as 22%.There may be skin and soft tissue infections around the fixed pin of the tracker,as well as fractures through tracking pin site.Most symptoms of soft tissue infections around the pin track are mild and can be cured through local dressing changes and other treatments.Fractures through tracking pin site have a significant impact on patients,but the incidence is low,mostly reported as individual cases.As of now,a total of 29 cases have been reported in the literature,of which 17 cases(59%)occurred in the femoral shaft,3 cases(10%)in the femoral epiphyseal end,7 cases(24%)in the tibial shaft,and 2 cases(7%)in the tibial epiphyseal end.10 cases(34%)were non displaced or occult fractures,which were cured through conservative treatment.The remaining 19 cases(66%)were displaced fractures,of which 4 cases(14%)were treated with open reduction and internal fixation,14 cases(48%)were treated with intramedullary nails,and 1 case(3%)underwent total keen revision surgery.Neurovascular damage caused by fixed pin is relatively rare.Research has found that the incidence of such special complications is very low,and most of them are relatively easy to manage.But surgeons should remain vigilant and standardize surgical operations,such as installing fixed pin with care and caution,to avoid the occurrence of such special complications as much as possible.

关 键 词：关节成形术 置换 机器人手术 手术中并发症 手术后并发症 综述 

分 类 号：R687.4[医药卫生—骨科学]