机器人辅助螺钉固定治疗不稳定型骨盆环多发骨折  

Robot-assisted screw fixation for unstable pelvic ring fractures

作　　者：张朕 王学光 段升军[2] 孙延斌 唐波 贾道福 李昌 赵厚岭 李上 李洪飞 刘华水 Zhang Zhen;Wang Xueguang;Duan Shengjun;Sun Yanbin;Tang Bo;Jia Daofu;Li Chang;Zhao Houling;Li Shang;Li Hongfei;LiuHuashui(Department of Orthopaedic Trauma Center,Central Hospital Affiliated to Shandong First Medical University,Jinan 250013,China;Department of Surgery,Jinan Third People's Hospital,Jinan 250132,China)

机构地区：[1]山东第一医科大学附属中心医院创伤中心,济南250013 [2]济南市第三人民医院外科,济南250132

出　　处：《中华骨科杂志》2024年第7期470-476,共7页Chinese Journal of Orthopaedics

基　　金：济南市卫生健康委员会科技计划(2020-3-25)。

摘　　要：目的探讨机器人辅助螺钉固定治疗不稳定型骨盆环多发骨折的临床疗效。方法回顾性分析2015年1月至2022年6月山东第一医科大学附属中心医院创伤中心采用骨科机器人辅助螺钉固定治疗不稳定型骨盆骨折患者76例,男43例、女33例,年龄(52.53±13.68)岁(范围16~87岁),高处坠落伤43例、车祸伤22例、挤压伤及重物砸伤11例。55例伤前参加工作,21例伤前不参加工作。骨折Tile分型B型72例、C型骨折4例。机器人辅助下采用内置外架系统(inter-nalfixator,INFIX)、前环通道螺钉、骶螺钉、LC-ⅡI螺钉内固定治疗不稳定型骨盆环骨折。记录术中出血量、透视次数、手术时间、术中规划导针成功率,采用Matta标准评估骨折复位质量,采用Majeed标准评估术后骨盆功能恢复情况。结果76例患者共150个部位接受手术,其中INFIX内固定术34个、前环通道螺钉48个、骶髂螺钉61个、LC-ⅡI螺钉7个部位。术中出血量20(10,47.5)ml(5~300ml)。术中透视次数(46.63±17.50)次(范围15~93次),其中INFIX内固定术(16.44±4.32)次(范围8~31次)、LC-Ⅱ螺钉(21.59±5.80)次(范围12~32次)前环通道螺钉(29.44±11.65)次(范围12~65次)骶螺钉(23.10±11.87)次(范围8~56次)。手术时间105(86150)min(30~290min),其中INFIX内固定术40(35,45)min(范围15~120min)、LC-Ⅱ螺钉50(35,55)min(范围20~65min)、前环通道螺钉70(48,120)min(范围25~240min)、骶髂螺钉50(35,50)min(范围25~235min)。术中规划导针成功率:INFIX内固定为100%(34/34),前环通道螺钉为58%(28/48),骶关节螺钉为93%(57/61),LC-Ⅱ螺钉为100%(7/7)。所有患者均获得随访,随访时间(6.46±2.26)个月(范围3~16个月),6个月内骨折均获临床愈合,平均(3.14±0.50)个月。末次随访时Matta评价,优21例、良43例、可12例,优良率84%(64/76),Majeed评分(81.82±9.14)分(范围50~92分),其中伤前参加工作(86.55±4.85)分(范围60~92分),优49例、良5例、可1例;伤前不参加工作(69.43±5.34)分(范Objective To investigate the clinical efficacy of robot-assisted screw fixation for unstable pelvic ring multifo-cal fractures.Methods A retrospective analysis was performed on 76 patients with unstable pelvic fractures treated with ortho-paedic robot-assisted screw fixation in the Trauma Center of the Affiliated Central Hospital of Shandong First Medical University from January 2015 to June 2022,including 43 males and 33 females,aged 52.53±13.68 years(range,16-87 years).There were 43 cases of falling injuries from high places,22 cases of traffic accidents,1l cases of crushing injuries and heavy objects.Fifty-five patients were employed before the injury,while 21 were not.Fractures were classified according to the Tile classification,with 72 cases classified as type B and 4 cases as type C.Robot-assisted fixation techniques included internal fixator(INFIX),anterior ring screws,sacroiliac screws,and LC-II screws.Intraoperative blood loss,fluoroscopy frequency,surgical time,and the success rate of initial guidewire placement were recorded.Fracture reduction quality was evaluated using the Matta criteria,and postoperative pelvic function recovery was assessed using the Majeed criteria.ResultsA total of 150 surgical procedures were performed on 76 patients,including 34 cases of INFIX fixation,48 cases of anterior ring screws,61 cases of sacroiliac joint screws,and 7 cases of LC-II screws.The mean intraoperative fluoroscopy frequency was 46.63±17.50 times(range,15-93 times).Intraoperative fluoroscopy frequency varied among different fixation techniques,with INFIX group at 16.44±4.32 times,LC-II group at 21.59±5.80 times,anterior ring screws group at 29.44±11.65 times,and sacroiliac screws group at 23.10±11.87 times.The intraoperative blood loss was 20(10,47.5)ml(range,5-300 ml),and the surgical time was 105(86,150)min(range,30-290 min).The mean surgical time varied among different fixation techniques.All patients were followed up for an average of 6.46±2.26 months(range,3-16 months).Clinical healing was achieve

关 键 词：骨盆 骨折 机器人手术 骨折固定术 

分 类 号：R687.3[医药卫生—骨科学]