3D导航下机器人辅助经皮通道螺钉治疗骨盆骨折的临床疗效分析  

Clinical efficacy of robot-assisted percutaneous channel screw fixation in the treatment of pel-vic fractures under 3D navigation

作　　者：陈忠尧 罗刚[1] 杜兴[1] 赵维康[1] 税巍[1] Chen Zhongyao;Luo Gang;Du Xing;Zhao Weikang;Shui Wei(Department of Orthopaedics,the First Affiliated Hospital of Chongqing Medical University,Chongqing400016,China)

机构地区：[1]重庆医科大学附属第一医院骨科,重庆400016

出　　处：《创伤外科杂志》2024年第7期506-511,共6页Journal of Traumatic Surgery

基　　金：重庆市医学科研项目(卫生健康委员会和科技局联合)(2022MSXM096);重庆市科卫联合医学科技创新四大工程青年项目(2023QNXM030)。

摘　　要：目的 探讨3D导航下机器人辅助经皮置入骨盆通道螺钉治疗不稳定性骨盆骨折的临床疗效。方法 回顾性分析2023年2月—10月重庆医科大学附属第一医院骨科采用3D导航下机器人辅助经皮置入骨盆通道螺钉技术治疗不稳定性骨盆骨折患者9例。男性4例,女性5例;年龄16~73岁,平均41.6岁;其中道路交通伤4例,高处坠落伤4例,砸伤1例;骨盆骨折Tile分型:B2.2型4例,B3.2型5例。记录手术时间、术中出血量、术中及术后并发症情况,评估骨折复位效果及术后骨盆功能恢复情况。结果 本组术中共置入20枚螺钉,平均2.2枚;置钉通道规划时间22~30min,平均25.8min;螺钉置入时间2~3min,平均2.6min;手术时间32~46min,平均37.2min。无一例进行导针调整,每枚导针置入透视次数3~7次,平均5.5次。术中出血量5~10 mL,平均8.9mL;本组患者术后均未见血管神经损伤等并发症发生。术后根据Matta骨折复位标准评价示骨盆通道螺钉置入位置均为优。结论 3D导航下机器人辅助经皮置入骨盆通道螺钉技术螺钉置入的效率及准确性高,手术操作精细且微创,术中射线暴露的时间短、手术创伤小、术后并发症少。在处理骨盆环损伤的治疗中该技术存在潜在优势。Objective To investigate the clinical efficacy of robot-assisted percutaneous placement of pel-vic channel screws under 3D navigation in the treatment of unstable pelvic fractures.Methods From Feb.to Oct.2023,the Department of Orthopedics at the First Affiliated Hospital of Chongqing Medical University managed 9 pa-tients with unstable pelvic fractures using the 3D navigation-assisted robotic technology for percutaneous placement of pelvic channel screws.Among them,there were 4 males and 5 females aged 16-73(mean 41.6)years,with 4 road traffic injuries,4 falls from height,and 1 crushing injury.According to Tile classification for pelvic fractures,4 cases were of type B2.2 and 5 of type B3.2.The surgical duration,intraoperative blood loss,and intraoperative and postop-erative complications were recorded.The quality of fracture reduction and postoperative pelvic function recovery were also assessed.Results A total of 20 channel screws were implanted for this case series,2.2 per patient.The time for placement planning was 22-30(mean 25.8)min.The screw implantation time was 2-3(mean 2.6)min.The op-eration time was 32-46(mean 37.2)min.No case required guidewire adjustment,with each guidewire inserted under 3-7(mean 5.5)times of fluoroscopy.The intraoperative blood loss was 5-10(mean 8.9)mL.No postoperative complication such as vascular or nerve injury was recorded.According to the Matta fracture reduction criteria,the po-sition of the pelvic channel screws implanted in this study was all rated as excellent.Conclusion 3D navigation for robot-assisted percutaneous placement of pelvic channel screws offers high efficiency and accuracy for unstable pel-vic fractures.The surgical procedure is fine and minimally invasive,with short exposure time to X-rays and few post-operative complications.This technology has potential advantages in the treatment of pelvic ring injuries.

关 键 词：骨盆骨折 骨盆环损伤 不稳定骨折 机器人辅助 3D导航 

分 类 号：R683.3[医药卫生—骨科学]