机器人导航定位系统辅助下经皮空心螺钉内固定治疗股骨颈骨折

Fixation with percutaneous cannulated screws assisted by robot navigation for femoral neck fractures

目的探讨机器人导航定位系统辅助下经皮空心螺钉内固定治疗股骨颈骨折的疗效。方法回顾性分析2012年10月至2014年6月采用机器人导航定位系统辅助下经皮空心螺钉内固定治疗的21例股骨颈骨折患者资料（导航组），男8例，女13例；年龄为20—85岁，平均（65．2±4．2）岁；骨折按Garden分型：Ⅰ型2例，Ⅱ型5例，Ⅲ型9例，Ⅳ型5例。选择同期采用传统徒手定位方法手术治疗的25例股骨颈骨折患者作为对照组。比较两组患者的手术时间、术中透视次数、术中出血量、总钻孔次数、骨折愈合时间及末次随访时髋关节Harris评分等。结果导航组患者的手术时间[（75．2±10．6）min]和骨折愈合时间[（5．3±2．5）个月]短于对照组[（85．1±11．3）min、（6．1±3．0）个月]，但差异均无统计学意义（P〉0．05）。导航组患者的术中透视次数[（28．5±9．8）次]、术中出血量[（9．4±7．6）mL]及总钻孔次数[（9．2±4．5）次]显著少于对照组[（48．6±8．1）次、（40．2±10．3）mL、（17．5±8．5）次]，差异均有统计学意义（P〈0．05）。导航组患者末次随访时髋关节Harris评分平均为（87．6±3．1）分，对照组患者平均为（86．9±4．7）分，差异无统计学意义（P〉0．05）。随访期间导航组无一例患者发生伤口感染、内固定物松动、骨折再移位及股骨头缺血性坏死等并发症。结论与传统徒手定位方法相比，机器人导航定位系统辅助下经皮空心螺钉内固定治疗股骨颈骨折具有设备操作相对简单、术中螺钉置入更加精准和规范等优点，实现了手术的微创化，减少了放射线的接触时间。

Objective To discuss clinical efficacy of fixation with percutaneous cannulated screws assisted by robot navigation for femoral neck fractures. Methods From October 2012 to June 2014, 21 patients with femoral neck fracture were treated by internal fixation with percutaneous cannulated screws as- sisted by robot navigation. They were 8 men and 13 women, 20 to 85 years of age （average, 65.2 ±4.2 years）. By the Garden classification, 2 cases were type Ⅰ, 5 type Ⅱ, 9 type Ⅲ and 5 type Ⅳ. The other 25 similar patients who had undergone at the same time conventional surgery with manual positioning were selected as a control group. The 2 groups were compared in terms of operation time, fluoroscopy frequency, intraoperative bleeding, total drilling, fracture healing time and Harris scores at the last follow-up. Results The robot navigation group needed insignificantly shorter operation time （75.2 ± 10.6 minutes versus 85. 1 ± 11.3 minutes） and fracture healing time （5.3 ± 2.5 months versus 6. 1 ±3.0 months） than the control group （ P 〉 0.05）. The robot navigation group incurred significantly less fluoroscopy frequency （28.5 ＋ 9.8 times versus 48.6 ± 8.1 times）, intraoperative bleeding （9.4 ±7.6 mL versus 40. 2 ＋ 10. 3 mL）, and total drilling （9.2 ±4.5 times versus 17.5 ±8.5 times） than the control group （ P 〈 0. 05）. There was no significant difference between the 2 groups in Harris scores at the last follow-up （87.6 ± 3.1 points versus 86.9 ± 4. 7 points） （ P 〉 0.05 ） . No such complications were found in all patients as infection, fixation loosening, fragment re-displacement and femoral head necrosis. Conclusion In the treatment of femoral neck fractures, fixation with percutaneous cannulated screws assisted with robot navigation is advantageous over conventional surgery with manual positioning, because the former leads to easier manipulation, more accurate screw insertion, less invasion and less radiation exposure.