局部麻醉下机器人辅助骶髂螺钉取出的临床应用分析

Clinical application of local anesthesia for TiRobot-assisted removal of sacroiliac screws

目的通过与全身麻醉下机器人辅助取出骶髂螺钉进行对比,探讨局部麻醉下机器人辅助取出骶髂螺钉的可行性及优、缺点。方法回顾性分析2017年1月至2020年12月成都大学附属医院骨科收治的39例骨盆后环骨折脱位经皮骶髂螺固定手术患者资料,均在机器人辅助下取出骶髂螺钉,根据麻醉方式不同分为局麻组和全麻组。局麻组18例,男10例,女8例;年龄(43.3±8.4)岁(25~58岁);全麻组21例,男12例,女9例;年龄(44.9±9.0)岁(23~60岁)。比较两组患者的术中规划螺钉取出路径时间、透视次数、透视时间、手术时间、麻醉时间、麻醉费用、术后疼痛视觉模拟评分(VAS)、术后下地时间。结果两组患者取钉前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者均获随访,切口均甲级愈合。局麻组和全麻组患者术中规划骶髂螺钉取出路径时间、术中透视次数、透视时间、手术时间比较差异均无统计学意义(P>0.05)。局麻组患者的麻醉时间[(41.6±8.3)min]、麻醉费用[(653.5±102.6)元]、术后下地时间[(2.6±0.6)h]显著少于全麻组患者[(52.3±9.5)min、(2475.6±261.8)元、(8.7±2.4)h],术后VAS评分(3.8±1.5)分显著高于全麻组患者[(2.5±1.3)分],差异均有统计学意义(P<0.05)。结论在局部麻醉下应用机器人辅助取出骶髂螺钉具有一定的可行性,相较于全身麻醉取出骶髂螺钉,其麻醉时间更短、麻醉费用更低、术后下地时间更早,但需要患者具有较好的依从性。

Objective To explore the feasibility and advantages and disadvantages of local anesthesia for TiRobot-assisted removal of sacroiliac screws by comparison with general anesthesia for TiRobot-assisted removal of sacroiliac screws.Methods A retrospective study was performed in 39 patients with posterior pelvic ring fracture-dislocation who had undergone removal of percutaneous sacroiliac screws after fracture union from January 2017 to December 2020 at Department of Orthopaedic Surgery,Hospital Affiliated to Chengdu University.Their sacroiliac screws were removed with TiRobot assistance under local anesthesia(LA group)or general anesthesia(GA group).In the LA group of 18 cases,there were 10 males and 8 females,aged(43.3±8.4)years(from 25 to 58 years);in the GA group of 21 cases,there were 12 males and 9 females,aged(44.9±9.0)years(from 23 to 60 years).The 2 groups were compared in terms of time for planning screw removal path,fluoroscopy frequency,fluoroscopy time,operation time,anesthesia time,anesthesia cost,postoperative visual analogue scale(VAS)and postoperative ambulation time.Results There was no statistically significant difference in baseline data between the 2 groups,showing comparability(P>0.05).Follow-ups revealed grade A wound healing in all patients.There were no significant differences between the 2 groups in time for planning screw removal path,fluoroscopy frequency,fluoroscopy time or operation time(P>0.05).The anesthesia time[(41.6±8.3)min],anesthesia cost[(653.5±102.6)yuan]and postoperative ambulation time[(2.6±0.6)h]in the LA group were significantly less than those in the GA group[(52.3±9.5)min,(2,475.6±261.8)yuan and(8.7±2.4)h]while the VAS score in the former group(3.8±1.5)was significantly higher than that in the latter group(2.5±1.3)(all P<0.05).Conclusions It is feasible to use local anesthesia for TiRobot-assisted removal of sacroiliac screws.In TiRobot-assisted removal of sacroiliac screws,compared with general anesthesia,local anesthesia may lead to shorter anesthesia time,lower anesthesia cast and shorter ambulation time,but the patients need to be compliant enough.