机器人辅助下经皮骶髂螺钉固定手术的优势及安全性研究

Advantages and security of sacroiliac lag screwing assisted by an orthopaedic TiRobot

目的探讨机器人辅助下经皮骶髂关节螺钉固定手术的优势及安全性。方法回顾性分析2015年12月至2017年8月期间成都大学附属医院骨科采用机器人辅助下经皮骶髂关节螺钉固定的11例骨盆后环骨折或骶髂分离患者资料。男7例,女4例,年龄为23~61岁,平均42.5岁。骨盆骨折按AO分型:B1.2型1例,B2.2型1例;C1.2型6例,C1.3型2例,C2.3型1例。观察置入骶髂关节螺钉的数量、术中规划骶髂关节螺钉置入路径时间、术中透视次数、时间、曝光时间、手术时间、手术出血量及骨折复位质量。结果11例患者术后获5~22个月(平均9.5个月)随访。共置入骶髂关节螺钉15枚,术中规划骶髂关节螺钉置入路径时间为9~25min,平均8.5min;术中透视次数为4~15次,平均8.5次;透视时间为3.2~6.5min,平均5.5min;曝光时间(C型臂X线机显示的透视时间)为2.4~16.3s,平均5.8s;手术时间为25~45min,平均34.5min;手术出血量为10~80mL,平均35mL。所有骶髂关节螺钉位置均满意,未进入骶管、骶孔及切出骨质,术后无神经系统损伤发生,切口均甲级愈合。术后全部骨折均愈合良好,愈合时间为4~7个月,平均5.6个月,骶髂关节螺钉无松动。采用Matta评分标准评定骨折复位质量:优9例,良1例,可1例。末次随访时采用Majeed骨盆骨折量化评估体系统评定功能:优8例,良3例。结论应用机器人辅助下骶髂关节螺钉固定治疗骨盆后环骨折具有创伤小、时间短、失血量少、确度高等优势,且安全性高,值得临床应用。

Objective To explore the advantages and security of orthopaedic TiRobot used to assist internal fixation with sacroiliac lag screws.MethodsFrom December 2015 to August 2017, 11 patients with fracture of pelvic posterior ring or sacroiliac separation were treated by internal fixation with sacroiliac lag screws assisted by an orthopaedic TiRobot at Department of Orthopaedic Surgery, Affiliated Hospital to Chengdu University. They were 7 men and 4 women, aged from 23 to 61 years (average, 42.5 years). Ac-cording to AO classification, there were one case of type B1.2, one case of type B2.2, 6 cases of type C1.2, 2 cases of type C1.3 and one case of type C2.3. The number of sacroiliac lag screws inserted, time for planning insertion approaches, fluoroscopy frequency, fluoroscopy time, exposure time of C-arm X-ray, op-eration time, blood loss and reduction quality were documented.ResultsThe 11 patients were followed up for 5 to 22 months (average, 9.5 months). A total of 15 sacroiliac screws were inserted. In the operations, time for planning insertion approaches averaged 8.5 minutes (from 9 to 25 minutes), fluoroscopy frequency 8.5 times (from 4 to 15 times), fluoroscopy time 5.5 minutes (from 3.2 to 6.5 minutes), exposure time of C-arm X-ray machine 5.8 seconds (from 2.4 to 16.3 seconds), operation time 34.5 minutes (from 25 to 45 minutes), and blood loss 35 mL (from 10 to 80 mL). All the screw positions were satisfactory, with no penetration into the sacral canal, sacral foramen or bone cortex. No postoperative neurovascular injury hap-pened. All the incisions primarily healed. All the fractures united well after 4 to 7 months (average, 5.6 months), without any screw loosening. By the Matta scoring for fracture reduction, 9 cases were excellent, one was good and one fair. By the Majeed functional scoring for pelvic fractures, 8 cases were rated as ex-cellent and 3 as good at the last follow-up.ConclusionOrthopaedic TiRobots can be used to assist in-ternal fixation with sacroiliac lag screws in the treatment of pelvic posterior ring injuries, with advantages of limited invasion, time, hemorrhage, and high safety and accuracy as well.