骨科机器人辅助下经皮螺钉内固定治疗骨盆与髋臼骨折

Percutaneous screw fixation assisted by an orthopedic robot for pelvic and acetabular fractures

目的探讨骨科机器人辅助经皮螺钉内固定治疗骨盆与髋臼骨折的安全性和有效性。方法回顾性分析2017年9月至12月期间佛山市中医院收治的15例新鲜闭合性骨盆与髋臼骨折患者资料。男10例,女5例;年龄为22~69岁,平均65.2岁。骨盆骨折9例,根据Tile分型:B型5例,C型4例;髋臼骨折6例:前柱骨折3例,后柱骨折2例,横形骨折1例。所有患者均在骨科机器人辅助下行各通道经皮螺钉内固定术。术中记录透视次数、导针调整次数、螺钉最终位置与规划时的偏移量。术后摄CT评价螺钉位置优良率、不良事件发生率,并定期随访评价患者功能恢复情况。结果手术共置入26枚螺钉,患者透视次数为12~49次,平均置入每枚螺钉透视17.3次;术中导针调整次数0~2次,平均0.3次;实际路径与规划偏离0.82~1.42mm,平均1.06mm。所有患者无手术相关神经、血管损伤,术后CT验证无螺钉切出骨皮质,螺钉位置优良率为100%。2例患者失访,其余13例患者术后获12~14个月(平均12.6个月)随访。末次随访时Majeed功能评分平均为88.6分(68~96分)。随访期间无一例患者发生神经功能症状。结论手术机器人辅助下行骨盆与髋臼骨折经皮螺钉内固定精准、安全、透视次数少,将成为骨盆与髋臼骨折微创手术技术发展的方向之一。

Objective To analyze the effectiveness and safety of percutaneous screw fixation assisted by an orthopedic robot for treatment of pelvic and acetabular fractures.MethodsFifteen patients with fresh closed pelvic or acetabular fracture were hospitalized from September to December 2017 at Department of Orthopaedics, Foshan Hospital of Traditional Chinese Medicine. They were 10 men and 5 women, from 22 to 69 years of age (average, 65.2 years). There were 9 pelvic fractures (5 cases of Tile type B and 4 ones of Tile type C) and 6 acetabular fractures (3 anterior column fractures, 2 posterior column fractures and one transverse fracture). All patients underwent percutaneous transpedicular screw fixation with the assistance of an orthopaedic robot. Fluoroscopic frequency, number of guide needle adjustment and deviation between initial planning and the final screw position were recorded intraoperatively. Postoperative CT was performed to eval-uate screw positions and incidence of adverse events. Functional recovery in the patients was evaluated in regular follow-ups.ResultsA total of 26 screws were implanted in the operation. The fluoroscopic fre-quency ranged from 12 to 49 times, with a mean value of 17.3 times per screw;the number of needle ad-justment ranged from 0 to 2 times(mean, 0.3 times);the deviation of the actual path from its initial plan-ning ranged from 0.82 to 1.42 mm (mean, 1.06 mm). No surgery-related neurovascular injury occurred in any patient. Postoperative CT examination revealed that no screws cut out of cortical bone, yielding a 100% rate of excellent and good screw positions. Two patients were lost to the follow-up, and the re-maining 13 patients were followed up for 12 to 14 months (mean, 12.6 months). Their Majeed functional scores at the final follow-up averaged 88.6 points (from 68 to 96 points). No neurological symptoms were observed during follow-up.ConclusionSince percutaneous screw fixation assisted by an orthopaedic robot is accurate and safe and needs less fluoroscopic frequency, it will became a major minimally invasive surgical technique for pelvic and acetabular fractures.