双平面骨科机器人辅助股骨颈骨折空心钉内固定

Bi-planar robot navigation system for insertion of cannulated screws in femoral neck fractures

目的探讨双平面骨科机器人系统辅助股骨颈骨折空心钉内固定的优势与不足。方法回顾分析2016年1—4月北京积水潭医院收治的行双平面骨科机器人辅助股骨颈空心钉内固定术的30例股骨颈骨折患者的病历资料。其中男11例,女19例,平均年龄56岁(39～82岁)。收集应用双平面骨科机器人系统的术中透视时间、导针调整次数和手术时间,通过测量术后正、侧位X线上螺钉的分散度及螺钉间的平行度评估手术效果。结果双平面骨科机器人系统采集图像的平均透视时间为2.3 s(1.0～6.0 s),规划螺钉置入的平均时间为2.8 min(1.0～7.0 min),导针置入的平均透视时间为5.7 s(2.0～9.0 s),空心钉置入的平均时间为12.7 min(8.0～22.0 min)。手术期间仅对1枚导针进行了重新调整。术后正位X线上螺钉的分散度为65.13%,侧位X线上为70.08%;正位X线上螺钉与股骨干夹角差为1.08°,侧位X线上为1.25°。结论双平面骨科机器人辅助股骨颈骨折空心钉内固定术能显著减少术中透视次数、导针调整次数及手术时间,且置入螺钉的分散度好。

Objective To evaluate the advantages and disadvantages of bi-planar robot navigation assisting cannulated screws implantation. Methods Clinical data of 30 patients with femoral neck fractures treated with bi-planar robot navigation assisted cannulated screws implantation in Beijing Jishuitan Hospital from January 2016 to April 2016 were retrospectively analyzed. There were 11 males and 19 females with an average age of 56 years（ ranged from 39 to 82 years）. The time of fluoroscopy images taken,drilling attempts and operation time were collected. The effect of the operation was evaluated by measuring the screw parallelism and screws angle through radiography. Results In bi-planar robot navigation system, the average time of fluoroscopy for image collecting was 2. 3 s（ 1. 0-6. 0 s）,the time for the surgery planning was 2. 8 min（ 1. 0-7. 0 min）,the average time of fluoroscopy for guidewire insertion was 5. 7 s（ 2. 0-9. 0 s）,and the average operation time for cannulated screws implantation was 12. 7 min（ 8. 0-22. 0 min）. Only one guidewire was readjusted during the operation. By radiographic measurement,paralled dispersion of the screws in anteroposterior radiographs was 65. 13%,and was 70. 08% in lateral radiographs. The average inclination of three cannulated screws in anteroposterior radiographs was 1. 08°,and was 1. 25° in lateral radiographs. Conclusion Biplanar robot navigation assisting the cannulated screw implantation for femoral neck fracture can significantly reduce the times of fluoroscopy,drilling attempts and operation time,and the simultaneously is with better screw parallelism and greater spread of the screws.