骨科手术机器人与人工置钉治疗股骨颈骨折失血量比较

Comparison of blood loss in patients with femoral neck fracture undergoing screw fixation with and without robot navigation

目的探讨骨科手术机器人定位下置钉治疗股骨颈骨折手术对失血的影响,寻找减少手术失血的方法。方法收集2016-12至2017-03医院收治的21例行机器人定位下空心钉内固定的股骨颈骨折患者为A组(机器人手术组),选取2016-06至2016-12未使用机器人定位行空心钉内固定的23例股骨颈骨折患者为B组(非机器人手术组),通过收集患者术日晨和术后第1、3、5天晨血常规,对比分析术后第1、3、5天的理论出血量、红细胞压积、血红蛋白量,及患者一般情况。结果 A组患者术后第1、3天失血量分别为(133±101)ml、(233±78)ml,均小于B组的(302±191)ml、(451±280)ml,两组对比差异均有统计学意义(P<0.05);A组术后1、3天的血红蛋白分别为(117.13±13.24)g/L、(123.16±12.09)g/L,均高于B组的(112.09±13.25)g/L、(117.31±13.32)g/L,差异均有统计学意义(P<0.05)。结论微创闭合复位空心钉固定治疗股骨颈骨折,使用机器人定位下进行手术,定位精准,术中穿刺次数减少,减少了手术的出血,值得临床推荐。

Objective To explore the effect of robot navigation for screw fixation in the treatment of femoral neck fractures in order to reduce blood loss with an orthopaedic surgical robot. Methods Twenty-one patients with femoral neck fractures that had undergone cannulated screw fixation with robot navigation between December 2016 to March 2017 were assigned to group A while another23 cases that were treated without robot navigation were assigned to group B. The hematocrit and hemoglobin content of these patients was determined through routine blood examination on the morning of the day for surgery and 1,3,5 days after operation. Blood loss in the two groups was calculated based on the blood examination results,patients＇ height as well as body weight. The results were compared between the two groups using statistical software. Results Blood loss on postoperative day 1 and day 3 was（ 133 ± 101） ml and（ 233 ± 78） ml in group A,but（ 302 ± 191） ml and（ 451 ± 280） ml in group B,respectively,so the difference was statistically significant（ P〈0. 05）. Hemoglobin content on postoperative day 1 and day 3 was（ 117. 13 ± 13. 24） g/L and（ 123. 16 ± 12. 09） g/L in group A,compared with（ 112. 09 ± 13. 25） g/L and（ 117. 31 ± 13. 32） g/L in group B,so the difference was also statistically significant（ P〈0. 05）. Conclusions Minimally invasive closed reduction with cannulated screw fixation for femoral neck fractures is a common operation. With robot navigation,localization is more accurate,thus the times of insertion are dramatically reduced together with blood loss.Robot navigation should be popularized.