骨科手术机器人辅助经皮椎弓根钉内固定治疗Levine-EdwardⅠ、Ⅱ型Hangman骨折

Treatment of Levine-Edward type Ⅰ and Ⅱ Hangman fractures with robot-assisted placement of transpedicular screws

目的探讨"天玑"骨科手术机器人在Levine-EdwardⅠ、Ⅱ型Hangman骨折经皮椎弓根钉内固定术中的应用价值。方法回顾性分析自2017-03—2018-03在"天玑"骨科手术机器人导航下经皮椎弓根钉内固定治疗5例LevineEdwardⅠ、Ⅱ型Hangman骨折(其中Ⅰ型1例,Ⅱ型4例)。术中Mayfield头架固定头颈部,骨折闭合复位成功后在骨科手术机器人辅助下经皮置入C2椎弓根钉,术后三维CT扫描评估螺钉的位置及骨折复位情况。结果本组5例均顺利完成手术,未出现神经、血管损伤。手术时间为64～130 min,平均93 min;术中出血量5～25 ml,平均12 ml。5例均获得随访,随访时间平均10.3(6～14)个月。术后复查颈椎X线片显示颈椎稳定性良好,无骨折成角或移位。术后CT显示骨折均愈合,骨折愈合时间平均3.5(3～6)个月。术后6个月颈椎创伤后Mayo评分:优4例,良1例。结论 "天玑"骨科手术机器人辅助经皮椎弓根钉内固定治疗Levine-EdwardⅠ、Ⅱ型Hangman骨折是一种微创、精准、安全可行的方法。

Objective To investigate the application of"TINAVI"orthopaedic surgical robot navigation system in the direct transpeducular fixation of Levine-Edward type Ⅰ and Ⅱ Hangman fractures.Methods Five cases of Levine-Edward type Ⅰ and Ⅱ Hangman fractures treated with"TINAVI"orthopaedic robots from March 2017 to March 2018 were retrospectively analyzed.The Mayfield head frame was used to fix the head during the operation.After closed reduction,the C2 pedicle screw was inserted percutaneously with the assistance of the orthopedic surgical robot.The position of pedicle screws and fractures were evaluated by three-dimensional CT scan.Results All the operations were successfully performed,without neurovascular complications postoperatively.The operation time was 64-130 min,with an average of 93 min.The blood loss was 5-25 ml,the mean value was 12 ml.All 5 cases were followed up for an average of 10.3 months(6-14 months).The postoperative X ray films showed that C2-C3 was stable without signs of translation or angulation.Postoperative CT scans showed that fracture healing was well,the healing time was 3-6 months with an average of 3.5 months.Six months postoperatively,the Mayo cervical scores were excellent in 4 cases,good in 1 case.Conclusion The 3 D C-arm-based TINAVI surgical robot guided C2 pedicle screw percutaneous insertion is safe,precise and feasible for the initial treatment of Levine-Edward type Ⅰ and Ⅱ Hangman fractures.