机器人辅助经皮复位微创内固定治疗Schatzker Ⅱ-Ⅲ型胫骨平台骨折

Robot-assisted percutaneous reduction and minimally invasive internal fixation for treating Schatzker Ⅱ-Ⅲ tibial plateau fracture

背景:精准、微创手术已成为当下外科手术追求的目标,伴随智能机器人的快速发展,骨折的精准、微创治疗也成为了必然趋势。目的:评价机器人辅助经皮复位微创内固定治疗SchatzkerⅡ-Ⅲ型胫骨平台骨折的临床疗效。方法:回顾性分析2017年4月至2018年8月在天津市天津医院采用机器人辅助和传统透视辅助内固定治疗单纯SchatzkerⅡ-Ⅲ型胫骨平台骨折患者的临床资料,其中机器人组22例,传统组26例。所有患者均为单侧、闭合、新鲜胫骨平台骨折。统计2组患者切口长度、手术时间、术中出血量、透视次数、螺钉一次性成功率、住院时间、骨折愈合时间、完全负重时间、术后并发症等指标;并在末次随访时记录膝关节活动度,采用Rasmussen影像学及临床评分评估患者膝关节功能。结果与结论:①术前2组患者一般资料差异无显著性意义(P>0.05);②与传统组相比,机器人组在术中失血、切口长度、透视次数、置入固定螺钉总钻孔次数、平均住院日、骨折愈合时间、完全负重时间、固定螺钉一次置入成功率等方面均具有优势,差异有显著性意义(P<0.05);而2种方式的手术时间相当(P=0.932);③机器人组对比传统组在膝关节活动度及Rasmussen临床功能评分反面亦具有优势(P<0.05);④另外机器人组术后有更少的并发症;⑤提示机器人辅助经皮微创内固定治疗SchatzkerⅡ-Ⅲ型胫骨平台骨折临床效果满意,其在微创手术、精准复位、坚强固定、加速术后康复方面存在明显优势。

BACKGROUND:Accurate and minimally invasive surgery procedure has become the pursuit of the current surgical goals.With the rapid development of intelligent robots,the precise and minimally invasive treatment of fractures has become an irresistible trend.OBJECTIVE:To evaluate the clinical efficacy of robot-assisted percutaneous reduction and minimally invasive internal fixation for Schatzker II-III tibial plateau fractures.METHODS:Clinical data of patients with Schatzker II-III tibial plateau fractures who received robot-(n=22,robot-assisted group)and traditional fluoroscopy(n=26,traditional group)-assisted internal fixation at Tianjin Hospital from April 2017 to August 2018 were analyzed retrospectively.All patients suffered from unilateral,closed,and fresh tibial plateau fractures.Statistical indicators included:incision length,operation time,intraoperative blood loss,number of fluoroscopy,one-time success rate of screw,hospitalization time,fracture healing time,total weight-bearing time and postoperative complications.At the last follow-up,the range of motion of knee was recorded.The function of knee was evaluated by Rasmussen’s imaging and clinical score.RESULTS AND CONCLUSION:(1)There was no significant difference in the baseline data between two groups(P>0.05).(2)Compared with the traditional group,the robot-assisted group was better in the intraoperative blood loss,incision length,number of fluoroscopy,total number of drilled screws for fixation,average hospitalization time,fracture healing time,total weight-bearing time,and one-time success rate of fixation screw placement(P<0.05).There was no significant difference in the operation time between two groups(P=0.932).(3)The range of motion of knee and Rasmussen clinical function score in the robot-assisted group were superior to those in the traditional group(P<0.05).(4)There were fewer postoperative complications in the robot-assisted group compared with traditional group.(5)These results indicate that robot-assisted percutaneous reduction and minimally internal fixation for the treating Schatzker II-III tibial plateau fracture are satisfactory.It has obvious advantages in minimally invasive surgery,precise reduction,rigid fixation and accelerated postoperative rehabilitation.