骨科手术机器人与"O"型臂X线导航辅助骨盆骨折经皮内固定术的比较

A comparative study of orthopaedic robot and O-arm navigation to pelvic fractures

目的比较应用骨科手术机器人(天玑)与"O"型臂X线机导航辅助下微创空心螺钉内固定治疗骨盆后环损伤的近期临床疗效,并评价其实用性和安全性。方法回顾性分析2017年6月至2020年5月收治42例Tile C型骨盆骨折患者资料。其中32例在"O"型臂X线机引导下经皮骶髂螺钉内固定(O-arm组),男24例,女8例,年龄(34±6.2)岁(范围24~68岁);骨盆骨折Tile分型:C1.1型3例,C1.2型8例,C1.3型21例,骶骨骨折根据Denis分区:Ⅰ区17例,Ⅱ区8例。10例应用第三代骨科手术机器人天玑系统辅助下经皮骶髂螺钉内固定(机器人组),男8例,女2例,年龄(36±5.2)岁(范围19~62岁);骨盆骨折Tile分型:C1.1型1例,C1.2型2例,C1.3型7例,骶骨骨折Denis分区:Ⅰ区5例,Ⅱ区2例。对于明显移位的骨盆骨折,采用Starr架辅助复位后,经皮骶髂关节螺钉固定骨盆后环损伤。采用Matta评分标准评价骨折复位质量,Majeed评分评价两组病例临床疗效;通过对两组病例的导针调整次数、术中透视时间、螺钉位置优良率和并发症发生率进行统计分析。结果O-arm组和机器人组术后CT平扫检查确认所有螺钉位置均满意,随访时间(8.2±2.5)个月(范围6~12个月)。O-arm组术中每一枚螺钉调整次数为(1.56±0.02)次,机器人组(0.34±0.06)次,差异有统计学意义(P=0.031);O-arm组每一枚螺钉置入所需透视时间为(7.36±2.63)s,机器人组(6.80±3.20)s,差异无统计学意义(P>0.05)。O-arm组手术时间(53.86±15.06)min,机器人组为(52.52±15.14)min,差异无统计学意义(P>0.05)。螺钉置入的位置分布:O-arm组共置入骶髂螺钉64枚,螺钉位置评价全部为优,优率100%;机器人组置入螺钉20枚,螺钉位置评价全部为优,优率100%,差异无统计学意义(P>0.05)。O-arm组骨折愈合时间(34.6±8.6)周,机器人组(33.4±9.4)周,差异无统计学意义(P>0.05)。术后O-arm组骨折复位质量Matta评分:优28例,良4例,优良率100%;机器人组:优8例,良2例,优良率100%;两组差异无统计学意义。末次随访时O-arm组Majeed评分55~87分,其中优17例,良9例,可6例,优良率81.2%(26/32);机器人组76~95分,其中优7例、良2例、可1例,优良率90%(9/10);两组Majeed评分优良率比较无统计学差异(P>0.05)。两组并发症发生率差异无统计学意义(P>0.05)。结论天玑骨科机器人系统与"O"型臂导航系统辅助下经皮空心螺钉内固定治疗骨盆后环损伤,手术精准、安全、微创,降低对患者及术者的辐射损害,临床效果均满意,是微创治疗骨盆骨折的理想新方法;天玑骨科机器人手术操作程序化,标准化,更为稳定,学习曲线短。

Objective By comparing the clinical effect of minimally invasive hollow screw internal fixation Assisted by orthopedic robot(TiRobot)and O-arm navigation in the treatment of pelvic fractures,and practicability and security of both treatments were evaluated.Methods Retrospective analysis of data of 42 cases of Tile C type pelvic fractures was employed during June 2017 to June 2020.Among them,32 cases,twenty-four men,eight women,aged 34±6.2 years(range 24-68 years),were treated with percutaneous screw fixation guided by O-arm X wire instrument.According to Tile classification,there were 3 cases of C1.1 type,8 cases of C1.2 type and 21case of C1.3 type.According to the Denis classification of sacral fractures,17 cases were in zone I,and 8 cases in zone II.Ten patients,eight males and two females,aged 36±5.2 years(range 19-62 years)were treated by percutaneous screw fixation assisted by orthopedic robot.According to Tile classification,there were 1 case of C1.1 type,2 cases of C1.2 type and 7 cases of C1.3 type.According to the Denis classification of sacral fractures,there were 5cases in zone I,2 cases in zone II.For those who got obviously displaced pelvic fractures,Starr frames were used and then internal fixation was used to fix pelvic anterior ring and posterior ring injury respectively.Based on the times of needle adjustments,intraoperative fluoroscopy time,good screw position and incidence of complications two groups were statistically analysed.Matta score was employed to evaluate the quality of fracture reduction,while the Majeed score was employed to evaluate the clinical efficacy.Through the two groups of cases guide needle adjustment times,intraoperative fluoroscopy time,screw position excellent and good rate and the incidence of complications,which were statistically analyzed.Results All screw positions were confirmed by CT scan after operation.The average time required for each screw placement of the O-arm group was 7.36±2.63 s,of the robot group was 6.80±3.20 s,so difference was not statistically significant(P<0.05).An average of screw adjustments per one screw was 1.56±0.02 times by O-arm,and by the robot group was 0.34±0.06 times,so differences between the two groups were statistically significant(P>0.05).The average operating time of O-arm group was 53.86±15.06 min,while the robot group was 52.52±15.14 min,so differences between the two groups were not statistically significant(P>0.05).Position distribution of screw placement in two groups,all screws in O-arm group of position evaluations were excellent,excellent rate was 100%,all screw position evaluations by robot were excellent,excellent rate was 100%,so difference in screw distribution between the two groups was not statistically significant(P>0.05).All cases were followed up for 6-12 months.Fracture healing time:34.6±8.6 weeks for O-arm group,33.4±9.4 weeks for robot group.Comparison between the two groups was not statistically significant(P>0.05).Majeed score of O-arm group was 55-87,including Excellence of 17 cases,goodness of 9,fairness of 6.The rate of excellence and goodness was 81.2%,while robot group was 76-95,and that were excellent 7 cases,1 good,and the excellent and good rate was 80%,there was no significant difference between Matta and Majeed score between the two groups(P>0.05).The incidence of complications between the two groups were no statistically significant(P>0.05).Conclusion Orthopedic robot system and O-arm navigation system assisted by percutaneous hollow screw fixation treatment of pelvic anterior and posterior ring injury,which are accurate,safe,minimally invasive,can reduce radiation damage to patients and surgeons.The efficacy were satisfactory.Both treatments are ideal for minimally invasive treatment of pelvic fractures,and the orthopedic robot have advantages of being programmed,standardized,stable and it’s learning curve is shorter.