徒手置钉与机器人辅助置钉治疗股骨颈骨折的临床疗效对比

Comparison of clinical effects of traditional manual and robot-assisted screw placement in the treatment of femoral neck fracture

目的比较徒手置钉与机器人辅助置钉治疗股骨颈骨折的临床疗效。方法回顾性分析德阳市人民医院骨科2018年1月—12月徒手置钉治疗(徒手置钉组)的股骨颈骨折患者和2019年5月—2020年5月机器人辅助置钉治疗(机器人组)的股骨颈骨折患者的病历资料。比较两组患者的临床治疗效果,并采用Harris评分对髋关节功能进行评价。结果共纳入患者85例,均为闭合性骨折。其中,徒手置钉组45例,机器人组40例。两组患者在术前等待时间、手术时间、住院时间、骨折愈合时间、术后1年并发症、术后1年髋关节功能评分方面比较,差异均无统计学意义(P>0.05)。机器人组的置钉时间[(11.1±2.0)vs.(23.8±2.3)min;t=27.142,P<0.001]、导针穿刺次数[(4.7±1.2)vs.(11.4±1.7)次;t=20.640,P<0.001]、术中透视次数[(10.8±1.7)vs.(21.0±1.8)次;t=26.990,P<0.001]及术中出血量[(8.1±2.0)vs.(12.0±1.7)mL;t=9.711,P<0.001]均少于徒手置钉组。两组患者均未并发伤口感染及血管神经损伤。结论采用机器人辅助置入空心螺钉治疗股骨颈骨折具有术中透视次数少、导针穿刺次数少、置钉准确、出血少等优点,与传统徒手置钉相比更有优势。

Objective To compare the clinical effects of traditional manual and robot-assisted implantation of cannulated screws in the treatment of femoral neck fracture.Methods The medical records of patients with femoral neck fracture in Department of Orthopaedics,People’s Hospital of Deyang City were analyzed retrospectively.The patients were divided into two groups,including the traditional manual implantation group from January to December2018 and the robot-assisted implantation group from May 2019 to May 2020.The clinical therapeutic efficacy of the two groups were compared.Harris hip function score was used to evaluate hip function.Results A total of 85 patients were included.All patients had closed fractures.There were 45 cases in the traditional manual implantation group and 40 cases in the robot-assisted implantation group.There was no significant difference between the two groups in preoperative waiting time,operation time,hospitalization time,fracture healing time,complications within one year after operation,or Harris hip function score one year after operation(P>0.05).The placement nail time[(11.1±2.0)vs.(23.8±2.3)min;t=27.142,P<0.001],frequency of guide pin insertion[(4.7±1.2)vs.(11.4±1.7)times;t=20.640,P<0.001],frequency of intraoperative fluoroscopy[(10.8±1.7)vs.(21.0±1.8)times;t=26.990,P<0.001]and intraoperative blood loss[(8.1±2.0)vs.(12.0±1.7)mL;t=9.711,P<0.001]in the robot-assisted implantation group were less than those in the traditional manual implantation group.No wound infection or neurovascular injury was found in the two groups.Conclusion Robotassisted implantation of cannulated screws in the treatment of femoral neck fracture has the advantages of less fluoroscopy,fewer guide pin insertion,less blood loss,more accurate screw placement than the traditional manual implantation of cannulated screws.