骨科手术机器人辅助与传统透视下经皮骶髂螺钉置入的优劣分析

Advantage and disadvantage of robot-assisted sacroiliac screw placement and traditional fluoroscopy in orthopedic surgery

背景:骨盆骨折患者常伴有骶髂关节分离,而治疗此病症最为有效的手术方式便是置入骶髂螺钉。目前常用的置钉方式主要为手术医师在透视下徒手置入,准确性及安全性较差,且术后螺钉位置与手术医师的经验息息相关。骨科手术机器人辅助下骶髂螺钉置入是近年来较为先进的手术方式,但因机器人造价较高,临床普及应用较为有限,因此,其手术安全性及可靠性目前存有较多争议。目的:探讨机器人辅助下骶髂螺钉置入的临床效果。方法:回顾2018年1月至2020年1月于佛山市中医院治疗的95例骨盆骨折患者,其中采用经皮骶髂螺钉置入48例,采用机器人辅助骶髂螺钉置入47例,比较两组患者骶髂螺钉置入所用手术时间、术后并发症发生例数、Matta评分、Majeed评分、Merle D‘Aubigne and Postel评分。结果与结论:①机器人辅助骶髂螺钉置入组手术时间明显短于经皮骶髂螺钉置入组(P<0.05),并发症发病率明显低于经皮骶髂螺钉置入组(P<0.05),经皮骶髂螺钉置入组内固定失效5例,骨折未愈合3例,机器人辅助骶髂螺钉置入组骨折未愈合1例,以上失败病例最终通过更换内固定达到愈合;②机器人辅助骶髂螺钉置入组Matta评分、Majeed评分、Merle D’Aubigne and Postel评分优良率均明显高于经皮骶髂螺钉置入组(P<0.05);③机器人辅助骶髂螺钉置入组透视时间为(7.2±1.5)s/次,明显短于经皮骶髂螺钉置入组(25.7±7.6)s/次,差异有显著性意义(P<0.05);④结果表明,机器人辅助下骶髂螺钉置入具有手术时间短、精确度高等优点。

BACKGROUND:Patients with pelvic fractures are often accompanied by sacroiliac joint separation,and the most effective surgical treatment for this condition is the placement of sacroiliac screws.At present,the commonly used nail placement method is mainly for the surgeon to place it by hand under fluoroscopy.The accuracy and safety are poor,and the screw position after surgery is closely related to the experience of the surgeon.Orthopedic surgical robot-assisted sacroiliac screw placement is an advanced surgical method recently.However,due to the high cost of robots and limited clinical applications,there are currently many controversies regarding the safety and reliability of the operation.OBJECTIVE:To investigate the clinical effect of robot-assisted sacroiliac screw placement.METHODS:A total of 95 patients with pelvic fractures treated in Foshan Hospital of Traditional Chinese Medicine from January 2018 to January 2020 were reviewed.Among them,48 patients underwent percutaneous sacroiliac screw placement and 47 patients underwent robot-assisted sacroiliac screw placement.The operation time of sacroiliac screw placement,the number of postoperative complications,Matta score,Majeed score,and Merle D'Aubigne and Postel score were compared between the two groups.RESULTS AND CONCLUSION:(1)The operation time of the robot-assisted sacroiliac screw placement group was significantly shorter than that in the percutaneous sacroiliac screw placement group(P<0.05).The incidence of complications was significantly lower in the robot-assisted sacroiliac screw placement group than that in the percutaneous sacroiliac screw placement group(P<0.05).Five cases of internal fixation failure and three cases of fracture nonunion were found in the percutaneous sacroiliac screw placement group.One case of fracture nonunion was found in the robot-assisted sacroiliac screw placement group.The healing of the above cases was finally achieved by replacing internal fixation.(2)The excellent and good rates of Matta score,Majeed score,and Merle D'Aubigne and Postel score were significantly higher in the robot-assisted sacroiliac screw placement group than those in the percutaneous sacroiliac screw placement group(P<0.05).(3)The fluoroscope time was significantly shorter in the robot-assisted sacroiliac screw placement group(7.2±1.5)s/times than that in the percutaneous sacroiliac screw placement group(25.7±7.6)s/times(P<0.05).(4)The results showed that the robot-assisted sacroiliac screw placement had the advantages of short operation time and high accuracy.