机器人导航经皮内固定治疗新鲜无移位的舟骨腰部骨折的疗效分析

Treatment of fresh undisplaced scaphoid lumbar fractures with robotic navigation and percutaneous internal fixation

目的探讨天玑骨科机器人导航经皮内固定治疗新鲜无移位的舟骨腰部骨折的疗效。方法回顾性分析2019年11月至2020年10月徐州仁慈医院手外科收治的8例新鲜无移位的舟骨腰部骨折患者资料,男7例,女1例;平均年龄为27.5岁(18~42岁);左侧5例,右侧3例。采用天玑骨科机器人导航定位,经皮置入Herbert螺钉固定治疗。术后定期随访行X线片及CT检查确定骨质愈合时间,采用Mayo腕关节评分、握力、捏力及腕关节活动度评价其功能恢复情况,采用疼痛视觉模拟评分(VAS)评价疼痛情况。结果8例患者术后获平均12.8个月(6~19个月)随访。所有患者伤口均一期愈合,无炎症、感染等并发症发生,术后3个月CT检查见骨折端均愈合。末次随访时伤侧腕关节主动活动范围平均为:屈曲67.9°,背伸64.1°,桡偏21.2°,尺偏52.2°;握力恢复至平均31.3 kg,平均恢复至健侧的85.2%(66.7%~100.0%);捏力平均恢复至19.5 kg,平均达健侧的89.3%(77.8%~100.0%);末次随访时患者Mayo腕关节功能评分平均为97.5分(95~100分),8例均为优。腕关节疼痛VAS评分平均为0.88分(0~2分)。结论采用天玑骨科机器人导航经皮螺钉固定治疗新鲜无移位的舟骨腰部骨折,可实现精准定位和置钉,从而实现快速康复。

Objective To investigate the clinical efficacy of robotic navigation and percutaneous internal fixation in the treatment of fresh undisplaced scaphoid lumbar fractures.Methods From November 2019 to October 2020,8 patients were treated at Department of Hand Surgery,Xuzhou Renci Hospital for fresh undisplaced scaphoid lumbar fractures.There were 7 males and one female with an average age of 27.5 years(from 18 to 42 years),and 5 left and 3 right cases.Navigation by a Tianji orthopedic robot was conducted to decide the positions for implantation of percutaneous Herbert screws to fixate the fractures.The bone healing was followed up by regular X-ray and CT examinations.The functional recovery was evaluated by Mayo wrist score,grip strength,pinch strength and wrist range of motion,and the wrist pain was evaluated by visual analogue scale(VAS).Results All the 8 patients were followed up for a mean time of 12.8 months(from 6 to 19 months).All the wounds healed by the first intention without any inflammation or infection.CT examination at 3 months postoperation found that all the fracture ends got united.At the final follow-up,the average active motions of the injured wrist were:67.9°in flexion,64.1°in extension,21.2°in radial deviation and 52.2°in unlar deviation,respectively.The average grip strength was recovered to 31.3 kg,reaching up to 85.2%(from 66.7%to 100.0%)of the contralateral wrist;the average pinch force was recovered to 19.5 kg,reaching up to 89.3%(from 77.8%to 100.0%)of the contralateral wrist.At the last follow-up,the Mayo wrist function scores averaged 97.5(from 95 to 100)and all the 8 cases were excellent.The VAS pain score of the wrist averaged 0.88(from 0 to 2).Conclusion In the treatment of fresh undisplaced scaphoid lumbar fractures,navigation with a Tianji orthopedic robot can be used to visualize percutaneous minimally invasive screw fixation so that accurate positioning and precise screw placement are ensured,leading to rapid rehabilitation.