机器人辅助经皮螺钉内固定治疗髋臼骨折的疗效

Effect of robot-assisted percutaneous screw internal fixation for acetabular fractures

目的探讨机器人辅助经皮螺钉内固定治疗髋臼骨折的疗效。方法回顾性分析2019年1月至2020年8月武汉市第四医院收治的33例髋臼骨折患者的临床资料,其中男19例,女14例;年龄43~62岁[(56.3±1.1)岁]。骨折按Judet-Letournel分型:前柱骨折11例,后柱骨折7例,横行骨折7例,“T”形骨折6例,前柱加后半横形骨折2例。按AO分型:62-A311例,62-A27例,62-B17例,62-B26例,62-B32例。均采用天玑骨科手术机器人辅助经皮螺钉内固定。记录手术时间、术中出血量、住院时间、骨折愈合时间,观察切口愈合情况及并发症。采用Matta复位标准评价骨折复位质量,术后6个月采用Harris功能评分评价功能恢复情况。结果患者均获随访6~12个月[(9.3±1.7)个月]。手术时间1.3~2.2 h[(1.7±0.3)h];术中失血量70~190 mL[(152.3±25.2)mL];住院时间7~12 d[(9.7±1.2)d];骨折愈合时间14~18周[(15.4±1.1)周]。所有手术切口Ⅰ期愈合。所有患者无切口感染、下肢深静脉血栓、脂肪栓塞、螺钉穿入髋关节、内固定失效骨折再移位、创伤性关节炎、股骨头坏死等并发症。按Matta复位标准:骨折解剖复位27例,满意复位6例。Harris功能评分优24例,良7例,可2例,差0例,优良率达93.9%。结论机器人辅助经皮螺钉内固定治疗髋臼骨折具有手术创伤小、置钉准确率高、并发症少等优势,有利于术后快速康复。

Objective To investigate the effect of robot-assisted internal fixation on acetabular fracture.Methods Clinical data of 33 patients with acetabular fractures admitted to Wuhan Fourth Hospital from January 2019 to August 2020 were analyzed by retrospective case-series study,including 19 males and 14 females.The age ranged from 43 to 62 years[(56.3±1.1)years].According to Judet-Letournel classification,there were 11 cases of anterior column fracture,7 cases of posterior column fracture,7 cases of transverse fracture,6 cases of T-shaped fracture,and 2 cases of anterior column plus posterior half transverse fracture.According to AO classification,there were 11 cases of 62-A3,7 cases of 62-A2,7 cases of 62-B1,6cases of 62-B2 and 2 cases of 62-B3.Tinavi orthopedic robot assisted percutaneous screw fixation.The operation time,intraoperative blood loss,length of hospital stay and time of bone union were recorded.Wound healing and complications were observed.The quality of fracture reduction was evaluated by Matta reduction criterion,and functional recovery was evaluated by Harris functional score six months after surgery.Results All patients were followed up for 6-12 months[(9.3±1.7)months].The operation time was 1.3-2.2 h[(1.7±0.3)h],intraoperative blood loss was 70-190 m L[(152.3±25.2)m L],length of hospital stay was 7-12 d[(9.7±1.2)d],and bone union time was 14-18 weeks[(15.4±1.1)weeks].All surgical incisions were stage I healed.None of the patients had complications such as incision infection,deep venous thrombosis of lower limbs,fat embolism,screw penetration of hip joint,internal fixation failure and re-displacement of fracture,traumatic arthritis,necrosis of femoral head,etc.According to Matta reduction standard,27 cases of fracture were anatomically reduced and 6 cases were satisfied with reduction.Harris functional score was excellent in 24 cases,good in 7 cases and fair in 2 cases,with an excellent and good rate of 93.9%.Conclusion Robot-assisted percutaneous screw fixation for acetabular fracture has the advantages of less surgical trauma,high accuracy of screw placement and fewer complications,which is conducive to rapid postoperative recovery.