关节镜下复位联合骨科机器人置钉治疗距骨颈骨折的疗效观察

Curative effect of arthroscopy eduction combined with orthopedic robotic screw placement in the treatment of talar neck fractures

目的探讨关节镜下复位联合骨科机器人置钉治疗距骨颈骨折的临床疗效。方法回顾性研究。纳入徐州仁慈医院足踝科2017年1月—2021年2月8例距骨颈骨折患者,其中,男7例、女1例,右侧5例、左侧3例,年龄30~62(41.8±11.3)岁,交通伤1例、高坠伤7例。患者均在关节镜下行撬拨复位骨科机器人辅助定位置入螺钉内固定手术。术后定期随访,观察患者术后并发症发生及骨折愈合情况,复查X线及CT,评价足部功能,末次随访均进行影像学检查,观察骨折愈合及有无距骨坏死,并采用疼痛视觉模拟评分法(VAS)、美国足踝外科协会(AOFAS)踝-后足评分量表对踝关节进行评分并与术前比较。结果8例患者手术均顺利,术后随访时间12~23(15.9±3.9)个月。切口均一期愈合,无患者发生骨折不愈合、距骨坏死,1例患者出现距下关节炎,口服非甾体药物能缓解。末次随访时,患者AOFAS评分97.0(96.0,99.3)分,VAS评分0(0,1)分,与术前比较差异均有统计学意义(Z=-2.52、-2.39,P值均<0.05)。结论关节镜下复位联合骨科机器人置钉技术治疗距骨颈骨折,具有创伤小、置钉精准等优点,临床治疗效果满意。

Objective This study aimed to investigate the clinical effect of arthroscopy combined with orthopedic robotic nails in the treatment of talar neck fractures.Methods A retrospective study included 8 patients with talus fractures admitted to the Department of Foot and Ankle of Xuzhou Renci Hospital from January 2017 to February 2021,including 7 males and 1 female,Five right and 3 left sides,aged 30-62(41.8±11.3)years,one case of traffic injury,and 7 cases of high fall injury.All patients underwent arthroscopic poking reduction of talar neck fractures,and orthopedic robot-assisted positioning and internal fixation with screws.Regular follow-up after operation was performed to observe the occurrence of postoperative complications and fracture healing.X-ray and CT were reviewed to evaluate foot function.At the last follow-up,imaging examinations were performed to observe fracture healing and talar osteonecrosis,and visual analog scale(VAS)was used,and compared with preoperative.The ankle joint was scored using the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot scale.Results All patients underwent successful operation,and they were followed up after the operation for 12-23(15.9±3.9)months.All incisions healed by primary intention,and no fracture nonunion nor talus necrosis occurred in any patient.One patient developed subtalar arthritis,which was relieved by oral nonsteroidal drugs.At the last follow-up,the AOFAS ankle-hindfoot score was 97.0(96.0,99.3)points,and the VAS score was 0(0,1)points,compared with the preoperative ratio,the difference was statistically significant(Z=-2.52,-2.39,all P values<0.05).Conclusion Arthroscopy combined with orthopedic robotic screw placement technology for the treatment of talar neck fractures has the advantages of less trauma and precise placement of the screws,and the clinical treatment effect is satisfactory.