机器人辅助下前柱螺钉与前环内置外固定架治疗不稳定骨盆骨折的疗效比较

Efficacy comparison of robot-assisted anterior column screw and anterior subcutaneous internal fixation for the treament of unstable pelvic fracture

目的比较骨科机器人辅助下微创置入前柱螺钉与前环内置外固定架(INFIX)内固定治疗不稳定骨盆骨折的临床疗效。方法采用回顾性队列研究分析2018年6月至2021年12月贵州省人民医院收治的42例不稳定骨盆骨折患者的临床资料,其中男25例,女17例;年龄16~68岁[(41.8±3.2)岁]。前柱螺钉组(22例)采用骨科机器人辅助下前柱螺钉固定骨盆前环骨折;INFIX组(20例)采用INFIX固定骨盆前环骨折。骨盆后环损伤均采用闭合复位经皮骶髂螺钉内固定。比较两组骨盆前环手术时间、术中出血量、术中透视次数、患者负重时视觉模拟评分(VAS)<3分的下床活动时间、骨折愈合时间。术后2 d按Matta评分标准评定骨盆骨折复位质量。末次随访时采用Majeed功能评分评估功能情况。观察两组术中及术后并发症情况。结果患者均获随访6~24个月[(11.3±0.5)个月]。前柱螺钉组骨盆前环手术时间为(33.4±2.6)min,INFIX组为(30.2±2.9)min(P>0.05)。前柱螺钉组术中出血量为(15.9±3.1)ml,INFIX组为(41.4±6.2)ml(P<0.01)。前柱螺钉组术中透视次数为(12.2±2.4)次,INFIX组为(14.7±2.5)次(P>0.05)。前柱螺钉组负重时VAS<3分的下床活动时间为(3.2±0.4)周,INFIX组为(6.6±1.2)周(P<0.01)。前柱螺钉组骨折愈合时间为(12.7±1.4)周,INFIX组为(16.2±1.9)周(P<0.01)。根据Matta评分标准:两组骨盆后环复位质量优良率均为100%;前柱螺钉组骨盆前环复位质量优16例,良6例,优良率为100%,而INFIX组优11例,良7例,可2例,优良率为90.0%(P<0.05)。末次随访时前柱螺钉组Majeed功能评分优16例,良4例,可2例,优良率为90.9%;INFIX组优10例,良6例,可4例,优良率为80.0%(P<0.05)。两组术中均未出现血管、神经、精索等重要组织损伤。前柱螺钉组术后未出现感染、精索损伤及内固定断裂等并发症。INFIX组术后发生切口脂肪液化2例,股外侧皮神经症状4例,异位骨化1例;未出现内固定断裂情况。结论与前环INFIX内固定比较,骨科机器人辅助下前柱螺钉治疗不稳定骨盆骨折具有出血量少、下地时间早、骨折愈合快、骨折复位质量良好、术后功能恢复满意、并发症少等优点。

Objective To compare the clinical efficacy of minimally invasive anterior column screw placement assisted by orthopedic robot with anterior subcutaneous internal fixation(INFIX)in the treatment of unstable pelvic fracture.Methods A retrospective cohort study was conducted to analyze 42 patients(25 males and 17 females);aged 16-68 years[(41.8±3.2)years]with unstable pelvic fracture admitted to Guizhou Provincial People's Hospital from June 2018 to December 2021.Anterior column screw group(n=22)received orthopedic robot-assisted anterior column screw fixation of anterior pelvic ring fracture,and INFIX group(n=20)received subcutaneous INFIX of anterior pelvic ring fracture.Posterior pelvic ring injuries were treated with closed reduction and percutaneous sacroiliac screw internal fixation.The operation time of anterior pelvic ring fixation,intraoperative blood loss,intraoperative fluoroscopy times,off-bed activity time when the visual analogue scale(VAS)was<3 points during weight-bearing and fracture healing time were compared between the two groups.The quality of pelvic fracture reduction was assessed according to the Matta scoring criteria at 2 days after surgery.The Majeed functional score was used to assess the functional status at the last follow-up.Intraoperative and postoperative complications were observed in both groups.Results All patients were followed up for 6-24 months[(11.3±0.5)months].The operation time of anterior pelvic ring fixation was(33.4±2.6)minutes in anterior column screw group and(30.2±2.9)minutes in INFIX group(P>0.05).The intraoperative blood loss was(15.9±3.1)ml in anterior column screw group and(41.4±6.2)ml in INFIX group(P<0.01).The intraoperative fluoroscopy times were 12.2±2.4 in anterior column screw group and 14.7±2.5 in INFIX group(P>0.05).The off-bed activity time was(3.2±0.4)weeks in anterior column screw group and(6.6±1.2)weeks in INFIX group(P<0.01).The fracture healing time was(12.7±1.4)weeks in anterior column screw group and(16.2±1.9)weeks in INFIX group(P<0.01).According to Matta scoring criteria,the excellent and good rate of posterior pelvic ring reduction quality was 100%in both groups,while the excellent and good rate of the quality of anterior pelvic ring reduction was 100%(excellent in 16 patients and good in 6)in anterior column screw group compared with 90.0%(excellent in 11 patients,good in 7,and fair in 2)in INFIX group(P<0.05).During the final follow-up,the excellent and good rate of Majeed functional score was 90.9%(excellent in 16 patients,good in 4 and fair in 2)in anterior column screw group,significantly different from 80.0%(excellent in 10 patients,good in 6 and fair in 4)in INFIX group(P<0.05).During the operation,no important tissue injuries such as blood vessels,nerves or spermatic cord occurred in either group.In anterior column screw group,no postoperative complications such as infection,spermatic cord injury or implant breakage occurred;in INFIX group,there were 2 patients with incision fat liquefaction,4 with lateral femoral cutaneous nerve symptoms and 1 with heterotopic ossification,without the occurrence of implant breakage.Conclusion Compared with anterior subcutaneous INFIX,orthopedic robot-assisted anterior column screw internal fixation for the treatment of unstable pelvic fracture has advantages of less bleeding,earlier tambulation,faster fracture healing,better fracture reduction quality,more satisfied postoperative functional recovery,and fewer complications.