机器人辅助与徒手经皮螺钉固定髋臼骨折

Robot-assisted versus freehand percutaneous screw fixation of acetabulum fractures

[目的]比较机器人辅助下经皮髋臼前柱顺行螺钉内固定术,与传统徒手经皮螺钉内固定治疗髋臼骨折的临床疗效。[方法]回顾性分析2018年1月—2021年9月在本院采用经皮置钉固定髋臼前柱骨折24例患者的临床资料。根据术前医患沟通结果,12例采用机器人辅助置钉,12例采用传统徒手置钉。比较两组围手术期、随访及影像结果。[结果]两组患者均顺利完成手术,术中无神经、血管损伤等严重并发症。两组手术时间的差异无统计学意义(P>0.05),机器人组置钉时间[(32.5±7.2) min vs (57.6±11.9) min, P<0.05]、导针调整次数[(0.5±0.5)次vs (6.8±1.1)次, P<0.05]、射线曝光时长[(23.0±7.6) s vs(78.5±13.7) s, P<0.05]、术中透视次数[(14.9±4.0)次vs (52.9±8.6)次, P<0.05]、术中出血量[(32.0±9.0) ml vs (74.8±19.5) ml, P<0.05]均显著少于徒手组,两组切口愈合等级及住院时间的差异无统计学意义(P>0.05)。两组均获随访12个月以上,两组恢复下地行走时间及完全负重活动时间的差异均无统计学意义(P>0.05)。随时间推移,两组VAS评分均显著减少(P<0.05),而Majeed评分均显著增加(P<0.05);相应时间点,两组间VAS评分和Majeed评分的差异均无统计学意义(P>0.05)。影像方面,与术后即刻相比,末次随访时,两组Matta评级、内固定位置均无显著改变(P>0.05)。两组影像骨折愈合时间的差异无统计学意义(P>0.05)。[结论]与传统徒手手术相比,机器人辅助下经皮髋臼前柱顺行螺钉内固定术置钉更精准,术中射线暴露量更低,组织损伤更小,临床效果稳定。

[Objective] To compare the clinical efficacy of robot-assisted(RA) versus traditional freehand(FH) percutaneous screw fixation for acetabular fractures. [Methods] A retrospective study was performed on 24 patients who had acetabular anterior column fracture fixed by percutaneous screws in our hospital from January 2018 to September 2021. According to the preoperative doctor-patient communication, 12 patients received RA technique, while the remaining 12 patients underwent the traditional FH technique. The perioperative, follow-up and imaging consequences were compared between the two groups. [Results] All the patients in both groups had operation performed smoothly without neurovascular injury and other serious complications. Although there was no a significant difference in operation time between the two groups(P>0.05), the RA group proved significantly superior to the FH group in terms of screw placement time [(32.5±7.2) min vs(57.6±11.9) min, P<0.05], guide pin adjustment times [(0.5±0.5) times vs(6.8±1.1) times, P<0.05], radiation exposure duration[(23.0± 7.6) sec vs(78.5 ±13.7) sec, P<0.05], intraoperative fluoroscopy times [(14.9±4.0) times vs(52.9±8.6) times, P<0.05] and intraoperative blood loss [(32.0±9.0) ml vs(74.8±19.5) ml, P<0.05]. However, there were no significant differences in incision healing grade and hospital stay between the two groups(P>0.05). All of them in both groups were followed up for more than 12 months, and there were no significant differences in time to return to walking and full weight-bearing activity between the two groups(P>0.05). As time went the VAS score for pain significantly decreased(P<0.05), while Majeed score significantly increased in both groups(P<0.05), which proved not statistically significant between the two groups at any time points accordingly(P>0.05). Radiographically, no significant changes in Matta rating or implant position were observed in both groups at the last follow-up compared to those immediately postoperatively(P>0.05). In addition,there was no significant difference in the fracture healing time on images between the two groups(P>0.05). [Conclusion] Compared with the traditional freehand technique, the robot-assisted percutaneous anterograde acetabular screw fixation is more accurate, with less intraoperative radiation exposure, less tissue damage, and more stable clinical efficacy.