机器人辅助手术治疗骶髂关节脱位伴耻骨骨折及文献学习

Robot-assisted surgery for sacroiliac joint dislocation with pubic fracture and literature study

目的:分享天玑机器人辅助经皮空心螺钉内固定治疗骶髂关节伴骨盆、耻骨骨折脱位的手术技术与初步临床结果。方法:回顾性分析宫玉锁主任医师手术治疗1例骶髂关节脱位伴骨盆、耻骨骨折的病历资料并检索文献,总结其临床表现、诊断、治疗方法及预后。根据影像资料明确骨折分型,进行手术讨论。按照机器人操作流程进行安装术前准备。在主控工作站进行规划,模拟、微调,进行手术。同时宫玉锁教授擅长中西医结合治疗,注重“筋骨失衡理论”,从事中医临床与骨科多年,临床上使用中医方剂治疗筋骨病积累了丰富经验。官主任使用经验方对此病例骨折三期进行治疗,疗效良好。结果:检索获得2018年―2022年国内外发表的30篇文献,统计分析骶髂关节脱位伴耻骨骨折治疗方法。本文方法中,共置入2枚螺钉,未出现血管、神经及脏器损伤,术后透视螺钉位置优良。结论:最新的手术方式结合中医中药,疗效肯定。骶髂关节脱位伴耻骨骨折属于高能量损伤,使用机器人辅助手术,结合中医学三期治疗,可加速骨折断端、伤口的愈合。通过文献及本案例,骨科天玑机器人辅助手术具有精确性高、微创出血极少、安全性高、手术时间短等特点,将会在未来更好地适用于治疗各类骨折。

Objective:To share the surgical technique and preliminary clinical results of Tianji(天玑)robot-assisted percutaneous cannulated screw internal fixation for sacroiliac joint with pelvic and pubic fracture and dislocation.Methods:The medical records of 1 case of sacroiliac joint dislocation with pelvis and pubic fracture treated by Chief Physician GONG Yusuo are retrospectively analyzed and literature is searched to summarize the clinical manifestations,diagnosis,treatment and prognosis.The imaging data is used to confirm the fracture classification,and the operation is discussed.Preoperative preparation is made according to the robot operation procedure.Planning,simulation,fine tuning and operation are performed at the master workstation.At the same time,Professor GONG Yusuo is good at the integrated treatment of traditional Chinese medicine and Western medicine and pays attention to the imbalance of tendons and bones theory.He has been engaged in the clinical practice of traditional Chinese medicine and orthopedics for many years.He has accumulated rich experience in the clinical treatment of sinew-bone disease with traditional Chinese medicine prescriptions.The director has used the empirical formula to treat the three stages of fracture,and the effect is good.Results:A total of 30 studies published at home and abroad from 2018 to 2022 were retrieved,and the treatment methods of sacroiliac joint dislocation with pubic fracture were statistically analyzed.In this reseach,a total of 2 screws were placed without vascular,nerve and organ damage,and the position of the screws was excellent after operation.Conclusion:The latest surgical methods combined with traditional Chinese medicine has a significant curative effect.Sacroiliac joint dislocation with pubic fracture is a high-energy injury.Robot-assisted surgery combined with three-stage treatment of fracture in traditional Chinese medicine can accelerate the healing of fracture ends and wounds.Through the literature and this case,orthopedic Tianji robot-assisted surgery has the characteristics of high accuracy,minimal invasive bleeding,high safety,and short operation time,and it will be better applied in all kinds of fracture treatment in the future.