机器人导航经皮前柱螺钉联合后路钢板固定治疗髋臼横断伴后壁骨折

Treatment of transverse with posterior wall fractures of acetabulum using robot-aided percutaneous anterior column screw combined with posterior plate

目的探讨机器人导航经皮前柱螺钉联合后路钢板固定治疗髋臼横断伴后壁骨折的疗效。方法回顾性分析2016年5月至2021年5月天津市天津医院创伤骨盆科采用机器人导航经皮前柱螺钉联合后路钢板固定治疗的13例髋臼横断伴后壁骨折患者资料,男9例、女4例,年龄(49.1±8.5)岁(范围25~65岁),车祸伤9例、坠落伤2例、撞击伤2例,合并后髋关节脱位7例、坐骨神经损伤1例。应用Kocher-Langenbeck入路行后柱后壁的复位固定并间接复位前柱,应用机器人导航经皮前柱螺钉固定前柱,记录术中置入前柱螺钉的时间、切口长度和并发症。使用Matta影像学标准评价骨折复位质量,采用Brooker分类评估异位骨化程度。术后3、6个月及末次随访时应用Matta改良的Postel Merle D'Aubigne评分评估功能。结果13例患者均顺利完成手术,置入前柱螺钉用时(19.4±4.0)min(范围17~23 min)、切口长度为(8.0±1.4)mm(范围6~10 mm)。术后影像学检查示所有前柱螺钉均位于骨性通道内,螺钉长度为(108.3±11.2)mm(范围90~130 mm),均未发生神经、血管损伤及切口感染等并发症。13例患者均获得随访,随访时间12~36个月,平均18.6个月;骨折均愈合,愈合时间2~6个月,平均3.4个月。根据Matta影像学评估方法,13例患者中11例骨折解剖复位,2例因前柱存在1~2 mm间隙而评价为不完全复位,解剖复位率为84%。术后3、6个月及末次随访时改良Postel Merle D'Aubigne评分分别为(13.4±1.1)分、(15.8±1.5)分和(17.0±1.7)分,差异有统计学意义(F=7.78,P=0.007);末次随访与术后3个月比较差异有统计学意义(P=0.002),与术后6个月比较差异无统计学意义(P=0.222)。末次随访时优8例、良4例、可1例,优良率达92%(12/13)。无一例发生异位骨化、创伤性关节炎及股骨头坏死。结论机器人导航经皮前柱螺钉联合后路钢板治疗髋臼横断伴后壁骨折安全,术后近期疗效满意。

Objective To explore the effectiveness and safety of robot-aided percutaneous anterior column screw combined with posterior plate fixtation treatment for transverse acetabular fractures with posterior wall.Methods A retrospective analysis was conducted on the data of 13 patients with transverse acetabular fractures and posterior wall fractures treated by robot-aided percutaneous anterior column screws combined with posterior plate in Tianjin Hospital from May 2016 to May 2021.There were 9 males and 4 females,aged 49.1±8.5 years(range,25-65 years),9 cases of vehicle accidents,2 cases of falling injuries,2 cases of impact injuries,7 cases of combined posterior hip dislocations,and 1 case of sciatic nerve injury.Apply Kocher-Langenbeck approach for reduction and fixation of the posterior wall and the posterior column and indirect reduction of the anterior column.Use robot navigation for percutaneous anterior column screw fixation,and record the time of inserting anterior column screws,incision length,and complications.The quality of fracture reduction was evaluated using Matta imaging,and the degree of ectopic ossification was evaluated using Brooker classification.The Matta modified Postel Merle D'Aobigne score was used to evaluate the function at 3,6 months after surgery and at the last follow-up.Results All 13 patients successfully completed the surgery.The insertion time of the anterior column screw was 19.4±4.0 min(range,17-23 min),and the incision length was 8.0±1.4 mm(range,6-10 mm).Postoperative imaging examination showed that all anterior column screws were located within the bone canal,with a screw length of 108.3±11.2 mm(range,90-130 mm),and no complications such as nerve or vascular injury or incision infection occurred.All 13 patients were followed up for a period of 12-36 months,with an average of 18.6 months;All fractures healed,with a healing time of 2-6 months,average 3.4 months.According to the Matta imaging evaluation method,11 of 13 patients had anatomical reduction of fractures,and 2 were evaluated as incomplete reduction due to a 1-2 mm gap in the anterior column.The anatomical reduction rate was 84%.At postoperative 3,6 months and the last follow-up,the modified Postel Merle D'Aobigne scores were 13.4±1.1,15.8±1.5,and 17.0±1.7,respectively,with statistically significant differences(F=7.78,P=0.007).The difference between the last follow-up and postoperative 3 months was statistically significant(P=0.002),and there was no statistically significant difference compared to postoperative 6 months(P=0.222).At the last follow-up,8 cases were excellent,4 cases were good,and 1 case was fair,with an excellent and good rate of 92%.There was no occurrence of ectopic ossification,traumatic arthritis,or necrosis of the femoral head.Conclusion Robot-aided percutaneous anterior column screw combined with posterior plate treatment for transverse acetabular fractures with posterior wall is safe and effective,and is worthy of clinical promotion.