机器人辅助螺钉固定治疗老年脆性骨盆骨折

Robot-assisted screws fixation for the treatment of fragility fractures of the pelvis

目的探讨基于骨性通道复位标准的机器人辅助螺钉固定治疗老年脆性骨盆骨折的临床疗效。方法回顾性分析2016年3月至2021年10月天津市天津医院创伤骨盆科治疗的50例老年脆性骨盆骨折患者资料,根据固定方式分为机器人辅助螺钉固定组(简称机器人组)和切开复位钢板固定组(简称切开组)。其中机器人组30例,男6例、女24例,年龄(75.03±7.32)岁(范围60~90岁),脆性骨盆骨折(fragility fractures of the pelvis,FFP)分型:Ⅱc型4例、Ⅲa型8例、Ⅲb型1例、Ⅲc型12例、Ⅳa型3例、Ⅳb型2例;切开组20例,男5例、女15例,年龄(71.90±5.51)岁(范围62~85岁),FFP分型:Ⅱc型2例、Ⅲa型6例、Ⅲc型9例、Ⅳa型3例。比较两组患者年龄、骨盆骨折分型、手术时间、术中出血量、骨折复位质量、骨盆部位疼痛视觉模拟评分(visual analogue scale,VAS)、Majeed评分、伤口愈合与否。结果两组患者均获得随访,随访时间6~24个月,平均12.72个月。机器人组手术时间(50.17±19.32)min(范围30~120 min)、术中出血量(55.50±28.60)ml(范围10~150 ml),切开组分别为(92.25±27.55)min(范围60~180 min)、(217.50±67.20)ml(范围150~400 ml),两组比较差异均有统计学意义(t=6.36,P<0.001;t=11.72,P<0.001)。根据Mears和Velyvis影像学评价标准,机器人组10例解剖复位、20例复位满意,切开组14例解剖复位、6例复位满意,两组比较差异有统计学意义(χ^(2)=6.46,P=0.011)。机器人组骨盆部位疼痛VAS评分术前为(7.33±1.32)分(范围4~9分)、术后1周为(4.13±1.07)分(范围3~8分)、末次随访时为(2.30±0.84)分(范围1~5分),切开组分别为(7.45±1.23)分(范围5~9分)、(5.25±1.25)分(范围3~8分)、(2.80±1.24)分(范围1~6分),两组组内差异均有统计学意义(F=162.18,P<0.001;F=70.18,P<0.001),术后1周两组比较差异有统计学意义(t=3.37,P=0.001)、术前和末次随访比较差异均无统计学意义(P>0.05)。末次随访时机器人组Majeed评分为(82.10±4.80)分(范围65~95分),切开组为(77.60±5.40)分(范围70~93分),差异有统计学意义(t=3.09,P=0.003)。机器人组术后无一例发生伤口感染,切开组4例发生伤口感染或裂开。机器人组1例LC-Ⅱ螺钉松动拔出,需再次手术行骨水泥强化固定;切开组1例螺钉松动,未再手术治疗。结论基于骨性通道复位标准,机器人辅助经皮微创通道螺钉固定治疗老年FFP复位满意、固定坚强,手术时间短,术中出血量少,术后患者疼痛缓解明显、并发症少,临床疗效满意。

Objective To investigate the clinical outcomes of fragility fractures of the pelvis(FFP)treated with robot-assisted screws,minimally reduction according to the pelvic osseous pathways.Methods A retrospective analysis was performed on the data of 50 elderly patients with FFP treated by the Department of Trauma and Pelvic Trauma of Tianjin Hospital from March 2016 to October 2021,and the 50 patients with FFP were divided into robotic-assisted screw fixation group(robot group)and open reduction steel plate fixation group(open group)according to the fixation method.There were 30 patients in the Robot group,6 males and 24 females,average age 75.03±7.32 years(range,60-90 years).According to Rommens and Hofmann FFP classification,there were 4 cases ofⅡc type,8 cases ofⅢa type,1 case ofⅢb type,12 cases ofⅢc type,3 cases ofⅣa type,2 cases ofⅣb type.There were 20 patients in the open group,5 males and 15 females,average age 71.90±5.51 years(range,62-85 years).According to Rommens and Hofmann FFP classification,there were 2 cases ofⅡc type,6 cases ofⅢa type,9 cases ofⅢc type,3 cases ofⅣa type.The two groups were compared with age,pelvic fracture classification,operation time,intraoperative blood loss,fracture reduction quality,visual analogue scale(VAS),Majeed score,and wound healing or not.Results All patients were followed up for 12.72 months(range,6-24 months).In the robot group,the operation time was 50.17±19.32 min(range,30-120 min),and intraoperative blood loss was 55.50±28.60 ml(range,10-150 ml);in the open group,the operation time was 92.25±27.55 min(range,60-180 min),and intraoperative blood loss was 217.50±67.20 ml(range,150-400 ml),there were statistical differences(t=6.36,P<0.001;t=11.72,P<0.001).According to Mears and Velyvis imaging evaluation criteria,in the robot group,anatomical reduction were achieved in 10 cases,satifactory reduction were achieved in 20 cases;in the open group,anatomical reduction were achieved in 14 cases,satifactory reduction were achieved in 6 cases,there were statistical differences(χ^(2)=6.46,P=0.011).In the robot group,VAS for pelvic pain was 7.33±1.32 points(range,4-9 points)before operation,4.13±1.07 points(range,3-8 points)one week after surgery,and 2.30±0.84 points(range,1-5 points)at the last follow-up;in the open group,VAS for pelvic pain was 7.45±1.23 points(range,5-9 points)before operation,5.25±1.25 points(range,3-8 points)one week after surgery,and 2.80±1.24 points(range,1-6 points)at the last follow-up,the difference between the two groups was statistically significant(F=162.18,P<0.001;F=70.18,P<0.001),the difference between the two groups was statistically significant 1 week after surgery(t=3.37,P=0.001),and there was no statistically significant difference between the two groups before surgery and the last follow-up(P>0.05).The Majeed score was 82.10±4.80(range,65-95)in the robot group,77.60±5.40(range,70-93)in the open group at the last follow-up,there were statistical differences(t=3.09,P=0.003).There was no wound complication in the robot group,there were 4 cases with wound infection or rupture in the open group.One LC-Ⅱscrew loosen in the robot group,which needed reoperation with cement,there was also 1 screw of plate loosening in the open group with no reoperation.Conclusion Robot-assisted screws fixation with minimally reduction based pelvic osseous pathways shows satisfactory clinical outcomes,satisfactory reduction,effective pain relief,and fewer postoperative complications in treatment of elderly FFP.