关节镜下复位联合机器人导航置钉治疗距骨后突骨折的疗效分析

Clinical analysis of arthroscopic-assisted reduction with robotic navigation combined in the treatment of posteriorprocess talus fracture

目的探讨关节镜下复位联合骨科机器人导航置钉治疗距骨后突骨折的疗效。方法病例系列报告。纳入2019年12月—2021年10月在徐州仁慈医院接受手术治疗的7例距骨后突骨折患者的临床资料。其中, 男5例、女2例, 年龄25~55岁(34.8±10.5)岁, 左侧4例、右侧3例。患者均在关节镜辅助下复位距骨后突骨折, 骨科机器人导航置入合适的空心螺钉。观察指标:术中出血量、手术时间、骨折愈合时间及并发症发生情况;术前与末次随访时, 采用视觉模拟评分法(VAS)评估患侧踝关节疼痛情况, 采用美国足踝外科协会(AOFAS)踝-后足功能量表评估患足踝关节功能情况。结果 7例患者均获得随访13~27(19.7±5.1)个月。手术时间(107.1±27.2)min, 出血量(48.5±6.9)mL, 骨折愈合时间(3.7±0.7)个月;无伤口感染、无神经损伤、无肌腱粘连, 其中2例出现距下关节疼痛, 二期在关节镜下行距下关节清理后, 疼痛明显改善。末次随访时, 患者踝关节疼痛VAS评分为(1.4±0.5)分、AOFAS踝-后足评分为(91.0±3.4)分, 较术前的(7.1±0.9)分与(59.2±8.8)分改善明显, 差异均有统计学意义(t=13.50、-11.10, P值均<0.001), 踝关节功能达到优6例、良1例。结论关节镜下复位联合骨科机器人导航置钉治疗距骨后突骨折具有骨折复位可视化、置钉精准、创伤小、出血少等优点, 临床疗效满意。

Objective This study aimed to investigate the effect of arthroscopic-assisted reduction combined with orthopedic robot guided screw placement for the treatment of posterior talar process fracture.Methods Case series study.The clinical data of 7 patients with posterior talar process fracture who underwent surgical treatment at Xuzhou Renci Hospital from December 2019 to October 2021 were retrospectively analyzed.Among them,there were 5 males and 2 females,aged 25 to 55(34.8±10.5)years.There were 4 cases on the left side and 3 cases on the right side.Arthroscopic-assisted reduction of talus posterior process fractures was performed in all cases,and appropriate hollow screws were placed under the guidance of the orthopedic robot.The observation indicators were intraoperative blood loss,operative time,fracture healing time,and complications.The visual analogue scale(VAS)was used to evaluate ankle pain,and the American Foot and Ankle Association(AOFAS)ankle-hindfoot function scale was used to evaluate the foot and ankle function before operation and at the last follow-up.Results All 7 patients were followed up for 13 to 27(19.7±5.1)months,with an operative time of(107.1±27.2)minutes,a bleeding volume of(48.5±6.9)mL,and a fracture healing time of(3.7±0.7)months.There was no wound infection,nerve injury,or tendon adhesion.In addition,2 patients had subtalar joint pain,and the pain was significantly relieved after arthroscopic subtalar joint cleaning in the second stage.At the last follow-up,the VAS score of the patient was 1.4+0.5 and AOFAS score was 91.0+3.4,which were significantly improved compared with the preoperative scores of 7.1±0.9 and 59.2±8.8.Furthermore,the differences were statistically significant(t=13.50,-11.10,all P values<0.001).The ankle joint function was excellent in six cases and good in one case.Conclusion Arthroscopic-assisted reduction combined with orthopedic robot guided screw placement for the treatment of posterior process fractures of the talus has the advantages of less trauma,less bleeding,visual reduction of fractures,and accurate screw placement.The clinical efficacy of this procedure is also satisfactory.