机器人辅助经皮通道螺钉固定LC-Ⅱ型骨盆骨折的疗效研究

Efficacy of robot-assisted percutaneous channel screw fixation for LC-II pelvic fractures

目的探讨机器人辅助经皮通道螺钉固定LC-Ⅱ型骨盆骨折的疗效。方法 2019年12月至2022年6月于上海市第十人民医院手术治疗的Young-Burgess LC-Ⅱ型骨盆骨折患者46例, 男27例、女19例, 年龄(39.65±15.28)岁(范围19~68岁)。致伤原因:交通伤28例、高空坠落伤18例;Tile分型均为B型骨盆骨折。根据手术方式分为:机器人组26例, 采用机器人辅助经皮通道螺钉内固定;徒手置钉组20例, 采用透视引导下微创徒手置钉内固定。比较两组手术的手术时间、术中出血量、导针调整次数、首次螺钉置入位置的优良率、术后垂直与水平方向位移和术后骨盆骨折复位质量Matta评分。采用视觉模拟评分(visual analogue scale, VAS)评估患者术前、术后1周的疼痛程度;末次随访采用Majeed标准评估临床疗效。记录术后及随访过程中是否有感染、血管神经损伤、螺钉断裂等相关并发症。结果所有患者均顺利完成手术, 并获得(11.93±3.09)个月(范围5~15个月)的随访。46例共置入经皮通道螺钉84枚, 其中机器人组47枚, 徒手置钉组37枚。机器人组手术时间和导针调整次数为(81.27±4.90) min、(0.58±0.76)次, 徒手置钉组为(102.95±8.73) min、(5.80±2.24)次, 差异有统计学意义(t=-10.68, P<0.001;t=-11.13, P<0.001)。两组术中出血量、术后垂直与水平方向位移的差异无统计学意义(P>0.05)。机器人组首次螺钉置入位置优44枚、良2枚、差1枚, 优良率为98%(46/47), 徒手置钉组优27枚、良5枚、差5枚, 优良率为86%(32/37), 差异有统计学意义(χ2=4.05, P=0.044)。机器人组术后1周VAS为(3.38±1.20)分, 徒手置钉组为(6.80±1.61)分, 差异有统计学意义(t=-8.25, P<0.001)。机器人组和徒手置钉组术后Matta标准优良率分别为92%、85%, 末次随访Majeed评分分别为(86.54±3.10)分、(85.7±2.20)分, 组间差异均无统计学意义(P>0.05)。所有患者均一期愈合, 术后及随访期间均未出现感染, 螺钉断裂等相关并发症。结论机器人辅助经皮通道螺钉固定治疗LC-Ⅱ型骨盆骨折可实现骨盆骨折的准确复位, 具有手术时间短、辐射暴露量少、安全和精度性高等特点。

Objective To investigate the therapeutic effect of robot-assisted percutaneous screw fixation in LC-II pelvic fractures.Methods A total of 46 patients with Young-Burgess LC-II pelvic fractures,who underwent surgical treatment at Shanghai Tenth People's Hospital from December 2019 to June 2022,were retrospectively analyzed.Among them,27 were male and 19 were female,with an average age of 39.78±15.11 years(range,19-68 years).The causes of injury were traffic accidents(28 cases)and fall from height(18 cases);all the cases were Type B pelvic fractures according to the Tile classification.The patients were divided into two groups based on the surgical approach:the robot group(26 cases)treated by Tianji robot-assisted percutaneous screw fixation,and the actual screw group(20 cases)treated by minimally invasive internal fixation under fluoroscopic guidance.The surgical time,blood loss,number of guide wire adjustments,the success rate of initial screw placement,postoperative vertical and horizontal displacement,and postoperative pelvic fracture reduction quality(Matta score)were compared between the two groups.Visual analogue scale(VAS)was used to assess patients'pain levels before and one week after surgery,and the clinical efficacy was evaluated using the Majeed score at the final follow-up.The occurrence of complications such as infection,vascular and nerve injury,and screw breakage was all recorded during the follow-up.Results All patients successfully underwent the surgery and were followed up for an average of 11.93±3.09 months(range,5-15 months).A total of 84 percutaneous screws were applied in the 46 cases,with 47 screws in the robot group and 37 screws in the actual screw group.The surgical time and number of guide wire adjustments were 81.27±4.90 minutes and 0.58±0.76 times in the robot group,102.95±8.73 minutes and 5.80±2.24 times in the actual screw group,with significant differences(t=-10.68,P<0.001;t=-11.13,P<0.001).There was no significant difference between the two groups in terms of intraoperative blood loss and postoperative vertical and horizontal displacement(P>0.05).The success rate of initial screw placement in the robot group was 98%(46/47,44 excellent,2 good,1 poor),while in the actual screw group,it was 86%(32/37,27 excellent,5 good,5 poor),with a significant difference(χ2=4.05,P=0.044).The VAS scores at one week postoperatively were 3.38±1.20 in the robot group and 6.80±1.61 in the actual screw group,with a significant difference(t=-8.25,P<0.001).The excellent rate of Matta score after surgery was 92%in the robot group and 85%in the actual screw group,and the Majeed scores at the final follow-up were 86.54±3.10 and 85.7±2.20 respectively,with no significant difference between the two groups(P>0.05).All patients achieved primary healing;no complications such as infection or screw breakage occurred during the follow-up period.Conclusion Robot-assisted percutaneous access screw fixation for LC-II pelvic fracture can achieve accurate reduction of pelvic fracture,and is characterized by short operative time,low radiation exposure,and high safety and accuracy.