机器人辅助骶髂螺钉内固定联合LC-Ⅱ螺钉外固定治疗骨盆骨折

Efficacy of robot-assisted minimally-invasive sacroiliac screw fixation combined with LC-II external fixation in treatment of pelvic fractures

目的探讨机器人辅助骶髂螺钉内固定联合LC-Ⅱ螺钉外固定治疗骨盆骨折的临床疗效。方法回顾性收集2018年5月至2022年11月于吉林大学第一医院骨科中心创伤骨科采用机器人辅助骶髂螺钉内固定联合LC-Ⅱ螺钉外固定治疗的骨盆骨折患者28例, 男19例、女9例, 年龄(43.4±16.9)岁(范围14~74岁)。根据骨盆骨折Tile分型:B型骨折6例, 包括B1型1例、B2型1例、B3型4例;C型骨折22例, 包括C1型10例、C2型9例、C3型3例。所有患者均采用闭合复位、机器人辅助骶髂螺钉固定后环骨折联合LC-Ⅱ螺钉外固定架固定前环的技术治疗。记录手术时间、透视时间、置钉位置优良率, 采用Matta标准评价骨盆骨折复位质量, 采用Majeed评分评价治疗效果。结果 28例患者均顺利完成手术, 随访时间(18.3±7.3)个月(范围4~31个月);手术时间(154.9±54.7) min(范围55~226 min)。11例应用骨盆解锁复位架进行复位, 17例徒手复位。共置入骶髂螺钉43枚, 每枚螺钉透视时间为(16.3±5.2) s(范围9~31 s), 根据Gras分级置钉质量Ⅰ级率为100%。术后Matta复位质量评价为优19例、良7例、可2例, 优良率为93%(26/28)。未出现神经、血管损伤等手术相关并发症。骨折愈合时间为(3.6±1.1)个月(范围2~6个月)。末次随访时Majeed疗效:优13例、良11例、可3例、差1例, 优良率为86%(24/28)。结论机器人辅助骶髂螺钉内固定联合LC-Ⅱ螺钉外固定治疗骨盆骨折, 具有置钉质量高、创伤小、手术时间短等特点。

Objective To investigate the clinical efficacy of robot-assisted minimally invasive sacroiliac screw fixation combined with LC-II external fixation in the treatment of pelvic fracture.Methods A retrospective analysis was conducted on 28 cases with pelvic fractures treated with robot-assisted minimally invasive sacroiliac screw fixation combined with LC-II external fixation from May 2018 to November 2022.There were 19 males and 9 females,with an average age of 43.4±16.9 years(range,14-74 years).There was 1 case of B1 type,1 case of B2 type,4 cases of B3 type,10 cases of C1 type,9 cases of C2 type and 3 cases of C3 type by Tile classification.All the cases were treated with closed reduction,LC-II external fixation for the anterior lesions and robot-assisted minimally invasive sacroiliac screw fixation for the posterior lesions.The operation time,fluoroscopy time and excellent rate of screw placement were recorded.The quality of fracture reduction was evaluated by Matta's criteria,and the clinical effect was evaluated by Majeed score.Results All the 28 cases successfully underwent the surgery.In 11 cases the fractures were reduced by the pelvic unlocking closed reduction device while in the other 17 cases manual reduction was applied.In this cohort,43 screws were implanted.All the screw positions reached level I by Gras grading.The average fluoroscopy time was 16.3±5.2 s(range,9-31 s)per screw.The average operation time was 154.9±54.7 min(range,55-226 min).According to the Matta's criteria,the reduction was rated as excellent in 19 cases,good in 7 cases,fair in 2 cases,yielding an excellent or good rate of 93%(26/28).No iatrogenic neurovascular injury was found in all the 28 patients.The average follow-up was 18.3±7.3 months(range,4-31 months).The fractures healed at 3.6±1.1 months(range,2-6 months)after the surgeries.At the final follow-up,the results of the Majeed scores were rated as excellent in 13 cases,good in 11 cases,fair in 3 cases and poor in 1 case,with an excellent or good rate of 86%(24/28).Conclusion The technique of robot-assisted minimally invasive sacroiliac screw fixation combined with LC-II external fixation used in the treatment of pelvic fracture showed good clinical results.