机器人辅助下经单一腹直肌外侧入路治疗涉及后柱的髋臼骨折的疗效分析

A single lateral-rectus approach in the robot-assisted treatment of acetabular fractures involving the posterior column

目的探讨天玑骨科机器人辅助下经单一腹直肌外侧入路(LRA)治疗涉及后柱的髋臼骨折的疗效。方法回顾性分析2021年8月至2023年3月湖北省十堰市太和医院创伤骨科收治的16例髋臼骨折患者资料。男13例,女3例;年龄51.5(35.8,56.8)岁;髋臼骨折分型采用Judet-Letournel分型:前柱伴后半横形骨折4例,T形骨折2例,双柱骨折10例;受伤至手术时间6.0(5.3,7.8)d。所有患者均采用天机骨科机器人辅助下经单一LRA治疗。记录患者的手术时间、出血量、骨折复位质量、末次随访时髋臼恢复情况、改良Merle d'Aubigné&Postel评分、并发症等。结果本组患者手术时间(4.1±0.6)h,出血量400(300,575)mL。骨折复位质量Matta标准评价:优10例,良5例,差1例。术后随访时间(11.3±3.9)个月。骨折均获得骨性愈合,愈合时间为3.0(2.3,4.0)个月。末次随访时改良Merle d'Aubigné&Postel评分:优9例,良6例,可1例。1例患者出现股外侧皮神经损伤,6例患者术后下肢深静脉血栓形成。随访期内未发生医源性血管损伤、内固定物松动、断裂、切口感染等。结论天玑骨科机器人辅助下经单一LRA可以完成涉及后柱的髋臼骨折的微创治疗,具有复位质量高、髋关节功能恢复好等优势。

Objective To investigate the clinical effects of a single lateral-rectus approach(LRA)in the Ti-Robot-assisted treatment of acetabular fractures involving the posterior column.Methods A retrospective study was conducted to analyze the clinical data of 16 patients with acetabular fracture who had been admitted to Department of Trauma Orthopedics,Taihe Hospital from August 2021 to March 2023.There were 13 males and 3 females with a mean age of 51.5(35.8,56.8)years.By the Judet-Letournel classification,there were 4 anterior and posterior semi-transverse fractures,2 T-shaped fractures,and 10 double-column fractures.The time from injury to operation was 6.0(5.3,7.8)d.All their acetabular fractures involving the posterior column were treated by a single LRA with the assistance of a Ti-Robot.Operation time,blood loss,complications,quality of fracture reduction,modified Merle d'Aubigné&Postel scores and acetabular recovery at the last follow-up were recorded.Results In this cohort,the operation time was(4.1±0.6)h and the blood loss 400(300,575)mL.By the Matta evaluation,the fracture reduction was excellent in 10 cases,good in 5 cases,and poor in 1 case.The follow-up time was(11.3±3.9)months.Bone union was achieved in all fractures after 3.0(2.3,4.0)months.By the modified Merle d'Aubigné&Postel scores at the last follow-up,9 cases were excellent,6 cases were good and 1 case was fair.Injury to the lateral femoral cutaneous nerve occurred in 1 patient,and deep venous thrombosis in 6 patients.Follow-ups revealed no iatrogenic vascular injury,loosening or rupture of internal fixation,or incision infection.Conclusion A single LRA approach can be used in the minimally invasive treatment assisted by a Ti-Robot for acetabular fractures involving the posterior column,demonstrating advantages of minimal invasion,high reduction quality and good functional recovery of the hip joint.