骨科手术机器人导航下闭合复位交锁髓内钉内固定治疗肱骨外科颈骨折的临床研究

Clinical study on closed reduction and interlocking intramedullary nail fixation for the treatment of humeral surgical neck fractures under the guidance of orthopedic surgical robots

目的 探讨骨科手术机器人导航下闭合复位交锁髓内钉内固定治疗肱骨外科颈骨折的临床效果。方法 选取60例肱骨外科颈骨折患者作为研究对象,根据术式不同分为对照组和观察组,各30例。对照组患者行切开复位锁定钢板内固定术治疗,观察组患者行天玑骨科手术机器人导航下闭合复位交锁髓内钉内固定术治疗。对比两组的手术时间、切口长度、术中出血量、骨折愈合时间、视觉模拟评分法(VAS)评分及Neer肩关节功能评分、术后并发症发生情况。结果 观察组患者手术时间(80.13±22.17)min显著长于对照组的(62.60±16.12)min,切口长度(4.23±1.85)cm显著短于对照组的(10.87±2.71)cm,术中出血量(68.53±25.87)ml显著少于对照组的(143.63±30.37)ml,骨折愈合时间(9.40±1.43)周显著短于对照组的(14.17±2.87)周,差异均有统计学意义(P<0.05)。观察组患者术后1周VAS评分(3.77±1.14)分显著低于对照组的(4.37±1.03)分,术后1个月Neer肩关节功能评分(55.63±4.76)分显著高于对照组的(47.53±4.79)分,差异有统计学意义(P<0.05)。两组患者术后1个月的VAS评分和术后3个月的Neer肩关节功能评分比较,差异无统计学意义(P>0.05)。两组患者末次随访均未见桡神经损伤、伤口感染、肱骨头缺血性坏死、内翻畸形愈合、内固定断裂或螺钉切出等并发症。结论 骨科手术机器人导航下闭合复位交锁髓内钉内固定治疗肱骨外科颈骨折较传统切开复位锁定钢板内固定术增加了手术时间,但切口较小,出血较少,术后患者功能恢复良好,是一种微创、有效且安全的治疗方法。

Objective To investigate the clinical effect of closed reduction and interlocking intramedullary nail fixation in the treatment of humeral surgical neck fractures under the guidance of orthopedic surgical robots.Methods 60 cases of humeral surgical neck fractures were selected as the research subjects.They were divided into a control group and an observation group based on the surgical procedures,with 30 cases in each group.Patients in the control group underwent open reduction and locking plate internal fixation treatment,while patients in the observation group underwent closed reduction and interlocking intramedullary nail internal fixation under the guidance of orthopedic surgical robots.Comparison was made on the surgical time,incision length,intraoperative bleeding volume,fracture healing time,visual analogue scale(VAS)score,and Neer shoulder joint function score,and postoperative complications between the two groups.Results In the observation group,the surgical time of(80.13±22.17)min was significantly longer than(62.60±16.12)min in the control group,the surgical incision length of(4.23±1.85)cm was shorter than(10.87±2.71)cm in the control group,the intraoperative bleeding volume of(68.53±25.87)ml was less than(143.63±30.37)ml in the control group,and the fracture healing time of(9.40±1.43)weeks was significantly shorter than(14.17±2.87)weeks in the control group.The difference was statistically significant(P<0.05).The VAS score of(3.77±1.14)points at 1 week after surgery of the observation group was significantly lower than(4.37±1.03)points of the control group,and the Neer shoulder function score of(55.63±4.76)points at 1 month after surgery was significantly higher than(47.53±4.79)points of the control group.The difference was statistically significant(P<0.05).There was no statistically significant difference in VAS score at 1 month after surgery and the Neer shoulder function score at 3 months after surgery between the two groups(P>0.05).No complications such as radial nerve injury,wound infection,avascular necrosis of the head of the humerus,varus deformity union,internal fixation rupture or screw removal were observed in the two groups at the last follow-up.Conclusion Closed reduction and interlocking intramedullary nail fixation under the guidance of orthopedic surgical robots for the treatment of humeral surgical neck fractures increases the surgical time compared with traditional open reduction and locking plate internal fixation treatment,but with smaller incisions,less bleeding,and good postoperative functional recovery of the patient,which is a minimally invasive,effective,and safe treatment method.