骨科机器人辅助下闭合复位空心钉内固定治疗股骨颈骨折

Orthopaedic robot assisted closed reduction and cannulated screw internal fixation for the treatment of femoral neck fractures

目的:探讨机器人导航定位系统辅助下闭合复位空心钉内固定治疗股骨颈骨折的临床初步疗效。方法:回顾分析2019年7月至2020年1月36例闭合性股骨颈骨折患者,根据是否采用机器人系统辅助股骨颈骨折内固定手术分为两组。采用机器人系统导航下闭合复位内固定治疗股骨颈骨折16例(导航组),男7例,女9例,年龄25~72(53.61±5.45)岁;骨折Garden分型,Ⅰ型3例,Ⅱ型3例,Ⅲ型8例,Ⅳ型2例。非导航组(对照组):采用闭合复位空心钉内固定治疗股骨颈骨折20例,男8例,女12例,年龄46~70(55.23±4.64)岁;GardenⅠ型2例,Ⅱ型4例,Ⅲ型11例,Ⅳ型3例。对两组患者手术时间、透视次数、导针钻孔次数、螺钉调整次数、术中出血量等指标进行评价。结果:两组术后均获随访,时间12~18(15.6±2.8)个月。两组骨折均愈合,无骨折延迟愈合及骨不连发生。两组愈合时间比较,差异无统计学意义(P=0.782)。末次随访时两组Harris评分比较,差异无统计学意义(P=0.813>0.05)。两组间手术时间比较,差异无统计学意义(P>0.05)。两组透视次数、导针钻孔次数、螺钉调整次数、术中出血量比较,差异均有统计学意义(P<0.05)。结论:机器人导航系统辅助下闭合复位空心钉内固定治疗股骨颈骨折操作微创化,螺钉置入精准化,而且减少医患术中X线照射损害。

Objective To investigate the preliminary clinical effect of closed reduction and cannulated nail internal fixation for femoral neck fracture assisted by robot navigation and positioning system.Methods From July 2019 to January 2020,16 cases of femoral neck fracture(navigation group)were treated with closed reduction and internal fixation guided by robot system,including 7 males and 9 females,aged 25 to 72 years old with an average of(53.61±5.45)years old;Garden classification of fracture:3 cases of typeⅠ,3 cases of typeⅡ,8 cases of typeⅢ,2 cases of typeⅣ.Non navigation group(control group):20 cases of femoral neck fracture were treated with closed reduction and hollow nail internal fixation,8 males and 12 females,aged 46 to 70 years old with an average of(55.23±4.64)years old;Garden typeⅠin 2 cases,typeⅡin 4 cases,typeⅢin 11 cases,typeⅣin 3 cases.The operation time,fluoroscopy times,guide needle drilling times,screw adjustment times,intraoperative bleeding volume and other indicators of two groups were evaluated.Results Both groups were followed up for 12 to 18 months with an average of(15.6±2.8)months.The fractures of both groups were healed without delayed union and nonunion.There was no significant difference in healing time between two groups(P=0.782).There was no significant difference in Harris scores between two groups at the last follow-up(P=0.813).There was no significant difference in operation time between two groups(P>0.05).There were significant differences between two groups in fluoroscopy times,guide needle drilling times,hollow screw replacement times,and intraoperative bleeding volume(P<0.05).Conclusion Closed reduction and hollow screw internal fixation assisted by robot navigation system for femoral neck fracture has the advantages of minimally invasive operation,precise screw placement,and reduction of X-ray radiation damage during operation.