ERAS在双平面机器人辅助经皮骶髂关节螺钉固定治疗骶骨骨折中的应用

Application of enhanced recovery after surgery in biplanar robot-assisted percutaneous sacroiliac joint screw fixation in the treatment of sacral fractures

目的评价加速康复外科(ERAS)在双平面机器人辅助经皮骶髂关节螺钉固定治疗骶骨骨折中的临床效果。方法选取2018年12月至2020年12月内蒙古医科大学附属医院采用双平面机器人辅助经皮骶髂关节螺钉固定治疗的24例骶骨纵形骨折患者作为研究对象,随机分为ERAS组与常规组(n=12),其中常规组采取常规围手术期管理模式,ERAS组在常规管理基础上实施ERAS精细化围手术期管理方案,对两组患者围手术期指标、影像学结果和疗效指标进行对比分析。结果对两组患者螺钉置入位置进行影像学检查(X线、CT扫描),均达到满意程度;Matta影像评分两组相近(P>0.05)。ERAS组术后2 d疼痛视觉模拟量表评分、术后3 d Braden压疮评分和末次随访Majeed评分均优于常规组,住院时间短于常规组,两组比较,差异具有统计学意义(P<0.05)。结论在机器人辅助经皮骶髂关节螺钉固定围手术期管理中运用ERAS理念,疼痛缓解更加有效、压疮风险更低、住院时间更短,更有利于骶骨骨折患者术后骨盆功能恢复,可在脊柱外科机器人手术中推广和应用。

Objective To evaluate the clinical effect of enhanced recovery after surgery(ERAS)in biplanar robot-assisted percutaneous sacroiliac screw fixation in the treatment of sacral fractures.Methods Twenty-four patients with longitudinal sacral fractures treated with biplanar robot-assisted percutaneous sacroiliac joint screw fixation in the Affiliated Hospital of Inner Mongolia Medical University from December 2018 to December 2020 were selected as the study objects,and were randomly divided into ERAS group and conventional group(n=12),in which conventional perioperative management mode was adopted in the conventional group,and the refined perioperative management plan of ERAS was implemented on the basis of routine management in the ERAS group.Perioperative indexes,imaging results and efficacy indexes of the two groups were compared and analyzed.Results Imaging examination(X-ray,CT scan)of screw placement in both groups achieved satisfactory results.Matta image scores were similar between the two groups(P>0.05).The pain visual analog scale score at 2 d after surgery,Braden pressure ulcer score 3 d postoperatively,and Majeed score at the lastest follow-up in ERAS group were better,and the length of hospital stay was shorter than those in the conventional group,the differences between two groups were statistically significant(P<0.05).Conclusions The application of ERAS concept in the perioperative management of robot-assisted percutaneous sacroiliac joint screw fixation has more effective pain relief,lower risk of pressure ulcers,shorter hospital stay,and is more conducive to the recovery of pelvic function of sacral fracture patients,which can be promoted and applied in robotic spinal surgery.