HoloSight创伤骨科手术机器人辅助二窗螺钉植入治疗髋臼骨折的临床研究

A clinical study of HoloSight Orthopaedic Trauma Surgery Robot-assisted infraacetabular screw placement for acetabular fractures

目的探讨使用HoloSight创伤骨科手术机器人辅助二窗螺钉植入治疗髋臼骨折的疗效。方法回顾分析2022年6月—2023年10月于两个医学中心行切开复位内固定并植入二窗螺钉治疗的23例髋臼骨折患者临床资料。根据二窗螺钉植入方式不同分为导航组(10例,采用HoloSight创伤骨科手术机器人辅助植钉)和徒手组(13例,采用传统X线透视引导植钉)。两组患者性别、年龄、身体质量指数、致伤原因、受伤至手术时间及Judet-Letournel分型等基线资料比较差异均无统计学意义(P>0.05)。比较两组患者二窗螺钉植钉时间、透视次数、导针调整次数、螺钉植入质量、骨折复位质量及髋关节功能。结果所有患者均顺利完成手术。导航组植钉时间、透视次数和导针调整次数明显少于徒手组(P<0.05)。导航组螺钉植入质量明显优于徒手组,差异有统计学意义(P<0.05)。两组患者均获随访,随访时间6~11个月,平均7.7个月。导航组和徒手组术后1周骨折复位质量达优良者分别为9、9例,末次随访时髋关节功能达优良者分别为12、12例,组间比较差异均无统计学意义(P>0.05)。两组患者骨折均愈合良好,愈合时间比较差异无统计学意义(P>0.05)。两组随访期间均未发生内固定失效、血管神经损伤、切口疝等植钉相关并发症。结论髋臼骨折治疗中,与传统徒手植钉比较,HoloSight创伤骨科手术机器人辅助植入二窗螺钉能减少植钉时间、提高植钉准确性、减少辐射量,是一种高效、准确及安全的手术方式。

Objective To investigate the effectiveness of HoloSight Orthopaedic Trauma Surgery Robot-assisted infra-acetabular screw placement for treatment of acetabular fractures.Methods The clinical data of 23 patients with acetabular fractures treated with open reduction and internal fixation and infra-acetabular screw placement in two medical centers between June 2022 and October 2023 were retrospectively analyzed.According to the the method of infraacetabular screw placement,the patients were divided into navigation group(10 cases,using HoloSight Orthopaedic Trauma Surgery Robot-assisted screw placement)and freehand group(13 cases,using traditional X-ray fluoroscopy to guide screw placement).There was no significant difference in gender,age,body mass index,cause of injury,time from injury to operation,and Judet-Letournel classification between the two groups(P>0.05).The time of infra-acetabular screw placement,the fluoroscopy frequency,the guide pin adjustment times,the quality of screw placement,the quality of fracture reduction,and the function of hip joint were compared between the two groups.Results All patients completed the operation successfully.The time of screw placement,the fluoroscopy frequency,and guide pin adjustment times in the navigation group were significantly less than those in the freehand group(P<0.05).The quality of screw placement in the navigation group was significantly better than that in the freehand group(P<0.05).Patients in both groups were followed up 6-11 months,with an average of 7.7 months.There were 9 and 9 cases in the navigation group and the freehand group who achieved excellent and good fracture reduction quality at 1 week after operation,and 12 and 12 cases with excellent and good hip joint function at last follow-up,respectively,and there was no significant difference between the two groups(P>0.05).The fractures in both groups healed well,and there was no significant difference in healing time(P>0.05).During the follow-up,there was no complication related to screw placement,such as failure of internal fixation,vascular and nerve injury,incisional hernia.Conclusion In the treatment of acetabular fractures,compared with the traditional freehand screw placement,the HoloSight Orthopaedic Trauma Surgery Robot-assisted screw placement can reduce the time of screw placement,improve the accuracy of screw placement,and reduce the amount of radiation,which is an efficient,accurate,and safe surgical method.