机器人手术系统辅助内固定手术治疗股骨颈骨折的效果及术后感染相关因素分析

Analysis of the effect of robot-assisted internal fixation in the treatment of femoral neck fractures and the related factors of postoperative infection

目的研究机器人手术系统辅助内固定手术治疗股骨颈骨折的效果并分析术后感染的相关因素。方法选取2019年4月至2022年4月空军军医大学第一附属医院收治的93例股骨颈骨折患者。完全随机分为对照组(46例)和观察组(47例)。对照组行传统徒手定位方式内固定手术,观察组行机器人手术系统辅助内固定手术。比较2组手术相关指标、空心钉与股骨颈轴线夹角、骨折愈合时间、Harris髋关节功能评分及并发症发生情况。根据术后感染情况分为感染组与未感染组,采用Logistic回归模型分析术后感染的影响因素。结果观察组术中透视时间、术中出血量及导针植入次数均短于/少于对照组[(14±5)s比(21±5)s、(8.0±3.5)ml比(10.1±2.4)ml、(4.8±0.8)次比(11.8±2.4)次](均P<0.05)。观察组正位、侧位X线片空心钉与股骨颈轴线夹角均小于对照组,骨折愈合时间短于对照组,Harris髋关节功能评分高于对照组(均P<0.05)。2组并发症发生率差异无统计学意义(P>0.05)。患者术后发生感染34例,未感染59例。感染组年龄≥60岁、术前贫血、围手术期异体输血比例、手术时间、引流管留置时间均大于/长于未感染组(均P<0.05)。Logistic回归分析结果显示,术前贫血、围手术期异体输血、手术时间及引流管留置时间为股骨颈骨折患者术后感染的独立影响因素(均P<0.05)。结论机器人手术系统辅助内固定手术用于股骨颈骨折治疗,能更精准置入空心钉,改善患者预后。围手术期密切关注贫血、异体输血等可减少术后感染。

Objective To study the effect of robot-assisted internal fixation in the treatment of femoral neck fractures and analyze the related factors of postoperative infection.Methods A total of 93 patients with femoral neck fracture admitted to the First Affiliated Hospital of Air Force Military Medical University from April 2019 to April 2022 were selected.They were randomly divided into control group(46 cases)and observation group(47 cases).The control group was treated with traditional freehand positioning method for internal fixation,and the observation group was treated with robot-assisted internal fixation.The operation related indicators,angle between cannulated screw and femoral neck axis,fracture healing time,Harris hip function score and complications were compared between the two groups.According to the postoperative infection,the patients were divided into infection group and non-infection group.Logistic regression model was used to analyze the influencing factors of postoperative infection.Results The intraoperative fluoroscopy time,intraoperative blood loss and the number of guide pin implantation in the observation group were shorter/less than those in the control group[(14±5)s vs(21±5)s,(8.0±3.5)ml vs(10.1±2.4)ml,(4.8±0.8)times vs(11.8±2.4)times](all P<0.05).The angle between the cannulated screw and the femoral neck axis on the positive and lateral positions in the observation group was smaller than that in the control group,the fracture healing time was shorter than that in the control group,and the Harris hip function score was higher than that in the control group(all P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).There were 34 patients with postoperative infection and 59 patients without infection.The age≥60 years,preoperative anemia,perioperative allogeneic blood transfusion rate,operation time and drainage tube indwelling time in the infection group were greater/longer than those in the non-infection group(all P<0.05).Logistic regression analysis results showed that preoperative anemia,perioperative allogeneic blood transfusion,operation time and drainage tube indwelling time were independent influencing factors for postoperative infection in patients with femoral neck fracture(all P<0.05).Conclusion Robot-assisted internal fixation for femoral neck fractures can achieve more accurate cannulated screw placement and improve the prognosis of patients.Close attention to anemia and allogeneic blood transfusion during the perioperative period can reduce postoperative infection.