骨科手术机器人辅助下微创治疗可间接复位的SchatzkerⅡ、Ⅲ型胫骨平台骨折的疗效分析

Minimally invasive robot-assisted treatment of tibial plateau fractures of Schatzker types Ⅱ and Ⅲ that can be indirectly reduced

目的探讨骨科手术机器人辅助下微创内固定治疗可间接复位的SchatzkerⅡ、Ⅲ型胫骨平台骨折的疗效。方法回顾性分析2019年12月至2021年12月武汉市第四医院骨科收治的18例SchatzkerⅡ、Ⅲ型胫骨平台骨折患者资料。男12例,女6例;年龄(45.2±9.6)岁。均为闭合性骨折,其中6例合并前交叉韧带止点撕脱骨折,1例合并内侧副韧带撕裂,8例合并外侧半月板撕裂。均采用骨科手术机器人辅助下间接复位后"栅栏"螺钉技术微创内固定治疗,合并前交叉韧带止点撕脱骨折和半月板撕裂的患者均一期行关节镜手术治疗,合并内侧副韧带撕裂的患者一期行切开修复。按Rasmussen放射学评分标准评价骨折复位情况,采用美国特种外科医院(HSS)评分评价膝关节功能。结果18例患者术后均获完整随访,时间(10.6±1.9)个月。术后即刻X线片均示骨折复位良好;骨折愈合时间为(11.3±1.2)周。术后6个月膝关节Rasmussen评分为(16.8±1.0)分,其中优5例,良13例。HSS评分为(93.2±3.0)分,其中优17例,良1例。末次随访时无一例患者发生腓总神经损伤、腘血管损伤、术后感染、内固定失效等严重并发症。结论骨科手术机器人辅助下微创内固定治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折效果良好,可以推广应用。

ObjectiveTo explore the advantages of minimally invasive internal fixation assisted by an orthopedic robot in the treatment of tibial plateau fractures of Schatzker types Ⅱ and Ⅲ that can be indirectly reduced.MethodsA retrospective study was conducted of the 18 patients who had been treated for tibial plateau fractures of Schatzker types Ⅱ and Ⅲ at Department of Orthopaedics,The Fourth Hospital of Wuhan from December 2019 to December 2021.They were 12 males and 6 females with an age of(45.2±9.6)years.All fractures were closed.Of them,6 were complicated with an avulsion fracture at the insertion point of the anterior cruciate ligament,1 with tear of the medial collateral ligament,and 8 with tear of the lateral meniscus.All patients were treated with minimally invasive internal fixation using the"fence"screw technique after indirect reduction assisted by an orthopedic surgical robot.Those combined with avulsion fracture of the anterior cruciate ligament and meniscus tear underwent one-stage arthroscopic surgery,while those combined with tear of the medial collateral ligament underwent one-stage open repair.The fracture reduction was evaluated according to the Rasmussen radiological scoring system,and the knee joint function evaluated using the American Hospital for Special Surgery(HSS)scoring system.ResultsAll the 18 patients were fully followed up for(10.6±1.9)months.The X-ray films immediately after surgery showed good fracture reduction.The fractures healed after(11.3±1.2)weeks.At 6 months after surgery,the Rasmussen knee score was(16.8±1.0)points,giving 5 excellent and 13 good cases;the HSS score was(93.2±3.0)points,giving 17 excellent and 1 good cases.By the last follow-up,no serious complications occurred,such as common peroneal nerve injury,popliteal vascular injury,postoperative infection,or internal fixation failure.ConclusionSince minimally invasive internal fixation assisted by an orthopedic robot can lead to fine clinical efficacy for tibial plateau fractures of Schatzker types Ⅱ and Ⅲ,this technique can be widely applied in clinical practice.