机器人辅助下联合球囊复位与经皮栅栏螺钉固定治疗AO/OTA41B2型胫骨平台骨折的近期疗效观察

Short-term Efficacy of Robot-assisted Balloon Reduction and Percutaneous Palisade Screw Fixation in the Treatment of AO/OTA41B2 Tibial Plateau Fracture

目的探讨机器人辅助下联合球囊复位与经皮“栅栏”螺钉固定治疗AO/OTA41B2型胫骨平台骨折的近期疗效观察。方法回顾性分析2019年9月至2022年9月期间我院创伤骨科收治的29例AO/OTA41B2型闭合性骨折病人。其中男14例,女15例;年龄为(44.17±9.53)岁(26~62岁),受伤至手术时间为(6.48±4.08)天(2~20天)。手术方式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。拍摄膝关节标准的正侧位片,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(Hospital for Special Surgery,HSS)评分评价膝关节功能。比较手术前后骨折区塌陷体积、胫骨平台外侧角(lateral proximal tibial angle,LPTA)、外侧胫骨平台后倾角(lateral posterior proximal tibial angle,LPPTA),基于CT比较术前规划与术中实际定位位置差异。结果29例病人均获得完整随访,随访时间为(15.10±6.13)个月(10~24个月),骨折愈合时间为(9.52±1.66)周(8~12周)。病人术后6个月膝关节Rasmussen评分为(17.34±1.04)分(14~18分),优18例,良11例;HSS评分为(93.83±2.22)分(89~97分),优29例。术后骨折区塌陷体积为(0.07±0.20)cm^(3)(0~0.77 cm^(3))、LPTA为91.75°±0.62°(90°~92°)、LPPTA为7.45°±1.97°(0°~10°),与术前比较[(3.27±2.14)cm^(3)(0.89~10.16 cm^(3))、84.81°±6.08°(70°~92°)、11.89°±14.16°(-20°~26.8°)],差异有统计学意义(t=8.193,P<0.001;t=-6.172,P<0.001;t=1.854,P=0.037)。术后CT验证实际球囊扩张冠状位与矢状位位置参数:(1.56±0.31)cm(1.11~2.28 cm)、(1.52±0.44)cm(0.94~2.10 cm),与术前规划比较[(1.56±0.32)cm(1.11~2.28 cm)、(1.52±0.44)cm(0.96~2.09cm)],差异无统计学意义(t=-0.256,P=0.400;t=-0.779,P=0.221)。末次随访时,未发生腓总神经损伤、腘血管损伤、术后感染、内固定失效等严重并发症。结论机器人辅助下联合球囊复位与经皮“栅栏”螺钉固定治疗AO/OTA41B2型胫骨平台骨折近期临床疗效满意。

Objective To investigate the short-term efficacy of robot-assisted combined balloon reduction and percutaneous“jail”screw fixation in the treatment of AO/OTA41B2 tibial plateau fracture.Methods A total of 29 patients with AO/OTA41B2 closed fracture admitted to our hospital from September 2019 to September 2022 were retrospectively analyzed.Among them,14 were male and 15 were female with average age of(44.17±9.53)years old(range 26-62 years old).The time from injury to operation was(6.48±4.08)days(range 2-20 days).All the surgical methods were treated by minimally invasive internal fixation with“Jail”technique screw after indirect reduction assisted by TiRobot.Standard anteroposterior and lateral radiographs of the knee were taken,the fracture reduction was evaluated according to the Rasmussen radiological score,and the knee function was evaluated using the Hospital for Special Surgery(HSS)score.The collapse volume of fracture area,lateral proximal tibial angle(LPTA)and lateral posterior proximal tibial angle(LPPTA)were compared before and after operation.CT was used to compare the difference between preoperative planning and actual positioning.Results All the 29 patients were followed up for(15.10±6.13)months(ranging from 10 to 24 months).Fracture healing time was(9.52±1.66)weeks(range 8 to 12 weeks).At 6th month after surgery,the Rasmussen score of the knee joint was(17.34±1.04)points(ranging from 14 to 18 points),of which 18 cases were excellent and 11 cases were good.Preoperative collapse volume of fracture site was(3.27±2.14)cm^(3)(range 0.89-10.16 cm^(3)),LPTA was 84.81°±6.08°(range 70°-92°),and LPPTA was 11.89°±14.16°(range-20°-26.8°),the collapse volume of the fracture area after surgery was(0.07±0.20)cm^(3)(range 0-0.77 cm^(3)),LPTA was 91.75°±0.62°(range 90°-92°),LPPTA was 7.45°±1.97°(range 0°-10°),and the difference was statistically significant(t=8.193,P<0.001;t=-6.172,P<0.001;t=1.854,P=0.037).Preoperative CT layout consisted of(1.56±0.32)cm(ranging from 1.11-2.28 cm),and(1.52±0.44)cm(ranging from 0.96-2.09 cm),while postoperative CT layout proved the actual parameters in coronal and sagittal position parameters[(1.56±0.31)cm(range 1.11-2.28 cm),(1.52±0.44)cm(range 0.94-2.10 cm)].There was no statistically significant difference(t=-0.256,P=0.400;t=-0.779,P=0.221).At the last follow-up,there were no serious complications such as common peroneal nerve injury,popliteal vascular injury,postoperative infection,and failure of internal fixation.Conclusion Robot-assisted balloon reduction combined with percutaneous“jail”screw fixation in the treatment of AO/OTA41B2 tibial plateau fracture has a satisfactory clinical effect.