机器人导航辅助下联合3D-C型臂微创手术治疗手舟骨骨折的临床疗效分析

Clinical Efficacy Analysis of Minimally Invasive Surgery with 3D-C Arm Assisted by Robot Navigation in the Treatment of Scaphoid Fractures

目的研究机器人导航辅助下联合3D-C型臂微创手术治疗手舟骨骨折的安全性和有效性。方法回顾性分析保定市第一中心医院2020年5月至2023年7月收治的11例手舟骨骨折病人,其中男9例,女2例,平均年龄为33.8岁(20~65岁),对病人行机器人导航辅助下联合3D-C型臂双头螺纹空心加压螺钉内固定手术治疗。术后记录病人并发症的发生情况,比较术前、术后第1天、术后第3天炎性指标的变化,采用疼痛视觉模拟量表(visual analogue scale,VAS)评分、Mayo腕关节评分及腕关节活动度评价功能恢复情况。结果机器人导航手术均顺利完成,平均手术时间64.1 min(50~100 min),微创手术出血均少量,平均随访时间5.5个月(3~14个月),所有病人术后均无并发症发生。病人术后X线片及CT扫描显示手舟骨内固定螺钉位置良好,骨折位置良好。病人术后第1天、术后第3天的炎性指标与术前比较,差异均无统计学意义(P>0.05),各时间点两两比较,差异无统计学意义(P>0.05)。病人术后1个月、末次随访时的VAS评分和Mayo腕关节评分与术前比较,差异均有统计学意义(P<0.05),且末次随访时与术后1个月比较,差异有统计学意义(P<0.05)。末次复查X线片及CT扫描见骨折均愈合良好,病人伤侧腕关节平均主动活动度为:屈曲71.2°、背伸67.5°、尺偏42.6°、桡偏21.8°,功能活动良好。结论机器人导航辅助下联合3D-C型臂微创手术治疗手舟骨骨折安全有效,该手术精度高,创伤小,术后反应小,恢复快。

Objective To study the safety and effectiveness of using robot navigation assisted combined with 3D-C arm minimally invasive surgery for the treatment of scaphoid fractures.Methods A retrospective analysis was conducted on 11 patients with scaphoid fractures admitted to Baoding No.1 Central Hospital from May 2020 to July 2023,including 9 males and 2 females with an average age of 33.8 years(20-65 years).The patients were treated with robotic navigation assisted surgery combined with 3D-C arm type double head threaded hollow compression screw internal fixation.The occurrence of complications in patients after surgery was recorded,the changes in inflammatory indicators before surgery,on the first day after surgery,and on the third day after surgery was compared,and functional recovery was evaluated using visual analogue scale(VAS)scores,Mayo wrist joint scores,and wrist joint range of motion.Results The robot guided surgery was successfully completed,with an average operation time of 64.1 min(50-100 min).The minimally invasive surgery had minimal bleeding,and the average follow-up time was 5.5 months(3-14 months).All patients had no postoperative complications.The patient's postoperative X-ray and CT scan showed that the position of the internal fixation screw of the scaphoid bone was good,and the fracture location was good.There was no statistically significant difference(P>0.05)in the inflammatory indicators of patients on the first and third day after surgery compared with preoperative levels,and there was no statistically significant difference(P>0.05)in pairwise comparisons at each time point.The VAS score and Mayo wrist joint score of the patient at one month after surgery and at the last follow-up were significantly different from those before surgery(P<0.05),and there was a significant difference between the last follow-up and one month after surgery(P<0.05).The last follow-up X-ray and CT scan showed that the fractures healed well,and the average active range of motion of the injured wrist joint were:71.2°in flexion,67.5°in dorsiflexion,42.6°in ulnar deviation,21.8°in radial deviation,with good functional activity.Conclusion The combination of robot navigation assisted and 3D-C arm minimally invasive surgery for the treatment of scaphoid fractures is safe and effective,with high precision,minimal trauma,minimal postoperative reactions,and fast recovery.