智能骨盆骨折复位机器人联合天玑机器人治疗不稳定型骨盆骨折的临床疗效

Clinical efficacy of intelligent pelvic fracture reduction robot combined with TiRobot in treating unstable pelvic fractures

目的探讨智能骨盆骨折复位机器人(Rossum Robot)联合天玑骨科手术机器人(TiRobot)治疗不稳定型骨盆骨折的早期疗效,并分析其临床优势与局限性。方法回顾性分析2022年5月至2023年11月于佛山市中医院创伤骨科利用Rossum Robot联合TiRobot治疗的19例不稳定型骨盆骨折患者的病历资料。骨盆骨折Tile分型:B型5例、C型14例。从受伤到手术的中位时间为12(10,14)(6~34)d。在Rossum Robot和TiRobot的联合介入下完成骨盆骨折微创闭合复位内固定术。手术前后均进行骨盆电子计算机断层扫描(computed tomography,CT)并拍摄前后位、出口位、入口位X线片,根据X线及CT影像测量骨盆复位后的最大残余位移,采用Matta标准评估骨折复位质量。记录透视频率、透视时间、手术时间、术中出血量、术中导针调整次数、置入螺钉的数量及质量、复位后的最大残余位移。根据术后CT三维重建图像对螺钉位置进行分级。记录术后随访时间、骨折愈合时间及术后并发症发生率,并利用Majeed评分系统进行功能评价。结果在Rossum Robot和TiRobot的联合介入下,19例患者都成功完成了骨盆骨折微创闭合复位内固定术。中位透视次数为28(18,55)(10~120)次,透视时间为25.2(16.2,33.0)(6.0~72.6)s,手术时间为206(203,212)(125~231)min,术中失血量为100(100,200)(50~400)mL,术中19例患者的导针调整次数一共为4次,平均每例患者调整0.21次。共置入67枚螺钉,螺钉置入位置的质量为优65枚,良0枚,差2枚。螺钉位置优良率为97.01%。复位后的最大残余位移为(6.59±3.68)(1.21~13.00)mm。根据Matta标准,骨盆的复位质量:优7例、良9例、可3例,优良率为84.21%。18例患者获得17.00(12.75,20.00)(6.00~21.00)个月随访,骨折愈合时间为3.55(3.35,4.18)(2.80~6.40)个月,随访期间并发症发生率为0%,末次随访时Majeed功能评分为(86.00±6.65)(74.00~98.00)分,其中优8例,良10例,优良率为100%。结论Rossum Robot联合TiRobot可以为大多数不稳定型骨盆骨折患者完成智能、安全、精准、微创、均质的闭合复位内固定,可以获得良好的早期疗效。

Objective To discuss the early efficacy of Rossum Robot combined with TiRobot in the treatment of unstable pelvic fractures,thereby analyzing its clinical advantages and limitations.Methods A retrospective evaluation of 19 patients with unstable pelvic fractures treated with Rossum Robot combined with TiRobot at the Department of Orthopedic Trauma,Foshan Hospital of Traditional Chinese Medicine between May 2022 and November 2023 was conducted.The cohort included 10 males and 9 females according to the Tile classification,there were 14 type C and 5 type B fractures.The median interval from injury to surgery was 12(6-34)d.Minimally invasive closed reduction and internal fixation of pelvic fracture was completed with the joint intervention of the Rossum Robot and TiRobot.Pelvic computed tomography(CT)scans and anteroposterior,outlet,and inlet X-rays were taken before and after surgery.The maximum residual displacement of pelvic rings after reduction were measured according to X-ray and CT images,and the quality of fracture reduction was evaluated by Matta criteria.The fluoroscopy frequency,fluoroscopy time,surgery time,intraoperative blood loss,number of intraoperative guide pin adjustments,quantity and quality of inserted screws,and maximum residual displacement of pelvic rings after reduction were documented.The screw positions were graded according to the postoperative three-dimensional CT reconstruction images.The postoperative monitoring period,fracture healing time and postoperative complications incidence were recorded,and the Majeed scoring system was used for functional evaluation.Results With the joint intervention of the Rossum Robot and TiRobot,all 19 patients successfully completed minimally invasive closed reduction and internal fixation of pelvic fractures.The median intraoperative fluoroscopy frequency was 28(10-120)times.The median fluoroscopy time was 25.2(6.0-72.6)s.The median surgery time was 206(125-231)min.The median intraoperative blood loss was 100(50-400)mL.During the surgery,the guide pin adjustment was performed a total of 4 times among 19 patients,with an average of 0.21 adjustments per patient.A total of 67 screws were inserted,with 65 screws being of excellent quality,0 screws good quality,and 2 screws poor quality.The overall excellent and good rate for the screws placement quality was 97.01%.The maximum residual displacement after reduction of pelvic ring was(6.59±3.68)(1.21-13.00)mm.According to Matta criteria,the reduction quality of the pelvic ring was excellent in 7 cases,good in 9 cases,and fair in 3 cases,with a good-to-excellent rate of 84.21%.Follow-up for the 18 cases lasted for 17 months(6-21)months,with the Majeed functional score averaging(86.00±6.65)(74.00-98.00)points and a good-to-excellent rate of 100%,with 8 cases scored excellent,and 10 good.Conclusions In our study,the Rossum Robot combined with TiRobot can complete intelligent,safe,accurate,minimally invasive,and homogeneous closed reduction and internal fixation for most patients with unstable pelvic fractures,and it can achieve good early efficacy.