镜下复位固定距骨颈骨折是否使用机器人的比较

Arthroscopic reduction and fixation of talus neck fractures with or without robotic assistance

[目的]探讨骨科机器人联合踝关节镜治疗HawkinsⅡ型距骨颈骨折的临床疗效。[方法]对2019年2月—2023年2月的65例HawkinsⅡ型距骨颈骨折患者采用关节镜手术治疗,依据术前医患沟通结果,33例采骨科机器人引导空心钉固定(机器人组),另外32例采用常规方法置钉固定(常规组)。比较两组围术期资料、随访结果。[结果]两组手术出血量、踝关节镜操作时间、住院时间、切口愈合质量、并发症发生率差异无统计学意义(P>0.05),机器人组置钉固定时间[(29.9±5.3)min vs(37.6±6.7)min,P<0.001]、术中透视次数[(4.6±1.2)次vs(9.7±1.7)次,P<0.001]和一次置钉成功率(94.0%vs 56.3%,P<0.001)均显著优于常规组。两组恢复完全负重活动时间的差异无统计学意义(P>0.05)。随着时间推移,两组的VAS评分均显著降低(P<0.05),而足内翻-外翻ROM、踝背伸-跖屈ROM、AOFAS评分均显著升高(P<0.05),但术后3个月、末次随访两组差异无统计学意义(P>0.05)。影像方面,两组骨折复位质量、术后Takakura退变评级、影像不良表现差异均无统计学意义(P>0.05)。[结论]骨科机器人联合踝关节镜治疗HawkinsⅡ型距骨颈骨折能够缩短置钉固定时间,减少透视次数,提高一次置钉成功率。

[Objective]To compare the clinical outcomes of arthroscopic reduction and internal fixation of Hawkins II type talus neckfractures with or without robotic assistance.[Methods]From February 2019 to February 2023,65 patients with Hawkins II type talus neckfractures were treated by arthroscopic reduction and internal fixation.According to preoperative doctor-patient communication,33 patientshad fractures fixed by cannulated screws under robotic assistance(robot group),and the other 32 patients were with conventional methods(the conventional group).The perioperative,follow-up and imaging data were compared between the two groups.[Results]Although therewas no significant difference in surgical blood loss,ankle arthroscopic operation time,hospital stay,incision healing quality and complica-tion rate between the two groups(P>0.05),the robot group proved significantly superior to the conventional group in terms of screw place-ment time[(29.9±5.3)min vs(37.6±6.7)min,P<0.001],intraoperative fluoroscopy times[(4.6±1.2)times vs(9.7±1.7)times,P<0.001],andsuccess rate of first screw placement(94.0%vs 56.3%,P<0.001).There was no significant difference to regain full weight-bearing activitiesbetween the two groups(P>0.05).As time went on,the VAS scores significantly decreased(P<0.05),while foot varus-valgus range of mo-tion(ROM),ankle-dorsal-plantar flexion ROM and AOFAS scores significantly increased in both groups(P<0.05),whereas which were notstatistically significant between the two groups at 3 months postoperatively and the last follow-up(P>0.05).Regarding imaging,there wereno significant differences in fracture reduction quality,postoperative Takakura degeneration scale and adverse signs between the two groups(P>0.05).[Conclusion]Robot-assisted arthroscopic reduction and internal fixation of Hawkins II type talus neck fractures does shorten thefixation time,reduce the number of fluoroscopy,and improve the success rate of one time screw placement.