机器人辅助空心钉固定PauwelsⅡ~Ⅲ型股骨颈骨折

Robot-assisted cannulated screw fixation of Pauwels type II-III femoral neck fractures

[目的]比较机器人辅助与传统徒手经皮空心螺钉内固定股骨颈骨折的临床疗效。[方法]回顾性分析2021年4月—2022年4月本科手术治疗Pauwels II~III型股骨颈骨折69例患者的临床资料。根据医患沟通结果,39例采用机器人辅助下置入空心螺钉(机器人组),30例采用徒手经皮置入空心螺钉(徒手组)。比较两组围手术期、随访和影像资料。[结果]机器人组手术时间[(61.9±13.5)min vs(87.0±14.4)min,P<0.001]、切口总长度[(2.2±0.4)cm vs(5.2±0.4)cm,P<0.001]、术中失血量[(29.3±4.8)ml vs(33.0±7.8)ml,P=0.018]、术中透视次数[(6.7±1.2)次vs(9.8±1.1)次,P<0.001]、导针调整次数[(4.5±1.1)次vs(7.9±0.9)次,P<0.001]均显著优于徒手组。机器人组完全负重时间[(104.6±4.3)d vs(108.7±8.1)d,P<0.001]显著早于徒手组。术后随时间推移,两组VAS评分、Harris评分、髋伸-屈ROM、髋内-外旋ROM均显著改善(P<0.05);机器人组Harris评分[术后1个月,(85.3±3.4)vs(82.2±3.3),P<0.001;术后6个月,(87.0±2.6)vs(82.8±4.2),P<0.001]、髋伸-屈ROM[术后1个月,(89.6±7.2)°vs(86.6±5.0)°,P=0.045;术后6个月,(105.2±4.6)°vs(102.8±4.0)°,P=0.030]及术后1个月的髋内-外旋ROM[(58.0±2.7)°vs(54.7±2.5)°,P<0.001]均显著优于徒手组。影像方面,机器人组在Garden对线指数、空心钉离散度、股骨颈短缩方面均显著优于徒手组(P<0.05),但两组颈干角和空心钉平行度、骨折愈合时间、Ficat评级的差异均无统计学意义(P>0.05)。[结论]与徒手经皮置入空心钉内固定相比,采用机器人辅助行空心钉内固定治疗股骨颈骨折具有手术时间短、置钉效果好、离散度大,早期髋关节功能恢复好等优点。

[Objective]To compare the clinical efficacy of robot-assisted versus traditional freehand percutaneous cannulated screwfixation for femoral neck fracture.[Methods]A retrospective analysis was performed on 69 patients who received surgical treatment for Pau-wels type II-III femoral neck fractures in our hospital from April 2021 to April 2022.According to doctor-patient communication,39 pa-tients were treated with robot-assisted fixation(the robot group),while other 30 patients underwent conventional free-hand percutaneouscannulated screw(the free hand group).The perioperative,follow-up and imaging data of the two groups were compared between the twogroups.[Results]The robot group proved significantly superior to the free hand group in terms of operation time[(61.9±13.5)min vs(87.0±14.4)min,P<0.001],the total length of incision[(2.2±0.4)cm vs(5.2±0.4)cm,P<0.001],intraoperative blood loss[(29.3±4.8)ml vs(33.0±7.8)ml,P=0.018],intraoperative fluoroscopy times[(6.7±1.2)times vs(9.8±1.1)times,P<0.001]and guide pin adjustment times[(4.5±1.1)times vs(7.9±0.9)times,P<0.001].In addition,the robot group resumed full weight-loading activity time significantly earlier than the freehand group[(104.6±4.3)days vs(108.7±8.1)days,P<0.001].The VAS score,Harris score,hip extension-flexion ROM,and hip internal-ex-ternal rotation ROM significantly improved in both groups over time(P<0.05).The robot groups was significantly better than the free handgroup in terms of Harris score[(85.3±3.4)vs(82.2±3.3),P<0.001]a month postoperatively,[(87.0±2.6)vs(82.8±4.2),P<0.001]6 monthspostoperatively;hip flexion-extension ROM[(89.6±7.2)°vs(86.6±5.0)°,P=0.045]a month postoperatively,[(105.2±4.6)°vs(102.8±4.0)°,P=0.030]6 months postoperatively;and hip internal-external rotation ROM[(58.0±2.7)°vs(54.7±2.5)°,P<0.001]a month postoperatively.Regarding image,the robot group was also significantly better than the free hand group in term of Garden alignment index,cannulatedscrew dispersion and femoral neck shortening(P<0.05),but there were no statistically significant differences in femoral neck-shaft angle and cannulated screw parallelism,fracture healing time and Ficat grade between the two groups(P>0.05).[Conclusion]Compared withhands-free technique,the robot-assisted cannulated screw fixation of femoral neck fracture has the advantages of shorter operation time,better screw placement with greater dispersion,and better early hip function recovery.