目的 探讨自主设计的复位机器人系统在股骨转子间骨折中的应用效果。 方法 回顾性分析2022年6月至2023年2月天津医科大学附属第四中心医院骨科收治的57例股骨转子间骨折患者资料。根据骨折复位方式分为机器人组（采用自主设计的复位机器人系统辅助复位髓内钉固定）和牵引床组（采用牵引床辅助复位髓内钉固定）。机器人组31例，男11例，女20例；年龄（78.7±9.3）岁；左侧16例，右侧15例；骨折AO/OTA分型：31-A1型17例，31-A2型12例，31-A3型2例。牵引床组26例，男12例，女14例；年龄（78.7±7.7）岁；左侧13例，右侧13例；骨折AO/OTA分型：31-A1型16例，31-A2型9例，31-A3型1例。比较两组患者的复位时间、手术时间、术中出血量、透视次数、复位质量及术前、术后1周、术后6个月疼痛视觉模拟评分（VAS）和髋关节Harris评分等。 结果 两组患者术前一般资料比较差异均无统计学意义（P>0.05），具有可比性。机器人组患者复位时间（4.4±2.2）min、手术时间（29.0±13.5）min、术中出血量（76.5±30.5）mL、透视次数（10.2±2.6）次、复位效果良好率80.6%（25/31）均优于牵引床组[（9.4±3.2）min、（49.3±13.3）min、（115.0±38.4）mL、（14.8±3.2）次、50.0%（13/26）]，两组间比较差异均有统计学意义（P<0.05）。所有患者术后获（6.8±0.3）个月随访。术前、术后6个月机器人组患者疼痛VAS评分分别为（6.2±1.3）、（2.4±0.8）分，牵引床组分别为（6.3±1.3）、（2.7±0.8）分，两组间比较差异均无统计学意义（P>0.05）；术后1周机器人组和牵引床组疼痛VAS评分分别为（3.3±1.2）、（4.8±1.5）分，两组间比较差异有统计学意义（P<0.001）。术前、术后6个月机器人组患者Harris评分分别为（35.3±3.0）、（88.7±3.4）分，牵引床组分别为（35.6±2.9）、（87.2±3.5）分，两组间比较差异均无统计学意义（P>0.05）；术后1周机器人组和牵引床组患者Harris评分分别为（57.3±3.7）、（46.7±2.8）分，两组间比较差异有统计学意义（P<0.05）。机器人组和牵引床组患者满意率分别为96.8%（30/31）、92.3%（24/26），差异无统计学意义（P>0.05）。 结论 自主设计的复位机器人系统辅助复位股骨转子间骨折能有效缩短复位和手术时间，减少出血量及透视次数，提高了解剖复位率。 Objective To explore the clinical effectiveness of a self-designed robot reduction system for femoral intertrochanteric fractures. Methods A retrospective study was conducted to analyze the 57 patients with intertrochanteric fracture who had been treated at Department of Orthopedics, The Fourth Affiliated Central Hospital of Tianjin Medical University from June 2022 to February 2023. The patients were divided into a robot group (using the self-designed robot reduction system to assist intramedullary nailing) and a traction bed group (using a traction bed to assist intramedullary nailing) based on their fracture reduction method. The robot group: 31 patients, 11 males and 20 females, with an age of (78.7±9.3) years 16 left and 15 right sides 17 cases of type 31-A1, 12 cases of type 31-A2 and 2 cases of type 31-A3 by the AO/OTA classification. The traction bed group: 26 patients, 12 males and 14 females, with an age of (78.7±7.7) years 13 left and 13 right sides 16 cases of type 31-A1, 9 cases of type 31-A2 and 1 cases of type 31-A3 by the AO/OTA classification. The 2 groups were compared in terms of reduction and operation time, intraoperative blood loss, fluoroscopy frequency, reduction quality, and VAS and Harris score at preoperation, 1 week and 6 months postoperation. Results The 2 groups were comparable due to insignificant differences in their preoperative general data (P>0.05). The robot group was significantly better than the traction bed group in reduction time [(4.4±2.2) min versus (9.4±3.2) min], operation time [(29.0±13.5) min versus (49.3±13.3) min], intraoperative blood loss [(76.5±30.5) mL versus (115.0±38.4) mL], fluoroscopy frequency [(10.2±2.6) times versus (14.8±3.2) times], and good/excellent rate of reduction [80.6% (25/31) versus 50.0% (13/26)] (P<0.05). All patients were followed up for (6.8±0.3) months. Respectively, the VAS scores at preoperation and 6 months postoperation was (6.2±1.3) and (2.4±0.8) points for the robot group, and (6.3±1.3) and (2.7±0.8) points for the traction bed group, showing no statistically significant differences between the 2 groups (P>0.05). However, the VAS score was (3.3±1.2) points for the robotic group and (4.8±1.5) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups (P<0.001). Respectively, the Harris scores at preoperation and 6 months postoperation were (35.3±3.0) and (88.7±3.4) points for the robot group, and (35.6±2.9) and (87.2±3.5) points for the traction bed group, showing no statistically significant differences between the 2 groups (P>0.05). However, the Harris score was (57.3±3.7) points for the robotic group and (46.7±2.8) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups (P<0.05). The patient satisfaction rates in the robot and traction bed groups were 96.8% (30/31) and 92.3% (24/26), respectively, showing no statistically significant difference (P>0.05). Conclusion Our self-designed robot reduction for femoral intertrochanteric fractures can effectively shorten reduction and operation time, reduce bleeding and fluoroscopy frequency, and enhance anatomical reduction.
Abstract
Objective To explore the clinical effectiveness of a self-designed robot reduction system for femoral intertrochanteric fractures. Methods A retrospective study was conducted to analyze the 57 patients with intertrochanteric fracture who had been treated at Department of Orthopedics, The Fourth Affiliated Central Hospital of Tianjin Medical University from June 2022 to February 2023. The patients were divided into a robot group (using the self-designed robot reduction system to assist intramedullary nailing) and a traction bed group (using a traction bed to assist intramedullary nailing) based on their fracture reduction method. The robot group: 31 patients, 11 males and 20 females, with an age of (78.7±9.3) years 16 left and 15 right sides 17 cases of type 31-A1, 12 cases of type 31-A2 and 2 cases of type 31-A3 by the AO/OTA classification. The traction bed group: 26 patients, 12 males and 14 females, with an age of (78.7±7.7) years 13 left and 13 right sides 16 cases of type 31-A1, 9 cases of type 31-A2 and 1 cases of type 31-A3 by the AO/OTA classification. The 2 groups were compared in terms of reduction and operation time, intraoperative blood loss, fluoroscopy frequency, reduction quality, and VAS and Harris score at preoperation, 1 week and 6 months postoperation. Results The 2 groups were comparable due to insignificant differences in their preoperative general data (P>0.05). The robot group was significantly better than the traction bed group in reduction time [(4.4±2.2) min versus (9.4±3.2) min], operation time [(29.0±13.5) min versus (49.3±13.3) min], intraoperative blood loss [(76.5±30.5) mL versus (115.0±38.4) mL], fluoroscopy frequency [(10.2±2.6) times versus (14.8±3.2) times], and good/excellent rate of reduction [80.6% (25/31) versus 50.0% (13/26)] (P<0.05). All patients were followed up for (6.8±0.3) months. Respectively, the VAS scores at preoperation and 6 months postoperation was (6.2±1.3) and (2.4±0.8) points for the robot group, and (6.3±1.3) and (2.7±0.8) points for the traction bed group, showing no statistically significant differences between the 2 groups (P>0.05). However, the VAS score was (3.3±1.2) points for the robotic group and (4.8±1.5) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups (P<0.001). Respectively, the Harris scores at preoperation and 6 months postoperation were (35.3±3.0) and (88.7±3.4) points for the robot group, and (35.6±2.9) and (87.2±3.5) points for the traction bed group, showing no statistically significant differences between the 2 groups (P>0.05). However, the Harris score was (57.3±3.7) points for the robotic group and (46.7±2.8) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups (P<0.05). The patient satisfaction rates in the robot and traction bed groups were 96.8% (30/31) and 92.3% (24/26), respectively, showing no statistically significant difference (P>0.05). Conclusion Our self-designed robot reduction for femoral intertrochanteric fractures can effectively shorten reduction and operation time, reduce bleeding and fluoroscopy frequency, and enhance anatomical reduction.
关键词
髋骨折/机器人/骨折固定术,髓内/复位/骨折微环境
Key words
Hip fractures/Robotics/Fracture fixation, intramedullary/Reduction/Fracture microenvironment
万方数据