摘要
目的 探讨机器人辅助螺钉固定治疗不稳定型骨盆环多发骨折的临床疗效.方法 回顾性分析2015年1月至2022年6月山东第一医科大学附属中心医院创伤中心采用骨科机器人辅助螺钉固定治疗不稳定型骨盆骨折患者76例,男43例、女33例,年龄(52.53±13.68)岁(范围16～87岁),高处坠落伤43例、车祸伤22例、挤压伤及重物砸伤11例.55例伤前参加工作,21例伤前不参加工作.骨折Tile分型B型72例、C型骨折4例.机器人辅助下采用内置外架系统(inter-nalfixator,INFIX)、前环通道螺钉、骶髂螺钉、LC-Ⅱ螺钉内固定治疗不稳定型骨盆环骨折.记录术中出血量、透视次数、手术时间、术中规划导针成功率,采用Matta标准评估骨折复位质量,采用Majeed标准评估术后骨盆功能恢复情况.结果 76例患者共150个部位接受手术,其中INFIX内固定术34个、前环通道螺钉48个、骶髂螺钉61个、LC-Ⅱ螺钉7个部位.术中出血量20(10,47.5)ml(5～300 ml).术中透视次数(46.63±17.50)次(范围15～93次),其中INFIX内固定术(16.44± 4.32)次(范围8～31次)、LC-Ⅱ螺钉(21.59±5.80)次(范围12～32次)、前环通道螺钉(29.44±11.65)次(范围12～65次)、骶髂螺钉(23.10±11.87)次(范围8～56次).手术时间 105(86,150)min(30～290min),其中INFIX内固定术40(35,45)min(范围 15～120 min)、LC-Ⅱ 螺钉50(35,55)min(范围20～65 min)、前环通道螺钉70(48,120)min(范围25～240 min)、骶髂螺钉50(35,50)min(范围25～235 min).术中规划导针成功率:INFIX内固定为100％(34/34),前环通道螺钉为58％(28/48),骶髂关节螺钉为93％(57/61),LC-Ⅱ螺钉为100％(7/7).所有患者均获得随访,随访时间(6.46±2.26)个月(范围3～16个月),6个月内骨折均获临床愈合,平均(3.14±0.50)个月.末次随访时Matta评价,优21例、良43例、可12例,优良率84％(64/76),Majeed评分(81.82±9.14)分(范围50～92分),其中伤前参加工作(86.55±4.85)分(范围60～92分),优49例、良5例、可1例;伤前不参加工作(69.43±5.34)分(范围50～73分),优18例、良2例、可1例;总体优良率97％(74/76).INFIX内固定术后8例发生股外侧皮神经损伤,伤后3个月复查时感觉均恢复;1例采用LC-Ⅱ螺钉患者术后发生退钉,于术后6个月骨折愈合后取出;1例采用通道螺钉患者术后发生切口感染,给予清创后感染控制.结论 机器人辅助螺钉固定治疗不稳定型骨盆环多发骨折术中出血量小、透视次数少、规划导针成功率高,骨盆骨折复位质量及术后功能满意.
Abstract
Objective To investigate the clinical efficacy of robot-assisted screw fixation for unstable pelvic ring multifo-cal fractures.Methods A retrospective analysis was performed on 76 patients with unstable pelvic fractures treated with ortho-paedic robot-assisted screw fixation in the Trauma Center of the Affiliated Central Hospital of Shandong First Medical University from January 2015 to June 2022,including 43 males and 33 females,aged 52.53±13.68 years(range,16-87 years).There were 43 cases of falling injuries from high places,22 cases of traffic accidents,11 cases of crushing injuries and heavy objects.Fifty-five patients were employed before the injury,while 21 were not.Fractures were classified according to the Tile classification,with 72 cases classified as type B and 4 cases as type C.Robot-assisted fixation techniques included internal fixator(INFIX),anterior ring screws,sacroiliac screws,and LC-Ⅱ screws.Intraoperative blood loss,fluoroscopy frequency,surgical time,and the success rate of initial guidewire placement were recorded.Fracture reduction quality was evaluated using the Matta criteria,and postoperative pel-vic function recovery was assessed using the Majeed criteria.Results A total of 150 surgical procedures were performed on 76 patients,including 34 cases of INFIX fixation,48 cases of anterior ring screws,61 cases of sacroiliac joint screws,and 7 cases of LC-Ⅱ screws.The mean intraoperative fluoroscopy frequency was 46.63±17.50 times(range,15-93 times).Intraoperative fluoros-copy frequency varied among different fixation techniques,with INFIX group at 16.44±4.32 times,LC-Ⅱ group at 21.59±5.80 times,anterior ring screws group at 29.44±11.65 times,and sacroiliac screws group at 23.10±11.87 times.The intraoperative blood loss was 20(10,47.5)ml(range,5-300 ml),and the surgical time was 105(86,150)min(range,30-290 min).The mean sur-gical time varied among different fixation techniques.All patients were followed up for an average of 6.46±2.26 months(range,3-16 months).Clinical healing was achieved in all patients within 6 months,with an average time of 3.14±0.50 months.At the last follow-up,fracture reduction quality assessed by the Matta score was excellent in 21 cases and good in 43 cases,with an excellent/good rate of 84％(64/76).The Majeed score was 81.82±9.14 points(range,50-92 points).For patients who were employed before the injury,the Majeed score was 86.55±4.85 points(range,60-92 points),with 49 cases rated as excellent,5 cases as good,and 1 case as fair.For patients who were not employed before the injury,the Majeed score was 69.43±5.34 points(range,50-73 points),with 18 cases rated as excellent,2 cases as good,and 1 case as fair.The overall excellent and good rate was 97％(74/76).Among patients who underwent INFIX internal fixation,8 cases experienced lateral femoral cutaneous nerve injury postoperatively,all of which recovered sensation after 3 months;1 case using LC-Ⅱ screws experienced screw loosening postoperatively and was advised to reduce activity,then the screw was removed after fracture healing at 6 months postoperatively;1 case using anterior ring chan-nel screws experienced surgical site infection postoperatively,which was controlled after debridement.Conclusion In the treat-ment of unstable pelvic ring multiple fractures,robot-assisted screw fixation has less blood loss,less fluoroscopy times,high suc-cess rate of planning guide needle,satisfactory reduction quality and postoperative function.
基金项目
济南市卫生健康委员会科技计划(2020-3-25)
NETL
NSTL
万方数据