骨科手术机器人辅助微创治疗骨盆环损伤108例临床分析

doi:10.6040/j.issn.1671-7554.0.2019.252

摘要/Abstract

摘要： 目的探讨骨科手术机器人辅助微创治疗骨盆环损伤手术策略和技巧,以及开展该手术应注意的问题。方法回顾性分析骨科手术机器人辅助微创治疗骨盆环损伤患者108例临床资料,其中男71例,女37例,21~79岁,平均41.6岁;单纯前环损伤6例,前后环联合损伤102例。根据骨折类型、程度、复位效果和骨性通道情况制定手术方案。记录手术并发症及疗效。结果 6例单纯前环损伤患者行机器人辅助经皮耻骨支螺钉固定;7例后环损伤合并耻骨联合分离患者行“杂交手术”;40例后环损伤合并单侧前环损伤患者行机器人辅助经皮空心螺钉骶髂关节、耻骨支固定;55例后环损伤合并双侧前环损伤患者,14例单纯螺钉固定,24例联合INFIX固定,17例“杂交手术”。机器人辅助共置入螺钉344枚,其中326枚一次置钉成功并位置满意。平均手术时间106 min,平均透视29.2次,每枚螺钉平均透视时间6.1 s。18枚导钉置入位置不满意,6枚位于骨性通道内未二次规划置钉,7枚切出,4枚穿透骨皮质经重新规划直到位置满意并完成置钉,1枚穿透耻骨皮质导致“死亡之冠”出血,改为“杂交手术”。术后随访平均4.2个月,固定失败2例。末次随访Majeed评分平均89.4分。结论根据骨盆环损伤类型制定不同的手术策略,掌握一定的手术技巧,机器人辅助手术为骨盆环损伤的微创治疗提供新的方式。

关键词: 骨盆, 骨折固定术,内, 机器人, 外科手术, 微创

Abstract: Objective To explore the surgical strategies, techniques and precautions of robot-assisted minimally invasive surgery for pelvic ring injuries. Methods The clinical data of 108 cases of pelvic ring injuries treated with robot-assisted minimally invasive surgery were reviewed. There were 71 male and 37 female, average age was 41.6 years(range, 21-79 years), including 6 cases of isolated anterior pelvic ring injuries and 102 cases of combined anterior and posterior pelvic ring injuries. The surgical plans were formulated based on the type and degree of injuries, effectiveness of the reduction, and integrity of the osseous channel. The surgical complications and efficacy were recorded. Results Percutaneous cannulated screw fixation of the pubic ramus was performed in 6 patients with isolated anterior pelvic ring injuries. Percutaneous cannulated sacroiliac screw fixation and open screw or plate fixation of the symphysis pubis was performed in 7 patients with posterior pelvic ring injuries combined with symphysis pubis separation. Percutaneous cannulated 山东大学学报 (医学版)57卷11期 -刘华水,等.骨科手术机器人辅助微创治疗骨盆环损伤108例临床分析 \=-sacroiliac screw and pubic ramus screw fixation was performed in 40 patients with posterior pelvic ring injury combined with unilateral anterior pelvic ring injury. For the 55 patients with posterior pelvic ring injury combined with bilateral anterior pelvic ring injury, cannulated screw fixation alone was performed in 14 cases, INFIX fixation in 24 cases, and “hybrid surgery” in 17 cases. A total of 344 screws were inserted with robotic assistance, of which 326 were successfully inserted to a satisfactory position on the first attempt. The average operation time was 106 minutes. Fluoroscopies were performed with an average of 29.2 times, and it took 6.1 s to place one screw. There were 18 unsatisfactory guiding needle placements during the surgeries, 6 of which remained in the bone tunnel and were not re-planned, 7 cut out, 4 penetrated the cortex and were re-planned to satisfactory position, 1 penetrated the pubic cortex, causing hemorrhage of the “crown of death” and was changed to “hybrid surgery”. During the follow-up of 4.2 months, 2 fixation failures were observed, and the average Majeed score was 89.4 points. Conclusion Robot-assisted surgery provides a novel modality for the minimally invasive treatment of pelvic ring injuries when the surgical strategy is properly formulated and surgeons have good techniques.

Key words: Pelvis, Fracture internal fixation, Robotics, Surgery, Minimally invasive surgery

中图分类号:

R683.3

刘华水,段升军,赵国辉,张朕,朱礼明,王学光,贾逢爽,刘士懂,刘珉岑,李明,陈华. 骨科手术机器人辅助微创治疗骨盆环损伤108例临床分析[J]. 山东大学学报 (医学版), 2019, 57(11): 52-59.

LIU Huashui, DUAN Shengjun, ZHAO Guohui, ZHANG Zhen, ZHU Liming, WANG Xueguang, JIA Fengshuang, LIU Shidong, LIU Mincen, LI Ming, CHEN Hua. Robot-assisted minimally invasive treatment of pelvic ring injuries: a clinical analysis of 108 cases[J]. Journal of Shandong University (Health Sciences), 2019, 57(11): 52-59.

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