TiRobot机器人辅助经皮空心螺钉内固定治疗不稳定型骨盆骨折

doi:10.6040/j.issn.1671-7554.0.2017.237

摘要/Abstract

摘要： 目的探讨应用骨科手术机器人辅助经皮空心螺钉内固定治疗骨盆前后环损伤的手术方法及疗效。方法利用第三代骨科手术机器人TiRobot系统于2016年11月至2017年2月对16例不稳定骨盆骨折患者行机器人辅助经皮空心螺钉内固定骨盆前、后环,观察置钉位置,记录手术时间、术中X线透视次数、切口长度、出血量、骨折愈合时间、术后功能等结果。结果平均手术时间65 min,平均透视次数14次。手术切口平均2 cm,平均术中出血量35 mL。所有置入螺钉位置精准满意,无一枚穿出骨皮质。伤口均一期愈合,未出现医源性血管、神经及脏器损伤。术后随访3~6个月,平均4.2个月,无骨折延迟愈合或畸形愈合。末次随访Majeed评分平均为86.7分。结论 TiRobot系统辅助经皮空心螺钉内固定治疗骨盆前后环损伤手术精确、安全,手术时间短,创伤小,对患者及医务人员放射性损害小,临床效果满意,是微创治疗不稳定型骨盆骨折的理想方法。

关键词: 骨折, 机器人, 骨盆, 骨折固定术

Abstract: Objective To explore the clinical efficacy of TiRobot-assisted percutaneous screw fixation in the treatment of unstable pelvic ring fractures. Methods The clinical data of 16 patients with unstable pelvic ring fractures treated with TiRobot-assisted percutaneous screw fixation of posterior and anterior pelvic ring during Nov. 2016 and Feb. 2017 were retrospectively reviewed, including the screw placement, operation time, X-ray number, incision length, blood loss, healing time, and postoperative functions. Results The average operation time was 65 minutes, average X-ray number was 14, average length of incision was 2 cm, and average blood loss was 35 ml. All screws were inserted in the accurate site, and no screw penetrated through bone cortex. All wounds were primary healing. No iatrogenic injury on blood vessels, nerves and organs occurred. During the followed-up of 3-6 months(average 4.2), no delayed union or malunion was observed. The Majeed score in the last follow-up visit averaged 86.7 points. Conclusion TiRobot-assisted percutaneous screw placement is minimally invasive in the treatment of unstable pelvic ring fractures, with advantages of precise and safe operation, short operation time, small trauma, and small radioactive damage.

Key words: Fracture, Robot, Fixation, Pelvis

中图分类号:

R683.3

刘华水,段升军,贾逢爽,刘士懂,陈华,王业本,贾堂宏,赵国辉,朱礼明,刘珉岑. TiRobot机器人辅助经皮空心螺钉内固定治疗不稳定型骨盆骨折[J]. 山东大学学报（医学版）, 2017, 55(7): 103-109.

LIU Huashui, DUAN Shengjun, JIA Fengshuang, LIU Shidong, CHEN Hua, WANG Yeben, JIA Tanghong, ZHAO Guohui, ZHU Liming, LIU Mincen. TiRobot-assisted percutaneous screw fixation in unstable pelvic ring fractures[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(7): 103-109.

参考文献

[1] Ward EF, Tomasin J,Vander Griend RA. Open reduction and internal fixation of vertical shear pelvic fractures[J]. J Trauma, 1987, 27(3): 291-295.
[2] Xu P, Wang H, Liu ZY, et al. An evaluation of three-dimensional image-guided technologies in percutaneous pelvic and acetabular lag screw placement[J]. J Surg Res, 2013, 185(1): 338-346.
[3] Giráldez-Sánchez MA, Lázaro-Gonzálvez Á, Martínez-Reina J, et al. Percutaneous iliosacral fixation in external rotational pelvic fractures. A biomechanical analysis[J]. Injury, 2015, 46(2): 327-332.
[4] Zhang L, Peng Y, Du C, et al. Biomechanical study of four kinds of percutaneous screw fixation in in two types of unilateral sacroiliac joint dislocation: a finite element analysis[J]. Injury, 2014, 45(12): 2055-2059.
[5] Carmack DB, Moed BR, McCarroll K, et al. Accuracy of detecting screw penetration of the acetabulum with intraoperative fluoroscopy andcomputed tomography[J]. J Bone Joint Surg Am, 2001, 83(9): 1370-1375.
[6] Gautier E, Bächler R, Heini PF, et al. Accuracy of computer-guided screw fixation of the sacroiliac joint[J]. Clin Orthop Relat Res, 2001, 393(393): 310-317.
[7] Karthik K, Colegate-Stone T, Dasgupta P, et al. Robotic surgery in trauma and orthopaedics: a systematic review[J]. Bone Joint J, 2015, 97(3): 292-299.
[8] 刘建全, 刘黎军, 黄俊锋, 等. 机器人导航定位系统辅助下经皮空心螺钉内固定治疗股骨颈骨折[J]. 中华创伤骨科杂志, 2015, 17(8): 692-698. LIU Jianquan, LIU Lijun, HUANG Junfeng, et al. Fixation with percutaneous cannulated screws assisted by robot navigation for femoral neck fractures[J]. Chinese Journal of Orthopaedic Trauma, 2015, 17(8): 692-698.
[9] 苏永刚, 王军强, 刘文勇, 等. 双平面骨科机器人系统辅助骶髂关节螺钉置人的实验研究[J]. 中华创伤骨科杂志, 2006, 8(1): 45-49. SU Yonggang, WANG Junqiang, LIU Wenyong, et al. The bi-planar navigation robot system: application for insertion of sacroiliac screws[J]. Chinese Journal of Orthopaedic Trauma, 2006, 8(1): 45-49.
[10] 苏永刚, 张维军, 王豫. 骶髂关节螺钉手术导航机器人系统设计及实验研究[J]. 北京生物医学工程, 2013, 32(4): 331-335. SU Yonggang, ZHANG Weijun, WANG Yu. Design and experimental research of a surgical navigation robotic system for sacro-iliac joint screw surgery[J]. Beijing Biomedical Engineering, 2013, 32(4): 331-335.
[11] Vaidya R, Colen R, Vigdorchik J, et al. Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series[J]. J Orthop Trauma, 2012, 26(1): 1-8.
[12] 祖罡, 毕大卫, 曹奇勇, 等. 髂前下棘椎弓根钉棒内固定技术在骨盆骨折中的应用[J]. 中国骨伤, 2016, 29(4): 369-372. ZU Gang, BI Dawei, CAO Qiyong, et al. Application of supra-acetabular spinal pedicle screws and a subcutaneous connecting rod(INFIX)of anterior inferior iliac spine in the treatment of pelvic fractures[J]. China Journal of Orthopaedics and Traumatology, 2016, 29(4): 369-372.
[13] 曹奇勇, 赵春鹏, 李宇能, 等. 内置外架(INFIX)治疗骨盆前环损伤[J]. 中国医刊, 2016, 51(10): 48-51. CAO Qiyong, ZHAO Chunpeng, LI Yuneng, et al. Internal fixator(INFIX)for treatment of the anterior pelvic ring injuries[J]. Chinese Journal of Medicine, 2016, 51(10): 48-51.
[14] 张彦龙, 吴春生, 宋连新, 等. 骨盆前方皮下内固定架治疗不稳定骨盆骨折[J]. 中华创伤杂志, 2015, 31(9): 828-832. ZHANG Yanlong, WU Chunsheng, SONG Lianxin, et al. Anterior subcutaneous internal fixation of unstable pelvic ring fracture[J]. Chinese Journal of Trauma, 2015, 31(9): 828-832.

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