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.

参考文献

[1] Leung KS, Tang N, Cheung LW, et al. Image-guided navigation in orthopaedic trauma [J]. J Bone Joint Surg Br, 2010, 2(10): 1332-1337.
[2] Zheng G, Nolte LP. Computer-assisted orthopedic surgery: current state and future perspective [J]. Front Surg, 2015, 23(2): 66.
[3] 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.
[4] 王满宜, 王军强. 计算机辅助导航骨科手术及医用机器人技术在创伤骨科的应用[J]. 中华创伤骨科杂志, 2005, 7(11): 1004-1009. WANG Manyi, WANG Junqiang. Medical robots and computer assisted navigation used in surgery of orthopaedic trauma [J]. Chinese Journal of Orthopaedic Trauma, 2005, 7(11): 1004-1009.
[5] 刘华水, 段升军, 贾逢爽, 等. 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, et al. TiRobot-assisted percutaneous screw fixation in unstable pelvic ring fractures [J]. Journal of Shandong University(Health Science), 2017, 55(7): 103-109.
[6] 蒋侃凌, 田维, 贾健. TiRobot手术机器人辅助经皮骶髂螺钉固定治疗骨盆后环不稳定损伤[J]. 天津医科大学学报, 2017, 23(3): 247-251. JIANG Kanling, TIAN Wei, JIA Jian. TiRobot surgical robotic navigation and location system assisted percutaneous iliosacral screws for treatment of unstable pelvic posterior ring injuries[J]. Journal of Tianjin Medical University, 2017, 23(3): 247-251.
[7] 赵春鹏, 王军强, 苏永刚, 等. 机器人辅助经皮螺钉内固定治疗骨盆和髋臼骨折[J]. 北京大学学报(医学版), 2017, 49(2): 274-280. ZHAO Chunpeng, WANG Junqiang, SU Yonggang, et al. Clinical research on robot-assisted percutaneous pelvic and acetabular screws surgery[J]. Journal of Peking University(Health Sciences), 2017, 49(2): 274-280.
[8] Liu HS, Duan SJ, Liu SD, et al. Robot-assisted percutaneous screw placement combined with pelvic internal fixator for minimally invasive treatment of unstable pelvic ring fractures[J]. Int J Med Robot, 2018,14(5):1927.
[9] Zwingmann J, Konrad G, Kotter E, et al. Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure [J]. Clin Orthop Relat Res, 2009, 467(7): 1833-1838.
[10] Wong JM, Bewsher S, Yew J, et al. Fluoroscopically assisted computer navigation enables accurate percutaneous screw placement for pelvic and acetabular fracture fixation[J]. Injury, 2015, 46(6): 1064-1068.
[11] 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.
[12] 张巍, 张立海, 陶笙, 等. 微创治疗骨盆前后环骨折的疗效与并发症分析[J]. 中华创伤杂志, 2014, 30(7): 647-651. ZHANG Wei, ZHANG Lihai, TAO Sheng, et al. Clinical effect and complication of minimally invasive surgery in treatment of anterior and posterior pelvic ring injury [J]. Chinese Journal of Orthopaedic Trauma, 2014, 30(7): 647-651.
[13] 任明光, 罗从风, 陈健, 等. C型臂机透视与导航下经皮空心螺钉内固定治疗骨盆骨折的比较研究[J]. 中华创伤骨科杂志, 2007, 9(10): 923-927. REN Mingguang, LUO Congfeng, CHEN Jian, et al. Comparison between the C-arm fluoroscopy and computer navigation in minimally invasive fixation with cannulated screws for pelvic fractures[J]. Chinese Journal of Orthopaedic Trauma, 2007, 9(10): 923-927.
[14] 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, 6(2): 327-332.
[15] 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.
[16] 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.
[17] 刘华水, 段升军, 贾逢爽, 等. TiRobot机器人辅助经皮空心螺钉联合INFIX治疗不稳定型骨盆骨折一例[J]. 中华骨科杂志, 2017, 37(16): 1054-1056. LIU Huashui, DUAN Shengjun, JIA Fengshuang, et al. Robot-assisted transcutaneous screw combined with INFIX for unstable pelvic fracture: a case report [J]. Chinese Journal of Orthopaedics, 2017, 37(16): 1054-1056.
[18] Carmack DB, Moed BR, McCarroll K, et al. Accuracy of detecting screw penetration of the acetabulum with intraoperative fluoroscopy and computed tomography[J]. J Bone Joint Surg Am, 2001, 83(9): 1370-1375.

相关文章 15

[1]	机器人辅助经椎间孔腰椎椎体间融合术手术技术专家组. 机器人辅助经椎间孔腰椎椎体间融合术专家共识[J]. 山东大学学报 (医学版), 2026, 64(2): 11-21.
[2]	胡冰涛,张文灿,王崇怡,林翔宇,王凯斌,冯运泽,刘郴,徐万龙,李乐,司海朋. 基于加速康复外科理念的单孔分体内镜微创技术治疗腰椎管狭窄症的临床效果分析[J]. 山东大学学报 (医学版), 2025, 63(3): 1-7.
[3]	山东省腔镜外科质量控制中心胸腔镜委员会. 山东省VATS/RATS非小细胞肺癌围术期质量控制指标专家共识(2025版)[J]. 山东大学学报 (医学版), 2025, 63(12): 1-5.
[4]	梁博文,陆清声. 机器人辅助主动脉腔内修复术的进展[J]. 山东大学学报 (医学版), 2024, 62(9): 61-65.
[5]	吕龙飞,李继如,翟允鹏,赵华善,郭锐,许洪修,黄赛,张士松. 单术者双孔法在电视辅助胸腔镜手术治疗儿童叶外型肺隔离症中的早期临床应用[J]. 山东大学学报 (医学版), 2024, 62(1): 57-62.
[6]	杜付鑫,张体冲,李倩倩,宋锐. 脊柱手术机器人研究进展[J]. 山东大学学报 (医学版), 2023, 61(3): 46-56.
[7]	刘亚军,袁强,吴静晔,韩晓光,郎昭,张勇. 130例锥形束CT影像腰椎椎弓根螺钉自动规划的初步分析[J]. 山东大学学报 (医学版), 2023, 61(3): 80-89.
[8]	王政,孙小刚,李超,王连雷,李冬来,原所茂,田永昊,刘新宇. 机器人辅助MIS-TLIF与徒手开放TLIF治疗腰椎退行性疾病的比较:2年随访[J]. 山东大学学报 (医学版), 2023, 61(3): 97-106.
[9]	李超,孙小刚,李昊,田永昊,原所茂,刘新宇,王连雷. 机器人联合三维“C”型臂辅助置钉在44例脊柱侧弯矫形术中的应用价值[J]. 山东大学学报 (医学版), 2023, 61(3): 107-114.
[10]	郭永园,孙厚义,张元凯,颜廷宾,刘培来,贾玉华. 鸿鹄机器人辅助全膝关节置换的早期学习曲线[J]. 山东大学学报 (医学版), 2023, 61(3): 115-120.
[11]	李希,王秉翔,李娜,曹丽娜,李爱华,冠潇,张志勉. 下肢外骨骼机器人康复训练对脑卒中偏瘫患者下肢运动的影响[J]. 山东大学学报 (医学版), 2023, 61(3): 121-126.
[12]	刘亚军,郎昭,郭安忆,刘文勇. 骨科冲击波治疗的智能化发展现状及趋势分析[J]. 山东大学学报 (医学版), 2023, 61(3): 7-13.
[13]	刘新宇,李冬来,赵文龙,王政,李超,王连雷,原所茂,田永昊. 机器人/导航辅助下椎弓根螺钉植入在脊柱畸形矫正中的应用[J]. 山东大学学报 (医学版), 2023, 61(3): 21-28.
[14]	乔桦,李慧武. 膝关节置换手术机器人应用现状与研究进展[J]. 山东大学学报 (医学版), 2023, 61(3): 29-36.
[15]	张英晨,赵帅,孙浩,毕文浩,吴志强,成小建,蒋立城. 局麻下非同步CT辅助联合超声定位微创经皮肾镜取石术治疗上尿路结石的效果[J]. 山东大学学报 (医学版), 2023, 61(10): 46-50.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed