机器人辅助经皮空心钉固定股骨颈骨折△

Robot- assisted percutaneous cannulated screw fixation of femoral neck fracture

摘要:

［目的］ 评价机器人辅助经皮空心钉固定股骨颈骨折的临床疗效。［方法］ 回顾性分析 2017 年 11 月—2019 年 5 月经皮空心钉固定股骨颈骨折 68 例患者的临床资料。根据术前医患沟通结果，32 例采用机器人辅助置钉，36 例徒手置钉。比较两组围手术期、随访和影像资料。［结果］机器人组手术时间、术中透视次数、导针定位次数、下地行走时间显著优于徒手组 （P<0.05）。随访 （31.4±6.8） 个月，机器人组骨不连 1 例，股骨头坏死 3 例；徒手组骨不连 2 例，股骨头坏死 5 例。机器人组恢复完全负重活动时间显著早于徒手组 （P<0.05）。随时间推移，两组的 Harris 评分、髋伸-屈、内-外旋 ROM 均显著增加 （P<0.05）；术后 1、3 个月机器人组的 Harris 评分、ROMs 均显著优于徒手组 （P<0.05），但末次随访时两组间差异无统计学意义（P>0.05）。影像方面，两组术后 Garden 指数差异无统计学意义（P>0.05）。机器人组空心钉平行度、分散度均显著优于徒手组 （P<0.05）。相应时点两组间在颈干角、Tonnis 髋退变分级的差异均无统计学意义 （P>0.05）。［结论］ 机器人辅助经皮空心钉固定股骨颈骨折可缩短手术时间，提高置钉精度，有利于髋关节功能的早期恢复。

Abstract:

[Objective] To evaluate the clinical efficacy of robot-assisted percutaneous cannulated screw fixation of femoral neck frac- tures. [Methods] A retrospective study was done on 68 patients who received percutaneous cannulated screw fixation of femoral neck frac- tures from November 2017 to May 2019. According to preoperative doctor- patient communication, 32 patients received robot- assisted screw placement, while the remaining 36 patients were treated with freehand screw placement. The documents regarding to perioperative pe- riod, follow-up and radiographs were compared between the two groups. [Results] The robot group proved significantly superior to the free- hand group in terms of operation time, intraoperative fluoroscopy times, guide pin positioning times and postoperative walking time (P＜ 0.05) . During the follow-up lasted for (31.4±6.8) months on a mean, the robot group had 1 case of nonunion and 3 cases of femoral head ne- crosis, whereas the freehand group had 2 cases of nonunion and 5 cases of femoral head necrosis. The robot group resumed full weight bear- ing activity significantly earlier than the freehand group (P＜0.05) . The Harris score, hip extension-flexion and internal-external rotation range of motions (ROMs) significantly increased in both groups over time (P＜0.05) , which in the robot group were significantly better than the freehand group at 1 and 3 months postoperatively (P＜0.05) , whereas became not statistically significant between the two groups at the latest follow-up (P＞0.05) . Radiographically, there was no significant difference in Garden index between the two groups (P＞0.05) , while the robot group was significantly superior to the freehand group in terms of the parallelism and dispersion of cannulated screw placement (P＜0.05) . However, there were no significant differences in neck-shaft angle and Tonnis grade for hip degeneration between the two groups at the corresponding time points (P＞0.05) . [Conclusion] Robot- assisted fixation of femoral neck fractures with cannulated screws does shorten the operation time, improve the accuracy of screw placement, and facilitate the early recovery of hip function.