镜下复位固定距骨颈骨折是否使用机器人的比较

Arthroscopic reduction and fixation of talus neck fractures with or without robotic assistance

摘要:

[目的] 探讨骨科机器人联合踝关节镜治疗Hawkins Ⅱ型距骨颈骨折的临床疗效。[方法] 对2019 年2 月—2023 年2 月的65 例Hawkins Ⅱ型距骨颈骨折患者采用关节镜手术治疗，依据术前医患沟通结果，33 例采骨科机器人引导空心钉固定（机器人组），另外32 例采用常规方法置钉固定（常规组）。比较两组围术期资料、随访结果。[结果] 两组手术出血量、踝关节镜操作时间、住院时间、切口愈合质量、并发症发生率差异无统计学意义（P＞0.05），机器人组置钉固定时间[(29.9±5.3) minvs (37.6±6.7) min, P＜0.001]、术中透视次数[(4.6±1.2) 次vs (9.7±1.7) 次, P＜0.001] 和一次置钉成功率（94.0% vs 56.3%, P＜0.001） 均显著优于常规组。两组恢复完全负重活动时间的差异无统计学意义（P＞0.05）。随着时间推移，两组的VAS 评分均显著降低（P＜0.05），而足内翻-外翻ROM、踝背伸-跖屈ROM、AOFAS 评分均显著升高（P＜0.05），但术后3 个月、末次随访两组差异无统计学意义（P＞0.05）。影像方面，两组骨折复位质量、术后Takakura 退变评级、影像不良表现差异均无统计学意义（P＞0.05）。[结论] 骨科机器人联合踝关节镜治疗Hawkins Ⅱ型距骨颈骨折能够缩短置钉固定时间，减少透视次数，提高一次置钉成功率。

Abstract:

[Objective] To compare the clinical outcomes of arthroscopic reduction and internal fixation of Hawkins II type talus neckfractures with or without robotic assistance. [Methods] From February 2019 to February 2023, 65 patients with Hawkins II type talus neckfractures were treated by arthroscopic reduction and internal fixation. According to preoperative doctor-patient communication, 33 patientshad fractures fixed by cannulated screws under robotic assistance (robot group), and the other 32 patients were with conventional methods(the conventional group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] Although therewas no significant difference in surgical blood loss, ankle arthroscopic operation time, hospital stay, incision healing quality and complica-tion rate between the two groups (P＞0.05), the robot group proved significantly superior to the conventional group in terms of screw place-ment time [(29.9±5.3) min vs (37.6±6.7) min, P＜0.001], intraoperative fluoroscopy times [(4.6±1.2) times vs (9.7±1.7) times, P＜0.001], andsuccess rate of first screw placement (94.0% vs 56.3%, P＜0.001). There was no significant difference to regain full weight-bearing activitiesbetween the two groups (P＞0.05). As time went on, the VAS scores significantly decreased (P＜0.05), while foot varus-valgus range of mo-tion (ROM), ankle-dorsal-plantar flexion ROM and AOFAS scores significantly increased in both groups (P＜0.05), whereas which were notstatistically significant between the two groups at 3 months postoperatively and the last follow-up (P＞0.05). Regarding imaging, there wereno significant differences in fracture reduction quality, postoperative Takakura degeneration scale and adverse signs between the two groups(P＞0.05). [Conclusion] Robot-assisted arthroscopic reduction and internal fixation of Hawkins II type talus neck fractures does shorten thefixation time, reduce the number of fluoroscopy, and improve the success rate of one time screw placement.