机器人辅助经皮螺钉与开放复位固定Tile C1~2型骨盆骨折△（开放获取）

Robot-assisted percutaneous channel screw versus conventional open reduction and internal fixation of Tile type C1-2 pelvic fractures

摘要:

[目的]比较机器人辅助与常规通道螺钉固定 Tile C1~2 型骨盆骨折的效果。[方法]回顾性分析 2020 年 6 月—2023 年 8 月本科收治的 185 例 Tile C1~2 型骨盆骨折患者的临床资料，根据医患沟通结果，93 例接受天玑骨科机器人辅助微创螺钉固定（机器人组），92 例接受常规开放复位固定（常规组），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 [(92.5±10.3) min vs (138.7±12.7) min, P＜0.001]、置钉时间 [(14.3±2.7) min vs (15.4±3.1) min, P=0.011]、切口长度 [(1.4±0.4) cm vs (1.6± 0.5) cm, P=0.003]、术中透视次数 [(2.5±0.8) 次 vs (2.8±0.9) 次, P=0.018]、术中失血量 [(31.7±4.2) mL vs (52.9±6.7) mL, P＜0.001]、住院时间 [(9.3±2.1) d vs (10.2±2.4) d, P=0.007]、总并发症发生率 [例 (%), 7 (7.6) vs 17 (18.4), P=0.027] 、首次置钉成功率 （95.7% vs 81.5%, P=0.002）、切口愈合等级 [甲/乙/丙, (42/37/14) vs (27/40/25), P=0.039] 均显著优于常规组。所有患者均获 12 个月以上随访， 机器人组下地行走时间 [(13.7±4.6) d vs (18.8±5.2) d, P＜0.001]、临床愈合时间 [(36.4±12.1) d vs (41.0±13.7) d, P=0.016] 显著早于常规组。随时间推移，两组患者 VAS、Majeed 评分均显著改善（P＜0.05），术前两组 VAS、Majeed 评分的差异均无统计学意义（P＞ 0.05），但术后 3 个月和末次随访时，机器人组 VAS 评分 [(3.1±1.0) vs (3.7±1.2), P＜0.001; (2.2±0.7) vs (2.8±0.9), P＜0.001] 、Majeed 评分 [(85.3±3.2) vs (80.4±4.1), P＜0.001; (90.1±1.8) vs (89.2±2.0), P=0.002] 均显著优于常规组。影像方面，术后相应时间点，机器人组 Matta 评级、骨折愈合率均显著优于常规组（P＜0.05）。[结论] 对于 Tile C1~2 型骨盆骨折，天玑骨科机器人辅助微创经皮通道螺钉固定后住院天数缩短，有效缓解疼痛，促进骨折快速愈合，术后并发症较少，安全性高。

Abstract:

[Objective] To compare the clinical consequence of robot-assisted percutaneous channel screw versus conventional open reduction and internal fixation (ORIF) of Tile type C1~2 pelvic fractures. [Methods] A retrospective research was conducted on 185 patients who had Tile type C1~2 pelvic fractures fixed surgically in our department from June 2020 to August 2023. According to doctor-patient communication, 93 patients received robot-assisted percutaneous channel screw placement (the robot group), while the other 92 patients received the conventional ORIF (the conventional group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] The robot group proved significantly superior to the conventional group in terms of operation time [(92.5±10.3) min vs (138.7±12.7) min, P＜0.001], screw placement time [(14.3±2.7) min vs (15.4±3.1) min, P=0.011], incision length [(1.4±0.4) cm vs (1.6±0.5) cm, P=0.003], intraoperative fluoroscopy times [(2.5±0.8) vs (2.8±0.9), P=0.018], intraoperative blood loss [(31.7±4.2) mL vs (52.9±6.7) mL, P＜0.001), hospital stay [(9.3±2.1) days vs (10.2±2.4) days, P=0.007], the total incidence of complications (7.6% vs 18.4%, P=0.027), first screw placement success rate (95.7% vs 81.5%, P=0.002), incision healing grade [A/B/C, (42/37/14) vs (27/40/25), P=0.039]. All patients in both groups were followed up for more than 12 months, and the robot group regained ambulation [(13.7±4.6) days vs (18.8±5.2) days, P＜0.001] and full weightbearing activity [(36.4±12.1) days vs (41.0±13.7) days, P=0.016] significantly earlier than the conventional group. The VAS and Majeed scores were significantly improved in both groups over time (P＜0.05). Although there were no statistical significances in VAS and Majeed scores between the two groups before surgery (P＞0.05), the robot group was significantly superior to the conventional group in terms of VAS score [(3.1±1.0) vs (3.7±1.2), P＜0.001; (2.2±0.7) vs (2.8±0.9), P＜0.001] and Majeed score [(85.3±3.2) vs (80.4±4.1), P＜0.001; (90.1±1.8) vs (89.2±2.0), P=0.002] 3 months postoperatively and at the latest follow-up. Radiographically, the robot group was also significantly better than the conventional group in terms of Matta grade and fracture healing rate at all time points postoperatively (P＜0.05). [Conclusion] For Tile type C1~2 pelvic fractures, the Tianji orthopedic robot assisted minimally invasive percutaneous channel screw fixation does shorten the hospital stay, effectively relieve pain, promote rapid fracture healing, reduce postoperative complications with high safety.