镜下胫骨平台骨折复位内固定是否机器人辅助的比较△

Robot-assisted versus conventional arthroscopic reduction and internal fixation for tibial plateau fractures

摘要:

[目的]比较关节镜治疗 Schatzker Ⅱ~Ⅳ胫骨平台骨折是否使用机器人辅助的临床效果。[方法]回顾性分析 2020 年 4 月—2023 年 4 月本院关节镜下治疗 Schatzker Ⅱ~Ⅳ胫骨平台骨折 53 例患者的资料。依据术前医患沟通结果，28 例采用机器人辅助镜下复位固定，另外 25 例常规镜下复位固定。比较两组围手术期、随访及影像结果。[结果]所有患者均顺利完成手术。机器人组的手术时间显著长于常规组 [min, (148.4±58.8) vs (103.6±33.5), P=0.005]，但是，机器人组在切口长度 [cm, (5.4±1.7) vs (8.2±2.7), P＜0.001]、术中透视次数 [次, (5.6±1.4) vs (9.1±1.9), P＜0.001]、术中失血量 [mL, (43.4±26.4) vs (70.0±30.6), P=0.001] 均显著优于常规组。机器人组下地行走时间 [d, (27.9±1.7) vs (30.4±3.3), P＜0.001] 和完全负重时间 [d, (74.8±11.6) vs (85.5±7.7), P＜0.001] 均显著早于常规组。术后 6 个月，机器人组的 VAS 评分 [分, (0.4±0.6) vs (1.0±0.9), P=0.011]、Rasmussen 临床评分 [分, (19.2±1.3) vs (18.3±1.1), P=0.017] 和膝伸屈 ROM [°, (114.2±6.2) vs (109.9±6.7), P=0.016] 均优于常规组，但末次随访时两组间 VAS 评分和 ROM 的差异无统计学意义（P＞0.05）。影像学方面，机器人组在影像骨折愈合时间、末次随访时关节退变 K-L 评级显著优于常规组 （P＜0.05）；然而，两组间术后即刻和末次随访时 Rasmussen 影像评分的差异均无统计学意义（P＞0.05）。[结论]骨科机器人联合关节镜辅助内固定治疗 Schatzker Ⅱ~Ⅳ型胫骨平台骨折的临床效果满意，其在微创、减轻疼痛、加速骨折愈合及术后康复等方面有显著的优势。

Abstract:

[Objective] To compare the clinical outcomes of arthroscopic treatment of Schatzker type Ⅱ~Ⅳ tibial plateau fractures with or without robot assistance. [Methods] A retrospective study was conducted on 53 patients who underwent arthroscopic treatment for Schatzker type Ⅱ~Ⅳ tibial plateau fractures in our hospital from April 2020 to April 2023. Based on preoperative doctor-patient communication, 28 patients were treated with robot-assisted arthroscopic reduction and fixation, while the remaining 25 patients received conventional arthroscopic reduction and fixation without robot assistance. The perioperative, follow-up, and imaging data of the two groups were compared. [Results] All patients successfully completed the surgery. The robot group consumed significantly longer operation time than the conventional group [min, (148.4±58.8) vs (103.6±33.5), P=0.005], but the robot-assisted group proved significantly superior to the conventional group in terms of incision length [cm, (5.4±1.7) vs (8.2±2.7), P＜0.001], intraoperative fluoroscopy [times, (5.6±1.4) vs (9.1±1.9), P＜0.001], and intraoperative blood loss [mL, (43.4±26.4) vs (70.0±30.6), P=0.001]. In addition, the robot-assisted group resumed ambulation [d, (27.9±1.7) vs (30.4±3.3), P＜0.001] and full weight-bearing activity [d, (74.8±11.6) vs (85.5±7.7), P＜0.001] significantly earlier than the conventional group. At 6 months postoperatively, the robot-assisted group was significantly better than the conventional group in terms of VAS score [points, (0.4±0.6) vs (1.0±0.9), P=0.011], Rasmussen clinical score [points, (19.2±1.3) vs (18.3±1.1), P=0.017], and knee flexion-extension ROM [°, (114.2±6.2) vs (109.9±6.7), P=0.016], although the differences in VAS and ROM between the two groups became not statistically significant at the last follow-up (P＞0.05). As for imaging, the robot group was significantly better than the conventional group regarding fracture healing time on images and K-L grade of joint degeneration at the last follow-up (P＜0.05). However, there were no statistically significant differences in Rasmussen radiographic scores between the two groups immediately postoperatively and at the last follow-up (P＞0.05).[Conclusion] The robot-assisted arthroscopic reduction and internal fixation take significant advantages of minimally invasive surgery, pain reduction, accelerated fracture healing, and postoperative recovery over the conventional counterpart for Schatzker type Ⅱ~Ⅳ tibial plateau fractures.