【摘要】：目的:評(píng)價(jià)一種外科手術(shù)機(jī)器人輔助經(jīng)皮螺釘內(nèi)固定治療骨盆和髖臼骨折手術(shù)的安全性與有效性。方法:選擇2016年1至4月北京積水潭醫(yī)院創(chuàng)傷骨科收治的12例骨盆和髖臼骨折患者為研究對(duì)象,將試驗(yàn)對(duì)象隨機(jī)分為試驗(yàn)組和對(duì)照組,試驗(yàn)組7例采用機(jī)器人輔助下醫(yī)生完成手術(shù),對(duì)照組5例采用透視引導(dǎo)下醫(yī)生徒手完成手術(shù),通過對(duì)兩組病例的手術(shù)總時(shí)間、術(shù)中透視時(shí)間、導(dǎo)針調(diào)整次數(shù)、螺釘置入位置優(yōu)良率和不良事件發(fā)生率進(jìn)行統(tǒng)計(jì)分析,評(píng)價(jià)機(jī)器人輔助骨盆和髖臼骨折進(jìn)行經(jīng)皮螺釘內(nèi)固定治療的有效性和安全性。結(jié)果:試驗(yàn)組7例患者共置入11枚螺釘,對(duì)照組5例患者共置入7枚螺釘。術(shù)后CT透視檢查確認(rèn)所有螺釘位置均滿意,但兩組螺釘?shù)姆植疾町愑薪y(tǒng)計(jì)學(xué)意義(P=0.016),試驗(yàn)組優(yōu)率高于對(duì)照組;試驗(yàn)組平均螺釘置入所需透視時(shí)間為(7.36±2.63)s,短于對(duì)照組的(41.80±13.99)s,差異有統(tǒng)計(jì)學(xué)意義(P0.001);試驗(yàn)組術(shù)中平均螺釘調(diào)整次數(shù)為(0.36±0.48)次,少于對(duì)照組的(9.00±3.06)次,兩組差異具有統(tǒng)計(jì)學(xué)意義(P=0.003);試驗(yàn)組平均手術(shù)時(shí)間為(43.86±49.06)min,對(duì)照組為(29.00±12.14)min,兩組差異無統(tǒng)計(jì)學(xué)意義(P=0.528)。進(jìn)行CT透視確認(rèn)所有螺釘位置滿意,未見穿出骨皮質(zhì)及進(jìn)入關(guān)節(jié)腔者,未見傷口感染等其他螺釘置入的相關(guān)并發(fā)癥發(fā)生。結(jié)論:外科手術(shù)機(jī)器人適用于輔助進(jìn)行骨盆和髖臼骨折經(jīng)皮螺釘內(nèi)固定治療,并具有置入準(zhǔn)確性高、透視輻射小、安全有效等優(yōu)點(diǎn)。
[Abstract]:Objective: to evaluate the safety and efficacy of robot assisted percutaneous screw fixation in the treatment of pelvic and acetabular fractures. Methods: twelve patients with pelvic and acetabular fractures admitted in Department of Orthopedics, Beijing Jishuitan Hospital from January to April 2016 were randomly divided into two groups: experimental group and control group. Seven patients in the test group were operated by a robot assisted doctor, and 5 patients in the control group were operated by a doctor with bare hands guided by fluoroscopy. The total time of operation, the time of fluoroscopy during operation and the times of adjusting the guide needle were used in the two groups. The excellent and good rate of screw placement and the incidence of adverse events were statistically analyzed to evaluate the efficacy and safety of robot assisted percutaneous screw fixation for pelvic and acetabular fractures. Results: 11 screws were implanted in 7 patients in test group and 7 screws in 5 patients in control group. Postoperative CT fluoroscopy confirmed that all screw positions were satisfactory, but the distribution of screws in the two groups was significantly different (P0. 016), and the excellent rate in the trial group was higher than that in the control group. The average fluoroscopy time of the test group was (7.36 鹵2.63) s, shorter than that of the control group (41.80 鹵13.99) s, the difference was statistically significant (P0.001). The average times of screw adjustment were (0.36 鹵0.48) times in the experimental group, less than (9.00 鹵3.06) times in the control group. The difference between the two groups was statistically significant (P0. 003). The mean operation time of the trial group was (43.86 鹵49.06) min, control group was (29.00 鹵12.14) min, there was no significant difference between the two groups (P0. 528). CT fluoroscopy was performed to confirm the satisfactory position of all screws. No complications such as wound infection and other screw implantation were found in the patients who had not perforated the bone cortex or entered the articular cavity. Conclusion: the surgical robot is suitable for assisted percutaneous screw fixation of pelvic and acetabular fractures, and has the advantages of high accuracy, low fluoroscopy and safety and effectiveness.
【作者單位】： 北京積水潭醫(yī)院創(chuàng)傷骨科;
【基金】：科技部國(guó)家重點(diǎn)研發(fā)計(jì)劃項(xiàng)目(2016YFC0105802)資助~~
【分類號(hào)】：R687.3;TP242

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