北京生物醫(yī)學(xué)工程

天璣骨科手術(shù)機(jī)器人輔助經(jīng)皮固定骶髂螺釘治療不穩(wěn)定骨盆后環(huán)骨折的應(yīng)用臨床

Clinical study of S2 iliosacral? screw fixation with TiRobot assistance in unstable posterior pelvic ring fracture

作者：韓巍張騰蘇永剛趙春鵬周力吳新寶王軍強(qiáng)

單位：北京積水潭醫(yī)院創(chuàng)傷骨科（北京 100035）北京天智航醫(yī)療科技股份有限公司（北京 100192）

關(guān)鍵詞：天璣；機(jī)器人輔助；經(jīng)皮；骶髂螺釘；骨盆骨折

分類號(hào)：R318.04

出版年·卷·期（頁碼）：2021·40·3（257-262）

摘要：

目的評(píng)估機(jī)器人輔助經(jīng)皮固定S2（骶髂）螺釘?shù)挠行浴踩砸约皽?zhǔn)確性。方法回顧性分析了自2016年1月至2019年1月在北京積水潭醫(yī)院接受S2骶髂螺釘固定治療不穩(wěn)定骨盆后環(huán)骨折的63例患者病例資料。其中試驗(yàn)組38例采用機(jī)器人輔助下醫(yī)生植入S2骶髂螺釘，對(duì)照組25例患者采用傳統(tǒng)透視下醫(yī)生徒手植入S2骶髂螺釘。通過評(píng)價(jià)術(shù)后CT掃描圖像評(píng)估所有螺釘植入位置及骨折復(fù)位情況，分析天璣（ TiRobot）骨科手術(shù)機(jī)器人輔助螺釘置入與醫(yī)生徒手植入螺釘在臨床表現(xiàn)的對(duì)比。結(jié)果兩組患者共計(jì)植入89枚S2骶髂關(guān)節(jié)螺釘，相比于醫(yī)生徒手植入螺釘，實(shí)驗(yàn)組具有提高植入精準(zhǔn)度、減少手術(shù)過程中輻射暴露、降低患者損傷等優(yōu)勢(shì)。對(duì)每個(gè)評(píng)判指標(biāo)進(jìn)行詳細(xì)描述，其中試驗(yàn)組植入54枚，對(duì)照組35枚。均未出現(xiàn)螺釘相關(guān)的并發(fā)癥及翻修手術(shù)。試驗(yàn)組螺釘位置優(yōu)良率為100%，高于對(duì)照組的85.7%（P<0.001）。試驗(yàn)組每枚螺釘?shù)耐敢晻r(shí)間及導(dǎo)針調(diào)整次數(shù)均少于對(duì)照組（P<0.001）。根據(jù)Matta標(biāo)準(zhǔn)評(píng)定的術(shù)后優(yōu)良率試驗(yàn)組及對(duì)照組分別為86.8%與90.0%，沒有統(tǒng)計(jì)學(xué)差異（P=0.750）。結(jié)論機(jī)器人輔助手術(shù)是一項(xiàng)更加精準(zhǔn)、微創(chuàng)的技術(shù)。天璣?骨科手術(shù)機(jī)器人輔助下植入S2骶髂螺釘治療不穩(wěn)定的骨盆后環(huán)骨折比透視下徒手操作成功率更高。機(jī)器人輔助下經(jīng)皮固定S2骶髂螺釘治療不穩(wěn)定骨盆后環(huán)損傷是安全且臨床可行的，具有較好的臨床應(yīng)用價(jià)值。

Objective Assesse the efficiency, safety and accuracy of S2 iliosacral screws fixation with robot assistance. Methods We analysed the patients treated with S2 IS screw fixation for unstable pelvic fractures from January 2016 to January 2019 in Beijing Jishuitan Hospital. In this study, we collected sixty-three patients (17 men and 46 women) aged between 21 and 55 years (with an average of 39.22 ± 9.28). There were 26 (41.3%) type B fracture and 37 (58.7%) type C fractures according to the Tile classification. All patients were divided into robot-assisted (RA) group (38 patients) and traditional free-hand (FH) group (25 patients). In RA group, the S2 IS screws implanted with Robot-assisted technique. While S2 IS screws implanted with traditional free-hand technique in FH group. We recorded the screw-related complications. The position of all screws and fracture reduction was assessed by postoperative CT scans. We also analysed the number of guide wire attempts and the radiation exposure for S2 screw implantation. Results A total of 89 IS screws were implanted into S2 iliosacral joint. Fifty-four screws were placed by RA, and 35 screws were by FH. There were no screw-related complications or revision surgery. In term of screw placement, the excellent and good rate was 100% in the RA group, better than that in the FH group, only 85.7% (P< 0.001). Both the fluoroscopy time per screw and the number of guide wire attempts in the RA group were much less than those in the FH group (P< 0.001). The overall postoperative excellent and good rate of Matta standard in RA and FH group was 86.8% and 90.0%, respectively (P= 0.750)，there was no statistical difference. Conclusion The Robot-assisted surgery is an accurate and minimally invasive technique. S2 IS screw implantation assisted by TiRobot to treat the posterior pelvic ring fractures, have a high success rate than the freehand technique. Percutaneous RA S2 IS screw fixation for unstable posterior pelvic ring injuries is safe and clinically feasible and has great clinical application value.

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