目的:本研究的目的是评估效率,安全,与传统的经皮徒手方法相比,使用机器人辅助方法进行空心螺钉固定的准确性。
方法:这项回顾性临床研究包括2018年6月至2020年6月通过机器人辅助技术或传统经皮徒手技术进行空心螺钉固定的18例舟状骨骨折患者。将所有患者分为机器人辅助组(9例)和传统手术组(9例)。操作时间,失血,术中荧光镜检查的数量,骨折愈合时间,梅奥手腕功能评分,记录两组螺钉植入的准确性。
结果:机器人辅助组的平均年龄为37.9±10.6岁(范围为30至52岁),有8个雄性和1个雌性,右侧舟骨骨折6例,左侧骨折3例。术前平均时间为2.8±0.7天(1至3天)。传统手术组平均年龄为31.6±6.8岁(范围为20~45岁),有8个雄性和1个雌性,右侧舟骨骨折5例,左侧骨折4例。术前平均时间为2.1±0.8天(范围为2至4天)。传统手术组术中透视次数为24.4±3.5,而机器人辅助组只有10.1±1.9,显著降低(P<0.05)。传统手术组平均手术时间为48.4±12.2min,机器人辅助组为32.6±4.2分钟,显著缩短(P<0.05)。在冠状位和矢状位术后CT图像上,实际螺钉位置与舟骨中心轴之间的角度分别为:传统手术组8.3°±2.3°和8.8°±1.6°,机器人辅助组3.8°±0.8°和4.3°±1.2°,因此机器人辅助组的准确性明显高于对照组(P<0.05)。两组患者腕关节功能恢复及骨折愈合时间差异无统计学意义。
结论:机器人辅助治疗舟骨骨折比传统徒手技术更准确,具有较短的手术时间和较少的术中透视。两种手术技术在术中出血方面没有区别,术后骨折愈合,或功能恢复。机器人辅助手术是安全的,有效,治疗舟骨骨折的准确方法。
The purpose of this study was to assess the efficiency, safety, and accuracy of cannulated screw fixation using a robot-assisted method compared with a traditional percutaneous freehand method.
This retrospective clinical study included 18 patients with scaphoid fracture who underwent cannulated screw fixation by robot-assisted technique or traditional percutaneous freehand technique from June 2018 to June 2020. All patients were divided into the robot-assisted group (9 patients) or the traditional surgery group (9 patients). The operation time, blood loss, number of intra-operative fluoroscopies, fracture healing time, Mayo wrist function score, and screw implantation accuracy were recorded in the two groups.
The average age of the robot-assisted group was 37.9 ± 10.6 years (with a range of 30 to 52 years), there were eight males and one female, and there were six cases of scaphoid fracture on the right side and three on the left side. The average pre-operative time was 2.8 ± 0.7 days (ranging from 1 to 3 days). The average age of the traditional surgery group was 31.6 ± 6.8 years (with a range of 20 to 45 years), there were eight males and one female, and there were five cases of scaphoid fracture on the right side and four on the left side. The average pre-operative time was 2.1 ± 0.8 days (with a range of 2 to 4 days). The number of intra-operative fluoroscopies was 24.4 ± 3.5 in the traditional surgery group, whereas it was only 10.1 ± 1.9 in the robot-assisted group, which was significantly lower (P < 0.05). The average operation time of the traditional operation group was 48.4 ± 12.2 min, and that of the robot-assisted group was 32.6 ± 4.2 minutes, which was significantly shorter (P < 0.05). The angles between the actual screw position and the central axis of the scaphoid on both the coronal and sagittal post-operative CT images were 8.3° ± 2.3° and 8.8° ± 1.6° for the traditional operation group and 3.8° ± 0.8° and 4.3° ± 1.2° for the robot-assisted group, so the accuracy of the robot-assisted group was significantly higher (P < 0.05). There were no significant differences between the two groups in wrist function recovery or fracture healing time.
Robot-assisted treatment of scaphoid fracture is more accurate than traditional freehand technology, with shorter operation time and fewer intra-operative fluoroscopies. There is no difference between the two surgical techniques in intra-operative bleeding, post-operative fracture healing, or functional recovery. Robot-assisted surgery is a safe, effective, and accurate method for treating scaphoid fracture.