机器人辅助经皮螺钉内固定治疗骨盆和髋臼骨折

目的：评价一种外科手术机器人辅助经皮螺钉内固定治疗骨盆和髋臼骨折手术的安全性与有效性。方法： 选择2016年1至4月北京积水潭医院创伤骨科收治的12例骨盆和髋臼骨折患者为研究对象，将试验对象随机分为试验组和对照组，试验组7例采用机器人辅助下医生完成手术，对照组5例采用透视引导下医生徒手完成手术，通过对两组病例的手术总时间、术中透视时间、导针调整次数、螺钉置入位置优良率和不良事件发生率进行统计分析，评价机器人辅助骨盆和髋臼骨折进行经皮螺钉内固定治疗的有效性和安全性。结果： 试验组7例患者共置入11枚螺钉，对照组5例患者共置入7枚螺钉。术后CT透视检查确认所有螺钉位置均满意，但两组螺钉的分布差异有统计学意义（P=0.016），试验组优率高于对照组；试验组平均螺钉置入所需透视时间为(7.36±2.63) s，短于对照组的(41.80±13.99) s，差异有统计学意义（P<0.001）；试验组术中平均螺钉调整次数为(0.36±0.48)次，少于对照组的(9.00±3.06)次，两组差异具有统计学意义（P=0.003）；试验组平均手术时间为(43.86±49.06) min，对照组为(29.00±12.14) min，两组差异无统计学意义（P=0.528）。进行CT透视确认所有螺钉位置满意，未见穿出骨皮质及进入关节腔者，未见伤口感染等其他螺钉置入的相关并发症发生。结论： 外科手术机器人适用于辅助进行骨盆和髋臼骨折经皮螺钉内固定治疗，并具有置入准确性高、透视辐射小、安全有效等优点。

Clinical research on robot-assisted percutaneous pelvic and acetabular screws surgery

Objective:To evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures.Methods: In the study,12 patients with pelvic and acetabular fractures who were treated in Beijing Jishuitan Hospital from January to April in 2016 were involved in this research.The research subjects were randomly divided into two groups: the experimental group and the control group.Robotic-assisted percutaneous sacroiliac screw internal fixations were performed under the guidance of fluoroscopy navigation in the experimental group;in the control group,doctors operated manually guided by fluoroscopy.Statistical analysis was performed on the total operation time,the intraoperative fluoroscopy time,the adjustment numbers of intraoperative guide wires,the excellent rate of screw placement and the incidence of adverse events in order to evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures.Results: Eleven screws were placed in 7 patients from the experimental group,while 7 screws were placed in 5 patients from the control group in total.All the screw placement positions were satisfactory according to postoperative CT images.The excellent rates of screw placement position were 100％ in both groups.However,the P value was 0.016 based on the comparison between the screws' distribution in the two groups which meant that the screw distribution of the experimental group was better than that of the control group.The average fluoroscopy time needed for screw insertion was (7.36±2.63) s in the experimental group while (41.80±13.99) s in the control group (P<0.001).This suggested that the difference between the two groups had statistical significances.Intra-operative fluoroscopy time of the experimental group was significantly smaller than that of the control group.The number of the average screw adjustment was (0.36±0.48) times in the experimental group while (9.00±3.06) times in the control group (P=0.003).This suggested that the difference of the number of the guide needle adjustment between the two groups had statistical significances,and the number of the experimental group was smaller than that of the control group.The average operation time was (43.86±49.06) min in the experimental group while only (29.00±12.14) min were needed in the control group (P=0.528).This suggested that the difference between the two groups had no statistical significance.That is,the total operation time of the two groups was equal.All the screws were in satisfactory positions according to validation results of CT scans.No complications such as screw breaking out the bone cortex and entering into the knee joint cavity,wound infection occurred.Conclusion: Surgical robots are suitable for robot-assisted percutaneous screw fixation in pelvic and acetabular fractures.Robot-assisted treatment of pelvic and acetabular fractures has significant advantages over manual operations including high accuracy,small perspective radiation,safety and efficiency.