基于术中三维透视图像使用“天玑”骨科机器人辅助经皮骶髂关节螺钉治疗后环不稳定型骨盆骨折

目的 探讨基于术中三维透视图像使用“天玑”骨科机器人辅助经皮骶髂关节螺钉治疗后环不稳定型骨盆骨折的安全性及临床效果。方法 回顾性分析武汉市第四医院2019年10月至2020年10月基于术中三维透视图像使用“天玑”骨科机器人辅助经皮骶髂关节螺钉治疗的12例后环不稳定型骨盆骨折患者的临床资料。其中，男8例，女4例；年龄32 ～ 69岁，平均41.2岁；体重47 ～ 88 kg，平均60.2 kg；致伤原因：车祸伤7例，高坠伤3例，重物压砸伤2例；骨盆骨折按Tile分型：B2型7例，B3型4例，C1型1例。所有患者均基于术中三维透视图像使用“天玑”骨科机器人辅助经皮置入骶髂关节螺钉，术后均摄骨盆X线片、CT＋3D重建评价骨折端复位质量及骶髂关节螺钉位置情况。记录手术总时间、置钉准备时间、置钉时间、术后并发症情况，螺钉位置优良率。末次随访时采用Majeed骨盆骨折量化评估系统进行功能评价。结果 本组12例患者共置入骶髂关节螺钉17枚，其中S₁单侧7枚，S₁双侧共8枚，S₁、S₂单侧各1枚。骶髂关节螺钉手术总时间平均65.1 min；置钉准备时间平均39.2 min；置钉时间平均25.4 min。2例患者术前常规静脉血栓筛查发现下肢深静脉血栓，1例腘静脉血栓并肺动脉分支血管栓塞，VTE总发生率为25.0%。术后X线评价骨折复位情况：优11例，良1例，优良率100%。术后CT评价螺钉位置：0级16枚，1级1枚，完全准确率：94.1%（16/17）。术后均无血管或神经损伤，无死亡病例，手术切口均一期愈合，无切口感染或愈合不良病例。所有骨盆骨折均活动骨性愈合，末次随访时Majeed评分为78 ～ 96分，平均89.3分。结论 基于术中三维透视图像使用“天玑”骨科手术机器人经皮微创置入骶髂关节螺钉，手术中能获取所需的高质量图像，螺钉规划时可从三个维度多平面确定理想的螺钉位置，通过机械臂的稳定导向准确置入螺钉。临床结果显示，螺钉置入准确性高，安全性好，手术及住院时间短，患者术后疼痛轻，可早期进行康复锻炼，并发症发生率低。

Treatment of unstable posterior pelvic ring fractures with percutaneous sacroiliac screw assisted by Ti-Robot based on intraoperative 3D fluoroscopy

Objective To investigate the safety and clinical effective of unstable posterior pelvic ring fractures with percutaneous sacroiliac screw assisted by Ti-Robot based on intraoperative 3D fluoroscopy.Methods A retrospective analysis of the clinical database of 12 patients with unstable posterior pelvic ring fractures who had accepted surgery assisted by Ti-Robot based on intraoperative 3D fluoroscopy in Wuhan Fourth Hospital from October 2019 to October 2020 was performed. There were 8 males and 4 females, aged from32 to 69 years, with an average of 41.2 years. Weight: 47-88 kg, average 60.2 kg. Causes of injury: 7 cases of car accident injuries, 3 cases of high fall injuries, 2 cases of heavy pressure injuries. According to Tile classification: 7 cases of type B2, 4 cases of type B3 and 1 case of type C1. All patients in this group were implanted sacroiliac screw assisted by Ti-Robot based on intraoperative 3D fluoroscopy. Postoperative pelvic X-ray and CT+3D reconstruction were taken to evaluate the reduction quality of the fracture and the accuracy of the sacroiliac screws. The total surgery time, the preparation time, the insertion time of screw, postoperative complications, and the accuracy of the sacroiliac screws were recorded. At the final follow-up, the Majeed pelvic fracture quantitative evaluation system was used for functional evaluation.Results In this group of 12 patients, 17 sacroiliac screws were inserted totally. There were 7 unilateral S₁ sacroiliac screws for 7 patients, 8 bilateral S₁ sacroiliac screws for 4 patients, and 1 unilateral S₁ and S₂ sacroiliac screw respectively for 1 patient. The mean total surgery time was 65.1 min; the mean preparation time was 39.2 min and the mean insertion time of screw was 25.4 min. A total of 3 patients developed deep venous thrombosis of the lower extremities, with a total incidence of 25.0%. There was no blood vessel or nerve injury, no death, primary wound healing, no wound infection or poor healing. The excellent rate of all fracture reduction and screw placement were100% and 94.1%(16/17) respectively. In all cases, pelvic fractures were healed. At the final follow-up, the Majeed score ranged from 78 to 96, with an average of 89.3.Conclusion Treatment of unstable posterior pelvic ring fractures with percutaneous sacroiliac screw assisted by Ti-Robot based on intraoperative 3D fluoroscopy, high-quality images could be obtained, the ideal screw position can be determined from three dimensions and multiple planes during the operation, and then the screw can be inserted accurately through the stable guidance of the manipulator. According to the clinical results, with such surgery, a high accuracy of the sacroiliac screw, good safety, shorter surgery and hospitalization time, light postoperative pain, early rehabilitation exercise, and low complication rate could be achieved.