机器人辅助与传统手术治疗股骨转子间骨折的前瞻性研究

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摘要目的比较机器人辅助与传统手术治疗股骨转子间骨折的疗效。方法本研究为前瞻性随机对照研究，共纳入2021年1月至2022年6月在上海交通大学医学院附属仁济医院创伤骨科接受手术治疗的股骨转子间骨折患者50例，机器人辅助组25例，其中男9例，女16例；年龄53~86岁，平均(71.6±9.5)岁。传统手术组25例，其中男13例，女12例；年龄51~85岁，平均(72.4±11.0)岁。机器人辅助组在天玑骨科机器人辅助下置入拉力螺钉，传统手术组以常规手术方式置入拉力螺钉。记录两组患者拉力螺钉导针穿刺次数、拉力螺钉置入过程透视次数、术中出血量、手术时间等。术后记录两组患者尖顶距(tipapex distance，TAD)及拉力螺钉位置优良率，术后完成12个月随访，记录髋关节功能评分及并发症发生情况。结果机器人辅助组TAD值为(13.70±1.91) mm，传统手术组为(15.77±2.57) mm，两组比较差异有统计学意义(P＝0.002)；机器人辅助组拉力螺钉位置优良率为100%，传统手术组为72%，两组比较差异有统计学意义(P＝0.004)。在拉力螺钉置钉过程中，机器人辅助组导针穿刺次数为(1.0±0.2)次，传统手术组为(2.3±1.2)次，两组比较差异有统计学意义(P＜0.001)；机器人辅助组透视次数为(4.4±0.6)次，传统手术组为(5.4±1.2)次，两组比较差异有统计学意义(P＝0.001)。两组患者手术时间、术中出血量、术后12个月髋关节功能评分差异无统计学意义(P＞0.05)。结论机器人辅助定位可以提高股骨转子间骨折手术中拉力螺钉置入的精确度并减少术中穿刺及透视造成的损伤。

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	肖伟元
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	周春
	曹昕琪
	白佳润
	郭韵悦
	黄平
	董宇启

关键词 ：股骨转子间骨折, 骨科机器人, 尖顶距

Abstract：

Objective To compare the outcome of robot assisted surgery and traditional surgery in the treatment of intertrochanteric fractures of the femur。Methods This is a prospective randomized controlled study that included 50 patients with intertrochanteric fractures of the femur who underwent surgical treatment at Renji Hospital from January 2021 to June 2022.There were 25 patients in the robot assisted surgery group，including 9 males and 16 females.The patient age ranged from 53 to 86 years，with an average age of (71.6±9.5) years.There were 25 patients in the traditional surgery group，including 13 males and 12 females.The patient age ranged from 51 to 85 years，with an average age of (72.4±11.0) years.The robot assisted surgery group placed lag screws with the assistance of Tirobot.The number of guide pin insertion，the fluoroscopy times during the insertion process，the operation time and intraoperative blood loss of the patients were collected.The tip apex distance (TAD) and lag screw position were evaluated after the surgery.Hip joint function scores and complications were recorded after a 12-month follow-up.Results The TAD value of the robot assisted group was (13.70±1.91) mm，while the TAD value of the traditional surgery group was (15.77±2.57) mm.The difference between the two groups was statistically significant (P＝0.002).The excellent rate of lag screw position in the robot assisted group was 100%，while the excellent rate of lag screw position in the traditional surgery group was 72%.The difference between the two groups was statistically significant (P＝0.004).During the insertion of the lag screw，the number of guide pin insertion in the robot assisted group was (1.0±0.2)，while the number of guide pin insertion in the traditional surgery group was (2.3±1.2).The difference between the two groups was statistically significant (P＜0.001).The fluoroscopy times in the robot assisted group was(4.4±0.6)，while the fluoroscopy times in the traditional surgery group was (5.4±1.2).The difference between the two groups was statistically significant (P＝0.001).There was no statistically significant difference in surgery time，intraoperative blood loss and hip joint function scores between the two groups (P＞0.05).Conclusion Robot assisted surgery can improve the accuracy of lag screw placement and reduce the damage caused by intraoperative puncture and fluoroscopy during the surgery of intertrochanteric fractures of the femur.

Key words： intertrochanteric fractures of the femur orthopedic robot tip apex distance

基金资助:上海市卫生健康委员会科研课题(20204Y0010)

通讯作者: 董宇启

作者简介: 肖伟元(1987－ )，男，主治医师，上海交通大学医学院附属仁济医院创伤骨科，xwy2013_rjgk@hotmail.com

引用本文:

肖伟元，金翔赟，周春，曹昕琪，白佳润，郭韵悦，黄平，董宇启. 机器人辅助与传统手术治疗股骨转子间骨折的前瞻性研究[J]. 实用骨科杂志, 2023, 29(9): 777-.
Xiao Weiyuan，Jin Xiangyun，Zhou Chun，Cao Xinqi，Bai Jiarun，Guo Yunyue，Huang Ping，Dong Yuqi. A Prospective Study of Robot Assisted Surgery Versus Traditional Surgery for the Treatment of Intertrochanteric Fractures of the Femur. sygkzz, 2023, 29(9): 777-.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I9/777

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