Department of Orthopaedics, Tianjin Hospital, Tianjin, China.
Orthop Surg. 2021 Apr;13(2):563-572. doi: 10.1111/os.12908. Epub 2021 Mar 4.
To investigate the surgical strategy, safety, and efficacy of close reduction and robot-aided minimally invasive lumbopelvic fixation in treatment of traumatic spinopelvic dissociation.
Data of 32 patients (21 males and 11 females) with traumatic spinopelvic dissociation treated by lumbopelvic fixation with robot-aided minimally invasive technique or conventional open procedure in our institution from March 2010 to April 2019 were retrospectively analyzed, and divided into robot group and control group. Intraoperative blood loss, surgical time, fluoroscopy frequency, total drilling times, infection rate, hospitalization time, and sacral fracture healing time were reviewed. Radiographs and computed tomography (CT) scans were totally acquired to evaluate the reduction quality, residual fracture displacement, and Gras classification on screws insertion after surgery. According to the Majeed scoring system, functional outcome was assessed for each patient at the final follow-up.
There were 12 patients in the robot group and 20 patients in the control group with no significant difference about the demographic data. The average surgical time was 148.3 ± 40.5 min with intraoperative blood loss of 142.5±36.7 mL in the robot group and 185.0 ± 47.8 min with 612.5 ± 182.7 mL in the control group (P = 0.034, P = 0.000). The robot group had a shorter mean hospitalization time at 19.9 ± 7.0 days compared to the control group with 28.6 ± 5.4 days (P = 0.010). The fluoroscopy frequency was 35.4 ± 3.0 in the robot group and 45.5 ± 3.6 in the control group (P = 0.000) and total drilling times were 7.1 ± 1.1 and 9.6 ± 1.3 (P = 0.000), respectively. The infection rate was 0% (0/12) in the robot group and 15% (3/20) in the control group (P = 0.159). According to the Gras classification on screw positioning, there were 11 cases in Grade I and 1 case in Grade II in the robot group, and 14 cases in Grade I and 6 cases in Grade II in the control group. All the patients were followed up consecutively for at least 12 months, with an average follow-up period of 17.1 ± 3.6 months. All sacral fractures healed with an average time of 3.8 ± 0.6 months in the robot group and 4.7 ± 0.7 months in the control group (P = 0.000). According to Majeed functional assessment investigation, the mean score of the patients was 87.2 ± 4.0 in the robot group and 83.1 ± 4.5 in the control group (P = 0.015).
Robot-aided minimally invasive lumbopelvic fixation for traumatic spinopelvic dissociation is a safe and feasible option with advantages of less intraoperative blood loss, less radiation damage, less hospitalization time, and better functional outcome.
探讨机器人辅助微创腰骶固定治疗创伤性脊柱骨盆分离的手术策略、安全性和疗效。
回顾性分析 2010 年 3 月至 2019 年 4 月我院采用机器人辅助微创技术或传统开放手术治疗的 32 例创伤性脊柱骨盆分离患者（男性 21 例，女性 11 例）的临床资料，将患者分为机器人组和对照组。回顾性分析两组患者的术中出血量、手术时间、透视次数、总钻孔次数、感染率、住院时间、骶骨骨折愈合时间，评估术后复位质量、残余骨折移位、螺钉置入 Gras 分级。末次随访时采用 Majeed 评分系统评估患者的功能结局。
机器人组 12 例，对照组 20 例，两组患者的一般资料比较，差异无统计学意义（P＞0.05）。机器人组平均手术时间为 148.3±40.5min，术中出血量为 142.5±36.7mL；对照组平均手术时间为 185.0±47.8min，术中出血量为 612.5±182.7mL，两组比较差异有统计学意义（P=0.034，P=0.000）。机器人组平均住院时间为 19.9±7.0d，短于对照组的 28.6±5.4d，差异有统计学意义（P=0.010）。机器人组透视次数为 35.4±3.0 次，少于对照组的 45.5±3.6 次，差异有统计学意义（P=0.000）；总钻孔次数为 7.1±1.1 次，少于对照组的 9.6±1.3 次，差异有统计学意义（P=0.000）。机器人组感染率为 0%（0/12），对照组为 15%（3/20），两组比较差异无统计学意义（P=0.159）。根据螺钉定位 Gras 分级，机器人组Ⅰ级 11 例，Ⅱ级 1 例；对照组Ⅰ级 14 例，Ⅱ级 6 例。所有患者均获得至少 12 个月的连续随访，平均随访 17.1±3.6 个月。所有骶骨骨折均愈合，机器人组平均愈合时间为 3.8±0.6 个月，对照组为 4.7±0.7 个月，两组比较差异有统计学意义（P=0.000）。根据 Majeed 功能评估调查，机器人组患者平均评分为 87.2±4.0，对照组为 83.1±4.5，两组比较差异有统计学意义（P=0.015）。
机器人辅助微创腰骶固定治疗创伤性脊柱骨盆分离是一种安全可行的方法，具有术中出血量少、辐射损伤小、住院时间短、功能结局好等优点。
