Zhang Yufu, Tan Jie, Zhang Xigong, Han Xiao, Li Yanchao, Gong Maoqi, Huang Qiang, Wang Junqiang, Jiang Xieyuan
Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, People's Republic of China.
JB JS Open Access. 2025 Jan 29;10(1). doi: 10.2106/JBJS.OA.24.00071. eCollection 2025 Jan-Mar.
The objective of this study was to compare the clinical outcomes of robot-assisted retrograde elastic intramedullary nailing and open reduction and internal fixation (ORIF) with a plate for displaced midshaft clavicular fractures.
All patients diagnosed with displaced midshaft clavicular fractures between November 1, 2022, and June 30, 2023, in our level-III hospital (most advanced level) were enrolled in this retrospective study; a total of 116 patients met the inclusion criteria. Patients were divided into 2 groups on the basis of treatment: robot-assisted retrograde elastic intramedullary nailing (RAN group) and ORIF with a plate (plate group). Operations in the RAN group were carried out using the novel TIANJI Robot system (TINAVI Medical Technologies) for navigation and planning of the optimal retrograde intramedullary nailing trajectory. Patient demographics, perioperative parameters, and complications were documented. Patients were followed at the trauma clinic for clinical and radiographic assessment.
There were 74 patients in the RAN group and 42 patients in the plate group. The RAN group exhibited a significantly shorter total operative time (mean, 52.20 ± 20.76 versus 86.83 ± 27.42 minutes), less blood loss (mean, 7.38 ± 5.54 versus 59.05 ± 30.11 mL), shorter incision length (mean, 1.28 ± 0.85 versus 9.79 ± 1.63 cm), and shorter duration of hospital stay (mean, 3.38 ± 0.73 versus 5.50 ± 1.99 days) (all p < 0.05). Nail treatment was also associated with a significantly shorter time to bone union (mean, 7.92 ± 2.46 versus 16.79 ± 5.18 weeks), a higher SCAR score (mean, 9.77 ± 0.51 versus 5.74 ± 1.15), a shorter time to return to sports (mean, 12.70 ± 2.35 versus 20.10 ± 4.10 weeks), and a shorter time to regain full range of shoulder motion (mean, 9.46 ± 2.35 versus 12.05 ± 2.95 weeks) (all p < 0.05). At the final follow-up, the Constant-Murley shoulder score was significantly higher in the RAN group (mean, 97.57 ± 2.77 versus 93.29 ± 7.63) (p < 0.05). Compared with the RAN group, the plate group had more complications (p < 0.05).
Robot-assisted retrograde elastic intramedullary nailing is a safe and minimally invasive treatment option for displaced midshaft clavicular fractures that promotes rapid healing, good cosmesis, excellent functional outcomes, and fewer complications compared with ORIF with a plate.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究的目的是比较机器人辅助逆行弹性髓内钉固定术与切开复位钢板内固定术（ORIF）治疗移位型锁骨中段骨折的临床疗效。
对2022年11月1日至2023年6月30日期间在我院（三级医院，最高级别）诊断为移位型锁骨中段骨折的所有患者进行了这项回顾性研究；共有116例患者符合纳入标准。根据治疗方法将患者分为2组：机器人辅助逆行弹性髓内钉固定术（RAN组）和切开复位钢板内固定术（钢板组）。RAN组的手术使用新型天玑机器人系统（天智航医疗科技）进行导航，并规划最佳的逆行髓内钉置入轨迹。记录患者的人口统计学资料、围手术期参数和并发症情况。在创伤门诊对患者进行随访，以进行临床和影像学评估。
RAN组有74例患者，钢板组有42例患者。RAN组的总手术时间明显更短（平均52.20±20.76分钟对86.83±27.42分钟），失血量更少（平均7.38±5.54毫升对59.05±30.11毫升），切口长度更短（平均1.28±0.85厘米对9.79±1.63厘米），住院时间更短（平均3.38±0.73天对5.50±1.99天）（所有p<0.05）。髓内钉治疗还与骨折愈合时间明显更短（平均7.92±2.46周对16.79±5.18周）、疤痕评分更高（平均9.77±0.51对5.74±1.15）、恢复运动时间更短（平均12.70±2.35周对20.10±4.10周）以及恢复肩关节全范围活动时间更短（平均9.46±2.35周对12.05±2.95周）相关（所有p<0.05）。在末次随访时，RAN组的Constant-Murley肩关节评分明显更高（平均97.57±2.77对93.29±7.63）（p<0.05）。与RAN组相比，钢板组的并发症更多（p<0.05）。
机器人辅助逆行弹性髓内钉固定术是治疗移位型锁骨中段骨折的一种安全、微创的治疗选择，与切开复位钢板内固定术相比，能促进快速愈合、具有良好的美容效果、出色的功能结局且并发症更少。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
