[1]张朕,刘华水,段升军,等.机器人辅助PFNA与传统手术治疗股骨粗隆间骨折的疗效比较[J].中华老年骨科与康复电子杂志,2020,(01):25-30.[doi:10.3877/cma.j.issn.2096-0263.2020.01.006]
　Zhang Zhen,Liu Huashui,Duan Shengjun,et al.Robot-Assisted PFNA treatment of femoral intertrochanteric fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2020,(01):25-30.[doi:10.3877/cma.j.issn.2096-0263.2020.01.006]
点击复制

机器人辅助PFNA与传统手术治疗股骨粗隆间骨折的疗效比较()
分享到：

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2020年01期
页码:
25-30
栏目:
股骨骨折
出版日期:
2020-02-05

文章信息/Info

Title:
Robot-Assisted PFNA treatment of femoral intertrochanteric fracture
作者:
张朕; 刘华水; 段升军; 赵国辉; 朱礼明; 王学光; 贾逢爽
250132 济南市第三人民医院创伤骨二科
Author(s):
Zhang Zhen;  Liu Huashui;  Duan Shengjun;  Zhao Guohui;  Zhu Liming;  Wang Xueguang;  Jia Fengshuang
Department of Trauma, Third People’s Hospital of Jinan, Jinan 250132, China
关键词:
股骨骨折;  机器人;  微创外科手术
Keywords:
Femoral fractures;  Robotics;  Minimally invasive surgical procedures
DOI:
10.3877/cma.j.issn.2096-0263.2020.01.006
文献标志码:
A
摘要:
目的 对比骨科手术机器人辅助微创治疗股骨粗隆间骨折手术与传统手术的疗效。方法 回顾分析50例股骨粗隆间骨折患者的临床资料，机器人手术组21例，常规手术组29例。其中男26例，女24例，平均年龄（70±15）岁；低能量生活伤44例、车祸伤4例、高处坠落伤2例，记录分析两组患者平均住院日、术前住院日、术中出血量、切口长度、手术时间以及围手术期输血量。所有手术均由经验丰富的骨伤同一团队完成，记录手术并发症，评价手术的效果。结果 两组平均住院日、术前住院日、手术时间无统计学差异；术中出血量（t=-5.159，P＜0.001）、围手术期输血量（t=-3.123，P=0.003）、主钉切口长度（t=-8.877，P＜0.001）、Hb（t=-2.285，P=0.033）及Hct下降方面（t=-2.064，P=0.052），机器人手术组较常规手术组有优势。所有患者3个月复查时均达临床愈合，术后DR示两组术后内固定优良率差异无统计学意义。术后4例患者出现深静脉血栓，2例患者骨折复位不良，7例内固定位置不佳。结论 本研究发现机器人辅助下精准、微创完成PFNA手术，较常规手术术中出血更少、主钉切口更小，在降低了临床用血量的同时在相同的住院时长下取得良好的疗效，该术式在患者高龄、基础条件差或临床用血量不足的情况下的稳定型骨折推荐使用。
Abstract:
Objective Comparative orthopaedic surgery Robot-Assisted minimally invasive surgery and conventional surgical treatment of femoral intertrochanteric fracture effect. Methods Retrospective analysis of 50 cases of intertrochanteric fractures in patients with clinical information, including robotic surgery group 21 cases, general surgery group 30 Cases. 26 male and 24 female, with an average of (70±15) years. The injury mechanism was low energy injuries 44 cases, car accident injuries 4 cases and falling 2 cases. The the recorded average length of stay, preoperative hospital day, intraoperative blood loss, length, operation time and the amount of perioperative Blood transfusions were analyzed. All operations are done by experienced doctor and complications records, assessment of the effectiveness of the operation were recorded. Results There was no statistical difference in the average hospitalization days, preoperative hospitalization days, and operation time between the two groups; intraoperative blood loss , perioperative blood transfusion, and length of the main staple incision , Hb and Hct decrease in robotic surgery group were better than the general surgery group. All patients reexamined at 3 m and all achieved clinical healing. Postoperative DR showed no statistically significant difference in the rate of internal fixation between the two groups. Deep venous thrombosis occurred in 4 patients after surgery, fracture reduction was poor in 2 patients, and internal fixation was poor in 7 patients. Conclusions This study found that robotic-assisted PFNA surgery can be performed accurately and minimally invasively, with less bleeding and smaller staple incisions compared with conventional surgery. It reduces clinical blood volume and achieves good results with the same length of hospital stay. Stable fractures are recommended for patients with advanced age, poor basic conditions, or insufficient blood for clinical use.

参考文献/References:

1 Bojan AJ, Beimel C, Speitling A, et al. 3066 consecutive gamma nails. 12 years experience at a single centre [J]. BMC Musculoskelet Disord, 2010, 11: 133.2 Mavrogenis AF, Panagopoulos GN, Megaloikonomos PD, et al. Complications after hip nailing for fractures [J]. Orthopedics, 2016, 39(1): e108-e116.3 Ostrum RF, Marcantonio A, Marburger R. A critical analysis of the eccentric starting point for trochanteric intramedullary femoral nailing [J]. J Orthop Trauma, 2005, 19(10): 681-686.4 Liu HS, Duan SJ, Xin FZ, et al. Robot-assisted Minimally-invasive Internal Fixation of Pelvic Ring Injuries: A Single-center Experience [J]. Orthop Surg, 2019, 11(1): 42-51.5 Duan SJ, Liu HS, Wu WC, et al. Robot-assisted Percutaneous Cannulated Screw Fixation of Femoral Neck Fractures: Preliminary Clinical Results [J]. Orthop Surg, 2019, 11(1): 34-41.6 刘华水, 段升军, 赵国辉, 等. 骨科手术机器人辅助微创治疗骨盆环损伤108例临床分析[J]. 山东大学学报(医学版), 2019, 57(11): 52-59+64.7 刘华水, 段升军, 贾逢爽, 等. TiRobot机器人辅助经皮空心螺钉内固定治疗不稳定型骨盆骨折 [J]. 山东大学学报:医学版, 2017, 55(7): 103-109.8 赵国辉, 朱礼明, 刘华水, 等. 应用TiRobot机器人辅助经皮空心螺钉内固定治疗髋臼前柱骨折的疗效 [J]. 骨科临床与研究杂志, 2019, 4(04): 219-224.9 刘华水, 段升军, 贾逢爽, 等. 机器人辅助经皮空心螺钉置入联合内置外架治疗不稳定型骨盆骨折一例报告 [J]. 中华骨科杂志, 2017, 37(16): 1054-1056.10 陈龙, 海涌, 关立, 等. 机器人辅助置入与徒手置入椎弓根螺钉的对比研究 [J]. 中国骨与关节杂志, 2017, 6(10): 730-736.11 田伟. 我国医用机器人的研究现状及展望 [J]. 骨科临床与研究杂志, 2018, 3(04): 193-194.12 田伟, 张琦, 李祖昌, 等. 一站对多地5G远程控制骨科机器人手术的临床应用 [J]. 骨科临床与研究杂志, 2019, 4(06): 349-354.13 Liu HS, Duan SJ, Liu SD, et al. Robot-assisted percutaneous screw placement combined with pelvic internal fixator for minimally invasive treatment of unstable pelvic ring fractures [J]. Int J Med Robot, 2018, 14(5): e1927.14 Tian W. Robot-Assisted posterior C1-2 transarticular screw fixation for atlantoaxial instability: a case report [J]. Spine (Phila Pa 1976), 2016, 41(Suppl 19): B2-B5.15 Tian W, Wang H, Liu YJ. Robot-assisted Anterior Odontoid Screw Fixation: A Case Report [J]. Orthop Surg, 2016, 8(3): 400-404.16 Wang JQ, Wang Y, Feng Y, et al. Percutaneous sacroiliac screw placement: a prospective randomized comparison of robot-assisted navigation procedures with a conventional technique [J]. Chin Med J (Engl), 2017, 130(21): 2527-2534.17 Mcconnell T, Tornetta P, Benson E, et al. Gluteus medius tendon injury during reaming for gamma nail insertion [J]. Clin Orthop Relat Res, 2003 (47): 199-202.18 Gardner MJ, Robertson WJ, Boraiah S, et al. Anatomy of the greater trochanteric ’bald spot’: a potential portal for abductor sparing femoral nailing? [J]. Clin Orthop Relat Res, 2008, 466(9): 2196-2200.19 Siegel RS. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip [J]. J Bone Joint Surg Am, 1996, 78(9): 1447; author reply 1447-8.20 Lilly RJ, Koueiter DM, Graner KC, et al. Computer-assisted navigation for intramedullary nail fixation of intertrochanteric femur fractures: A randomized, controlled trial [J]. Injury, 2018, 49(2): 345-350.

相似文献/References:

[1]刘军,李计东,刘丽君,等.双反牵引复位经皮微创锁定接骨板内固定治疗股骨远端骨折的临床疗效[J].中华老年骨科与康复电子杂志,2017,(01):27.[doi:10.3877/cma.j.issn.2096-0263.2017.01.006]
　Liu Jun,Li Jidong,Liu Lijun,et al.The efficacy of double reverse traction combined with percutaneous minimally invasive locking plate internal fixation in treatement of distal femoral fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(01):27.[doi:10.3877/cma.j.issn.2096-0263.2017.01.006]
[2]付松,邵诗泽,王龙强,等.Quadrant系统下椎间融合辅助机器人治疗老年单节段腰椎退变的临床研究[J].中华老年骨科与康复电子杂志,2017,(02):70.[doi:10.3877/cma.j.issn.2096-0263.2017.02.002]
　Fu Song,Shao Shize,Wang Longqiang,et al.Clinical research on interbody fusion assisted by Quadrant systemand robot in the treatment of single segment lumbar degenerative[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(01):70.[doi:10.3877/cma.j.issn.2096-0263.2017.02.002]
[3]丛锐军,仇荣敏,刘俊峰,等.顺势牵引复位技术治疗股骨干骨折的前瞻性随机对照临床试验[J].中华老年骨科与康复电子杂志,2018,(04):193.[doi:10.3877/cma.j.issn.2096-0263.2018.04.001]
　Cong Ruijun,Qiu Rongmin,Liu Junfeng,et al.Prospective randomized trial of homeopathic traction reduction technique for femoral shaft fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(01):193.[doi:10.3877/cma.j.issn.2096-0263.2018.04.001]
[4]王昊 方诗元 王叙进 徐磊 杨家赵 李黎 刘雷.传统切开复位与顺势反向牵引复位微创固定治疗股骨远端骨折的临床比较[J].中华老年骨科与康复电子杂志,2018,(05):257.
　Wang Hao,Fang Shiyuan,Wang Xujin,et al. Clinical comparison between traditional open reduction and Zhang’s traction device for minimally invasive treatment of distal femoral fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(01):257.
[5]王建华,林艳,吴永东,等.经皮撬拨复位内固定技术对难复性股骨粗隆间骨折老年患者NE、AngⅡ水平及髋关节功能的影响[J].中华老年骨科与康复电子杂志,2021,(01):9.[doi:10.3877/cma.j.issn.2096-0263.2021.01.003]
　Wang Jianhua,Lin Yan,Wu Yongdong,et al.Effect of percutaneous plucking reduction and internal fixation technology on the levels of NE and AngⅡand hip joint function in elderly patients with irreversible intertrochanteric fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2021,(01):9.[doi:10.3877/cma.j.issn.2096-0263.2021.01.003]
[6]宋涯含,晁洪露,田华,等.机器人在骨科应用相关研究的国际现状与趋势分析[J].中华老年骨科与康复电子杂志,2023,(01):59.[doi:10.3877/cma.j.issn.2096-0263.2023.01.011]
　Song Yahan,Chao Honglu,Tian Hua,et al.Global status and research trend of robot application in orthopedics by bibliometric analysis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2023,(01):59.[doi:10.3877/cma.j.issn.2096-0263.2023.01.011]

备注/Memo

备注/Memo:
国家重点研发计划数字诊疗装备研发重点专项（国家科技部国科生字[2017]49号2017YFC0114002）
更新日期/Last Update: 2020-07-07