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目的比较机器人导航下与传统经皮空心拉力螺钉内固定术治疗股骨颈骨折的疗效,探讨机器人导航的优势。方法回顾分析2013年1月-2014年12月,于机器人导航下行经皮空心拉力螺钉内固定术的20例股骨颈骨折患者临床资料(导航组),并与同期采用传统经皮空心拉力螺钉内固定术治疗的18例患者(对照组)进行比较。两组患者性别、年龄、致伤原因、受伤至手术时间、侧别及骨折类型等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录两组手术时间、术中透视时间、导针植入次数、术中出血量以及骨折愈合情况。于术后1周正、侧位X线片上测量并计算螺钉相互平行程度。术后12个月采用Harris评分标准对髋关节功能进行评价。结果两组术后切口均Ⅰ期愈合。导航组手术时间与对照组比较,差异无统计学意义(t=—1.139,P=0.262),但术中透视时间、导针植入次数以及术中出血量均显著低于对照组(P<0.05)。术中对照组2枚螺钉穿透骨质进入关节腔,导航组无螺钉进入关节腔。两组患者均获随访,随访时间12~24个月,平均18个月。术后正、侧位X线片测量示,导航组螺钉相互平行程度显著优于对照组,比较差异有统计学意义(t=25.021,P=0.000;t=18.659,P=0.000)。X线片复查示,导航组骨折均愈合(100%),愈合时间为(21.8±2.8)周;对照组16例(88.9%)骨折愈合,愈合时间为(24.0±3.7)周。两组骨折愈合率以及愈合时间比较,差异均无统计学意义(χ~2=2.346,P=0.126;t=1.990,P=0.055)。术后12个月,导航组髋关节功能Harris评分为(87.1±3.7)分,显著高于对照组的(79.3±4.7)分,比较差异有统计学意义(t=—5.689,P=0.000)。结论与传统术式相比,机器人导航下经皮空心拉力螺钉内固定术治疗股骨颈骨折定位准确,手术创伤小,术中X线暴露时间显著减少,髋关节功能恢复好。
Objective To compare the effects of robotic navigation and traditional percutaneous hollow lag screw fixation in the treatment of femoral neck fracture and to explore the advantages of robot navigation. Methods The clinical data of 20 patients with femoral neck fracture treated by robotic navigation and percutaneous hollow lag screw fixation from January 2013 to December 2014 were retrospectively analyzed. The results were compared with those of the conventional percutaneous hollow lag screw 18 patients treated with fixed surgery (control group) were compared. There was no significant difference between the two groups in general information such as sex, age, cause of injury, time from injury to operation, side and type of fracture (P> 0.05). The operation time, intraoperative fluoroscopy time, the number of guided needle implants, intraoperative blood loss and fracture healing were recorded. At 1 week after surgery, lateral X-ray films were measured and the screws were parallel to each other. At 12 months after operation, the hip function was assessed using the Harris score. Results The two groups of incisions healed in the first stage. The operation time of the navigation group was not significantly different from that of the control group (t = -1.139, P = 0.262), but the intraoperative fluoroscopy time, the number of guide pins implanted and intraoperative blood loss were significantly lower than those of the control group (P < 0.05). Intraoperative control group 2 screws penetrate the bone into the joint cavity, the navigation group without screws into the joint cavity. Two groups of patients were followed up for 12 to 24 months with an average of 18 months. Postoperative and lateral X-ray measurements showed that the screws in the navigation group were significantly better than the control group, with significant difference (t = 25.021, P = 0.000; t = 18.659, P = 0.000). X-ray examination showed that all the fractures were healed (100%) and the healing time was (21.8 ± 2.8) weeks in the navigation group while the healing time was 24.0 ± 3.7 weeks in the control group (88.9%). There was no significant difference in healing rate and healing rate between the two groups (χ ~ 2 = 2.346, P = 0.126; t = 1.990, P = 0.055). At 12 months after operation, the Harris score of hip function in the navigation group was (87.1 ± 3.7) points, significantly higher than that in the control group (79.3 ± 4.7), with significant difference (t = -5.689, P = 0.000) . Conclusion Compared with traditional surgical procedures, percutaneous hollow lag screw fixation with robotic navigation can accurately locate femoral neck fractures, reduce traumatic injuries, significantly reduce intraoperative X-ray exposure time and improve hip joint function.