北京生物医学工程

天玑骨科手术机器人辅助经皮固定骶髂螺钉治疗不稳定骨盆后环骨折的应用临床

Clinical study of S2 iliosacral? screw fixation with TiRobot assistance in unstable posterior pelvic ring fracture

作者：韩巍张腾苏永刚赵春鹏周力吴新宝王军强

单位：北京积水潭医院创伤骨科（北京 100035）北京天智航医疗科技股份有限公司（北京 100192）

关键词：天玑；机器人辅助；经皮；骶髂螺钉；骨盆骨折

分类号：R318.04

出版年·卷·期（页码）：2021·40·3（257-262）

摘要：

目的评估机器人辅助经皮固定S2（骶髂）螺钉的有效性、安全性以及准确性。方法回顾性分析了自2016年1月至2019年1月在北京积水潭医院接受S2骶髂螺钉固定治疗不稳定骨盆后环骨折的63例患者病例资料。其中试验组38例采用机器人辅助下医生植入S2骶髂螺钉，对照组25例患者采用传统透视下医生徒手植入S2骶髂螺钉。通过评价术后CT扫描图像评估所有螺钉植入位置及骨折复位情况，分析天玑（ TiRobot）骨科手术机器人辅助螺钉置入与医生徒手植入螺钉在临床表现的对比。结果两组患者共计植入89枚S2骶髂关节螺钉，相比于医生徒手植入螺钉，实验组具有提高植入精准度、减少手术过程中辐射暴露、降低患者损伤等优势。对每个评判指标进行详细描述，其中试验组植入54枚，对照组35枚。均未出现螺钉相关的并发症及翻修手术。试验组螺钉位置优良率为100%，高于对照组的85.7%（P<0.001）。试验组每枚螺钉的透视时间及导针调整次数均少于对照组（P<0.001）。根据Matta标准评定的术后优良率试验组及对照组分别为86.8%与90.0%，没有统计学差异（P=0.750）。结论机器人辅助手术是一项更加精准、微创的技术。天玑?骨科手术机器人辅助下植入S2骶髂螺钉治疗不稳定的骨盆后环骨折比透视下徒手操作成功率更高。机器人辅助下经皮固定S2骶髂螺钉治疗不稳定骨盆后环损伤是安全且临床可行的，具有较好的临床应用价值。

Objective Assesse the efficiency, safety and accuracy of S2 iliosacral screws fixation with robot assistance. Methods We analysed the patients treated with S2 IS screw fixation for unstable pelvic fractures from January 2016 to January 2019 in Beijing Jishuitan Hospital. In this study, we collected sixty-three patients (17 men and 46 women) aged between 21 and 55 years (with an average of 39.22 ± 9.28). There were 26 (41.3%) type B fracture and 37 (58.7%) type C fractures according to the Tile classification. All patients were divided into robot-assisted (RA) group (38 patients) and traditional free-hand (FH) group (25 patients). In RA group, the S2 IS screws implanted with Robot-assisted technique. While S2 IS screws implanted with traditional free-hand technique in FH group. We recorded the screw-related complications. The position of all screws and fracture reduction was assessed by postoperative CT scans. We also analysed the number of guide wire attempts and the radiation exposure for S2 screw implantation. Results A total of 89 IS screws were implanted into S2 iliosacral joint. Fifty-four screws were placed by RA, and 35 screws were by FH. There were no screw-related complications or revision surgery. In term of screw placement, the excellent and good rate was 100% in the RA group, better than that in the FH group, only 85.7% (P< 0.001). Both the fluoroscopy time per screw and the number of guide wire attempts in the RA group were much less than those in the FH group (P< 0.001). The overall postoperative excellent and good rate of Matta standard in RA and FH group was 86.8% and 90.0%, respectively (P= 0.750)，there was no statistical difference. Conclusion The Robot-assisted surgery is an accurate and minimally invasive technique. S2 IS screw implantation assisted by TiRobot to treat the posterior pelvic ring fractures, have a high success rate than the freehand technique. Percutaneous RA S2 IS screw fixation for unstable posterior pelvic ring injuries is safe and clinically feasible and has great clinical application value.

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