摘要
目的探讨骨科手术机器人辅助双Endobutton内固定治疗新鲜肩锁关节脱位的早期临床疗效。方法 2020年1月至2022年1月收治新鲜肩锁关节脱位患者39例, 其中19例应用国产第三代骨科手术机器人天玑系统辅助双Endobutton悬吊内固定, Rockwood分型Ⅲ型11例、Ⅳ型8例;20例采用常规切开双Endobutton内固定术, Rockwood分型Ⅲ型13例、Ⅳ型7例。比较两组病例手术时间、术中出血量、切口长度及住院时间, 术后第2天和术后1年肩锁关节CT影像学参数(锁骨远端下皮质与肩峰下皮质的距离、上下两枚Endobutton的距离、锁骨远端前缘与肩峰前缘的水平间距、喙突骨隧道直径及锁骨骨隧道直径), 术前及术后12个月的视觉模拟评分(visual analogue scale, VAS)评分、Constant-Murley肩关节功能评分、肩关节外展活动度。结果术后机器人组随访时间(10.8±2.4)个月, 常规组(11.5±3.1)个月。机器人组术后12个月VAS评分由术前(5.3±2.1)分降低至(0.3±0.2)分, 差异有统计学意义(t=10.46, P=0.014);Constant-Murley评分由术前(55.6±6.4)分提高至(92.0±4.2)分, 差异有统计学意义(t=7.28, P=0.012);肩关节外展活动度由术前42.2°±5.4°增加至172.6°±6.1°, 差异有统计学意义(t=17.24, P<0.001)。机器人组手术时间为(74.4±6.6) min, 较常规切开组的(61.7±7.2) min长, 差异有统计学意义(t=5.43, P=0.037)。两组术前、术后12个月的VAS、Constant-Murley评分、肩关节外展活动度、CT影像测量指标的差异均无统计学意义(P>0.05)。随访期间机器人组2例出现锁骨上表面皮质骨溶解;常规切开组1例出现复位丢失、1例锁骨上皮质骨溶解、4例喙突骨隧道一侧皮质缺损。结论骨科机器人辅助和常规切开双Endobutton钛板内固定治疗新鲜肩锁关节脱位均可取得良好的早期临床效果。机器人辅助下精准建立锁骨及喙突骨隧道, 可克服常规切开手术骨隧道偏移的缺点, 防止复位再丢失。机器人辅助和常规切开Endobutton内固定均存在骨隧道扩大的问题。
Objective To investigate the early clinical effects of orthopedic surgery robot-assisted double Endobutton titanium plate internal fixation in the treatment of fresh acromioclavicular joint dislocation.Methods Thirty-nine patients with fresh acromioclavicular joint dislocation were included from January 2020 to January 2022.A total of 19 patients were treated with double Endobutton suspension internal fixation assisted by the domestic third-generation orthopaedic surgical robot(TiRobot®2.0)Dimensity system.There were Rockwood type III in 11 cases,type IV in 8 cases.Twenty cases were treated with conventional incision double Endobutton internal fixation,with Rockwood type III in 13 cases,type V in 7 cases.The operation duration,blood loss volume,incision length and hospitalization time were compared between the two groups.The following CT parameters of acromioclavicular joint at 2 days and 1 year after operation,distance between distal inferior cortex of clavicle and subacromial cortex,distance between upper and lower endobuttons,horizontal distance between anterior edge of distal clavicle and anterior edge of acromion and diameter of coracoid process and diameter of clavicular tunnel were measured.The visual analogue score(VAS),Constant-Murley shoulder function score and shoulder abduction activity were also evaluated before and at 12 months after operation.Results The follow-up duration was 10.8±2.4 months in the robot group and 11.5±3.1 months in the routine group.The VAS score of the robot group decreased from 5.3±2.1 to 0.3±0.2 at 12 months after operation(t=10.46,P=0.014).The Constant-Murley score increased from 55.6±6.4 to 92.0±4.2.The range of shoulder abduction increased from 42.2°±5.4°to 172.6°±6.1°(t=17.24,P<0.001).The operation duation of the robot group was 74.4±6.6 min,which was longer than that of the conventional group 61.7±7.2 min(t=5.43,P=0.037).There was no significant difference in VAS score,Constant-Murley score,shoulder abduction activity or CT measurement between the two groups(P>0.05).During the follow-up,two cases in the robot group had cortical osteolysis on the supraclavicular surface,one case in the conventional group had loss of reduction,one case in the supraclavicular cortical osteolysis,and 4 cases in the cortical defect on the side of the coracoid process tunnel.Conclusion Orthopedic robot-assisted and conventional incision with double Endobutton titanium plate internal fixation in treating fresh acromioclavicular joint dislocation can achieve satisfied early clinical effects.Accurate establishment of clavicle and coracoid bone tunnel assisted by robot can overcome the defects of bone tunnel deviation in conventional incision operation and can prevent reduction and bone loss.However,robot-assisted and conventional incision Endobutton internal fixation could enlarge bone tunnel.
作者
杨成志
王仁崇
曾慧珍
谢湘涛
许鉴
唐经励
吴昊
李兵
胡居正
Yang Chengzhi;Wang Renchong;Zeng Huizhen;Xie Xiangtao;Xu Jian;Tang Jingli;Wu Hao;Li Bing;Hu Juzheng(Trauma Center,Fourth Affiliated Hospital of Guangxi Medical University(Liuzhou Worker's Hospital),Liuzhou 545005,China;Department of Ultrasound Diagnostic,Fourth Affiliated Hospital of Guangxi Medical University(Liuzhou Worker's Hospital),Liuzhou 545005,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2022年第21期1423-1432,共10页
Chinese Journal of Orthopaedics
基金
广西卫健委自筹经费课题(Z20180512)
国家自然科学基金(82102632)。
关键词
肩锁关节
关节脱位
机器人手术
外科手术
计算机辅助
骨板
钛
Acromioclavicular joint
Joint dislocations
Robotic surgical procedures
Surgery,computer-assisted
Bone plates
Titanium
作者简介
通信作者:胡居正,Email:hujuzheng@sina.com。
