骨科手术机器人辅助下微创内固定手术治疗骨盆骨折的病例对照研究

doi:10.3969/j.issn.1006-7795.2025.05.005

摘要/Abstract

摘要： 目的通过对比分析手术机器人辅助与传统徒手微创手术治疗骨盆骨折的临床指标，探讨其技术优势及适用场景，以期为临床决策提供依据。方法回顾性分析2022年1月至2024年12月采用微创内固定治疗的59例骨盆骨折患者的临床资料。根据手术方法分为传统组（26例）及机器人导航组（33例）。手术前后均进行骨盆电子计算机断层扫描（computed tomography，CT）并拍摄前后位、出口位、入口位X线片，根据X线及CT影像测量骨盆复位后的最大残余位移及螺钉的精度。记录术中透视次数、辐射剂量、手术时间、出血量、置入螺钉的数量、复位后的最大残余位移及螺钉精度。结果两组患者年龄、性别、致伤原因及骨折分型差异无统计学意义，具可比性。两组患者术中出血量及骨折复位质量差异无统计学意义。传统组手术时间为52.5(30.8, 62.3) min，机器人组为60(50, 82.5) min；传统组术中透视次数及辐射剂量分别为(19.1±5.4)次、33.1(27.5, 43.9）mGy，机器人组平均为(12.1±4.9)次、123.1(101.1, 131.4) mGy。机器人组术后螺钉精度较传统组更优，更多采用前柱螺钉固定且术后下地时间更短。结论骨科机器人辅助骨盆骨折微创手术在提高置钉精度、减少医师辐射暴露方面显著优于传统徒手操作，是治疗不稳定骨盆骨折的一种可优先选择的手术方法。

关键词: 骨盆骨折, 手术机器人, 导航, 骶髂螺钉, 微创手术, 辐射暴露

Abstract: Objective To explore the technical advantages and applicable scenarios of surgical robot-assisted versus conventional freehand minimally invasive surgery for pelvic fractures by comparing clinical indicators, thereby providing evidence for clinical decision-making. Methods A retrospective case-control study was conducted on 59 patients with pelvic fractures treated with minimally invasive internal fixation between January 2022 and December 2024. Patients were divided into a conventional group (26 cases) and a robot-assisted navigation group (33 cases) based on the surgical technique. Pre- and postoperative pelvic computed tomography (CT) scans were performed, and anteroposterior, outlet, and inlet view radiographs were obtained. The maximum residual displacement after pelvic reduction and screw placement accuracy were measured based on radiographic and CT imaging. Intraoperative fluoroscopy frequency, radiation dose, operative time, blood loss, number of implanted screws , maximum residual displacement after reduction, and screw accuracy were recorded. Results No significant differences were observed between the two groups in age, gender, injury mechanism, or fracture classification, indicating comparability. Blood loss and fracture reduction quality showed no significant differences. The operative time was 52.5(30.8, 62.3) min in the conventional group and 60(50, 82.5) min in the robot-assisted group. Intraoperative fluoroscopy frequency and radiation dose were (19.1 ± 5.4) times and 33.1(27.5, 43.9) mGy in the conventional group, compared to (12.1 ± 4.9) times and 123.1(101.1, 131.4) mGy in the robot-assisted group. The robot-assisted group demonstrated superior screw placement accuracy, increased utilization of anterior column screws, and shorter postoperative ambulation time. Conclusion Robot-assisted minimally invasive surgery for pelvic fractures significantly outperforms conventional freehand techniques in improving screw placement accuracy and reducing radiation exposure for surgeons. It represents a preferable option for treating unstable pelvic fractures.

Key words: pelvic fracture, robotic surgery, navigation, sacroiliac screw, minimally invasive surgery, radiation exposure

中图分类号:

R683

龙安华, 张家凡, 杨琦, 汪雄飞, 张亚奎, 王雪飞, 刘亮. 骨科手术机器人辅助下微创内固定手术治疗骨盆骨折的病例对照研究[J]. 首都医科大学学报, doi: 10.3969/j.issn.1006-7795.2025.05.005.

Long Anhua, Zhang Jiafan, Yang Qi, Wang Xiongfei, Zhang Yakui, Wang Xuefei, Liu Liang. A case-control study of minimally invasive internal fixation for pelvic fractures assisted by an orthopedic surgical robot[J]. Journal of Capital Medical University, doi: 10.3969/j.issn.1006-7795.2025.05.005.

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