机器人辅助经皮空心螺钉内固定治疗隐匿性Lisfranc损伤
|
摘要
[目的]探讨应用骨科手术机器人辅助经皮空心螺钉内固定治疗隐匿性Lisfranc损伤的手术疗效。[方法]2017年1月～2018年1月,对10例隐匿性Lisfranc损伤患者采用第三代骨科手术机器人TiRobot系统辅助经皮空心螺钉行内固定手术治疗,观察置钉路径及位置,记录手术时间、术中透视次数及透视时间、手术切口长度、出血量、术后并发症及术后康复情况等。[结果]所有置入螺钉均位置精确无误,平均手术时间(50.16±19.32)min,平均透视次数(8.21±3.02)次,平均切口长度(5.23±1.82)mm,平均术中出血量(15.37±6.71)ml。无任何严重并发症,如医源性血管、神经及脏器损伤和骨筋膜室综合征。术后随访3～10个月,平均(5.03±1.90)个月,无关节再脱位或畸形愈合。末次随访AOFAS评分结果:平均(87.32±10.37)分,其中优7例,良2例,可1例。[结论]骨科手术机器人辅助经皮空心螺钉内固定手术方式适用于治疗隐匿性Lisfranc损伤,并具有置钉精确度高、手术时间短、透视次数少、创伤小、并发症少等优点,临床效果满意,是微创治疗Lisfranc损伤的有效方法。
[Objective] To explore the clinical outcomes of Ti Robot-assisted percutaneous screw fixation for occult Lisfranc injuries.[Methods] A retrospective study was conducted on 10 patients who received Ti Robot-assisted percutaneous screw fixation for occult Lisfranc injuries from Jan 2017 to Jan 2018.The screw placement,operation time,frequency of X-ray image intensifier used intraoperatively,incision length,blood loss,bony healing time,and postoperative function were evaluated.[Results] All screws were inserted accurately without penetration through bone cortex.The operation lasted(50.16±19.32)minutes on average,with X-ray exposure of(8.21±3.02) times,incision length of(5.23±1.82) mm,and blood loss of(15.37±6.71) ml.No severe complications,such as neurovascular injuries and compartment syndrome,happened in anyone of them.The patients were followed up from 3 to 10 months with an average of 5 months.No re-dislocation and malunion occurred in any of them.At the latest follow up,the AOFAS proved(87.32±10.37),corresponding to the results of excellent in 7,good in 2 and fair in 1 patient.[Conclusion] Ti Robot-assisted percutaneous screw placement is minimally invasive and very effective for occult Lisfranc injuries,with advantages of high precise of screw placement,shortening operation time and less complication
[Objective] To explore the clinical outcomes of Ti Robot-assisted percutaneous screw fixation for occult Lisfranc injuries.[Methods] A retrospective study was conducted on 10 patients who received Ti Robot-assisted percutaneous screw fixation for occult Lisfranc injuries from Jan 2017 to Jan 2018.The screw placement,operation time,frequency of X-ray image intensifier used intraoperatively,incision length,blood loss,bony healing time,and postoperative function were evaluated.[Results] All screws were inserted accurately without penetration through bone cortex.The operation lasted(50.16±19.32)minutes on average,with X-ray exposure of(8.21±3.02) times,incision length of(5.23±1.82) mm,and blood loss of(15.37±6.71) ml.No severe complications,such as neurovascular injuries and compartment syndrome,happened in anyone of them.The patients were followed up from 3 to 10 months with an average of 5 months.No re-dislocation and malunion occurred in any of them.At the latest follow up,the AOFAS proved(87.32±10.37),corresponding to the results of excellent in 7,good in 2 and fair in 1 patient.[Conclusion] Ti Robot-assisted percutaneous screw placement is minimally invasive and very effective for occult Lisfranc injuries,with advantages of high precise of screw placement,shortening operation time and less complication
引文
[1]Murphy N,Olney D.Lisfranc joint injuries:trauma mechanisms and associated injuries[J].J Trauma,1994,36(3):464.
[2]杨战锋.切开复位内固定术与关节融合术治疗陈旧性Lisfranc损伤的临床疗效[J].中国伤残医学,2015,9(1):58-59.
[3]杨茂伟,梁单,郭宝磊,等.Lisfranc损伤切开复位内固定术与关节融合术临床疗效的Meta分析[J].中国医科大学学报,2011,40(4):364-367.
[4]Bai W,Cao Q,Leng C,et al.A novel optimal coordinated controlstrategy for the updated robot system for single port surgery[J].Int J Med Robot,2017,13(3):e1844.
[5]韩晓光,刘亚军,范明星,等.骨科手术机器人技术发展及临床应用[J].科技导报,2017,35(10):19-25.
[6]Lee CA,Birkedal JP,Dickerson EA,et al.Stabilization of Lisfranc joint injuries:a biomechanical study[J].Foot Ankle Int,2004,25(5):365-370.
[7]沈雷,蒋雷生,戴力扬.Lisfranc损伤的诊断和治疗[J].临床骨科杂志,2006,9(2):121-123.
[8]孙金占,张玉昌,张磊.切开复位内固定治疗Lisfranc关节损伤[J].中国矫形外科杂志,2009,8:635-636.
[9]Wu J,Zhao K.Efficacy of open reduction and internal fixation with hollow screws in treating Lisfranc injury[D].J Shanxi College Traditional Chinese Med,2015.
[10]余霄.Lisfrance损伤的相关临床诊治现状[J].中国矫形外科杂志,2011,19(12):998-1001.
[11]高翔,赵晓涛,陈玉宏,等.隐匿性Lisfranc损伤的早期诊断与治疗[J].中国矫形外科杂志,2013,21(16):1669-1672.
[12]Kuo RS,Tejwani NC,Digiovanni CW,et al.Outcome after open reduction and internal fixation of Lisfranc joint injuries[J].JBJS,2000,82(11):1609-1618.
[13]Solan M C,Miyamoto RG,Jasper LE,et al.Ligamentous restraints of the second tarsometatarsal joint:a biomechanical evaluation[J].Foot Ankle Int,2001,22(8):637.
[14]Coetzee JC,Ly TV.Treatment of primarily ligamentous Lisfranc joint injuries[J].J Bone Joint Surg Am,2007,88(3):514-520.
[15]Ly TV,Coetzee JC.Treatment of primarily ligamentous lisfranc joint injuries:primary arthrodesis compared with open reduction and internal fixation.a prospective,randomized study[J].J Bone Joint Surg Am,2006,88(3):514-520.
[16]Barkana DE.Design and implementation of a control architecture for robot-assisted orthopaedic surgery[J].Int J Med Robotics Computer Assisted Surg,2010,6(1):42-56.
[17]Suero EM,Hartung T,Westphal R,et al.Improving the human-robot interface for telemanipulated robotic long bone fracture reduction:Joystick device vs.haptic manipulator[J].Int J Med Robotics Computer Assisted Surg,2018,14(1):1863.
[18]Panzica M,Suero EM,Westphal R,et al.Robotic distal locking of intramedullary nailing:technical description and cadaveric testing[J].Int J Med Robot,2017,13(4):1831.
[19]Karthik K,Colegate-Stone T,Dasgupta P,et al.Robotic surgery in trauma and orthopaedics:a systematic review[J].Bone Joint J,2015:97-B(3):292-299.
[2]杨战锋.切开复位内固定术与关节融合术治疗陈旧性Lisfranc损伤的临床疗效[J].中国伤残医学,2015,9(1):58-59.
[3]杨茂伟,梁单,郭宝磊,等.Lisfranc损伤切开复位内固定术与关节融合术临床疗效的Meta分析[J].中国医科大学学报,2011,40(4):364-367.
[4]Bai W,Cao Q,Leng C,et al.A novel optimal coordinated controlstrategy for the updated robot system for single port surgery[J].Int J Med Robot,2017,13(3):e1844.
[5]韩晓光,刘亚军,范明星,等.骨科手术机器人技术发展及临床应用[J].科技导报,2017,35(10):19-25.
[6]Lee CA,Birkedal JP,Dickerson EA,et al.Stabilization of Lisfranc joint injuries:a biomechanical study[J].Foot Ankle Int,2004,25(5):365-370.
[7]沈雷,蒋雷生,戴力扬.Lisfranc损伤的诊断和治疗[J].临床骨科杂志,2006,9(2):121-123.
[8]孙金占,张玉昌,张磊.切开复位内固定治疗Lisfranc关节损伤[J].中国矫形外科杂志,2009,8:635-636.
[9]Wu J,Zhao K.Efficacy of open reduction and internal fixation with hollow screws in treating Lisfranc injury[D].J Shanxi College Traditional Chinese Med,2015.
[10]余霄.Lisfrance损伤的相关临床诊治现状[J].中国矫形外科杂志,2011,19(12):998-1001.
[11]高翔,赵晓涛,陈玉宏,等.隐匿性Lisfranc损伤的早期诊断与治疗[J].中国矫形外科杂志,2013,21(16):1669-1672.
[12]Kuo RS,Tejwani NC,Digiovanni CW,et al.Outcome after open reduction and internal fixation of Lisfranc joint injuries[J].JBJS,2000,82(11):1609-1618.
[13]Solan M C,Miyamoto RG,Jasper LE,et al.Ligamentous restraints of the second tarsometatarsal joint:a biomechanical evaluation[J].Foot Ankle Int,2001,22(8):637.
[14]Coetzee JC,Ly TV.Treatment of primarily ligamentous Lisfranc joint injuries[J].J Bone Joint Surg Am,2007,88(3):514-520.
[15]Ly TV,Coetzee JC.Treatment of primarily ligamentous lisfranc joint injuries:primary arthrodesis compared with open reduction and internal fixation.a prospective,randomized study[J].J Bone Joint Surg Am,2006,88(3):514-520.
[16]Barkana DE.Design and implementation of a control architecture for robot-assisted orthopaedic surgery[J].Int J Med Robotics Computer Assisted Surg,2010,6(1):42-56.
[17]Suero EM,Hartung T,Westphal R,et al.Improving the human-robot interface for telemanipulated robotic long bone fracture reduction:Joystick device vs.haptic manipulator[J].Int J Med Robotics Computer Assisted Surg,2018,14(1):1863.
[18]Panzica M,Suero EM,Westphal R,et al.Robotic distal locking of intramedullary nailing:technical description and cadaveric testing[J].Int J Med Robot,2017,13(4):1831.
[19]Karthik K,Colegate-Stone T,Dasgupta P,et al.Robotic surgery in trauma and orthopaedics:a systematic review[J].Bone Joint J,2015:97-B(3):292-299.