机器人导航经皮微创内固定术治疗钩骨钩骨折的临床效果观察

doi:10.3760/cma.j.cn101202-20210519-00135

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摘要目的探讨应用骨科机器人导航经皮内固定治疗钩骨钩骨折的临床疗效。方法回顾性研究。纳入2019年9月—2020年11月徐州仁慈医院手外科治疗的21例新鲜钩骨钩骨折患者的资料。其中男18例,女3例;年龄26~56岁,平均40.7岁。患者均采用骨科机器人导航定位,经皮精准置入Herbert螺钉内固定治疗。观察患者手术时间、术中出血量、术后切口愈合情况及手术相关并发症发生情况。术后定期复查,观察患者骨折愈合时间。末次随访时：测量并比较患侧与健侧腕关节屈曲、背伸活动角度,尺侧、桡侧偏斜角度,捏力及握力;采用改良 Mayo 腕关节评分评估腕关节功能;采用疼痛视觉模拟评分法（VAS）评价腕关节主动及被动活动疼痛程度。结果所有患者顺利完成手术,手术时间45~55 min,平均50 min。术中出血量0.5~1.0 mL,平均0.75 mL。患者术后切口均一期愈合,无切口感染,无尺神经损伤、环小指屈肌腱损伤。21例患者均获得随访,随访时间5~18个月,平均11.5个月。患者术后骨折均愈合,愈合时间3~4个月。患者末次随访时：患侧腕关节屈曲、背伸活动角度,尺侧、桡侧偏斜角度,捏力及握力分别为69.4°±1.5°、54.5°±2.1°、41.2°±1.7°、14.5°±1.6°、（10.5±1.5）kg、（35.1±1.6）kg,健侧分别为70.2°±1.4°、55.3°±2.0°、42.3°±1.6°、15.3°±1.5°、（11.3±1.3）kg、（35.9±1.5）kg,侧别间差异均无统计学意义（P值均>0.05）;腕关节主动活动疼痛VAS评分0~2分、平均0.88分,被动活动疼痛VAS评分0~2分、平均0.98分;改良Mayo腕关节功能评分89~100分,平均94.5分,其中优20例、良1例。结论应用机器人导航定位系统辅助经皮微创内固定治疗钩骨钩骨折具有精准定位、精准置钉及不损伤尺神经、环小指屈肌腱等优点,临床疗效可靠,可作为治疗无移位的钩骨钩骨折的优先选择。

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	唐洪伟
	齐伟亚
	朱辉
	方杰
	郑大伟
	江起庭

关键词 ：骨折固定术,内, 钩骨钩骨折, 外科手术,计算机辅助, 导航技术, 微创手术

Abstract：Objective To investigate the clinical effect of robot-guided percutaneous internal fixation in the treatment of unhook fracture. Methods A retrospective study was conducted. Data of 21 patients with fresh unhook fracture treated by Hand Surgery in Xuzhou Renci Hospital from September 2019 to November 2020 were included. The patients comprised 18 males and 3 females aged 26-56 years, with an average of 40.7 years. All patients were treated with robot navigation and positioning and had precise insertion of Herbert screw for percutaneous internal fixation. Operative time, intraoperative blood loss, postoperative incision healing and occurrence of surgery-related complications were observed. Fracture healing time was observed after the operation. At the last follow-up, wrist flexion and dorsiflexion, ulnar and radial deflection angles, pinch force, and grip force were measured and compared between the affected and healthy sides. The modified Mayo wrist score was used to evaluate wrist function. Visual analog scale (VAS) was used to evaluate active and passive pain. Results All patients completed the operation successfully, and the operation time was 45-55 minutes, with an average of 50 minutes. The intraoperative blood loss was 0.5-1.0 mL, with an average of 0.75 mL. The postoperative wound healing was considered primary in all patients, and wound infection, ulnar nerve injury, and annular flexor tendon injury of little finger were not detected. All 21 patients were followed up for 5-18 months (mean 11.5 months). All the fractures healed after surgery, and the healing time was 3-4 months. At the last follow-up, the angle of wrist flexion and dorsiflexion on the affected side, the angle of ulnar and radial deviation, the pinch force, and the grip force were 69.4°±1.5°, 54.5°±2.1°, 41.2°±1.7°, 14.5°±1.6°, (10.5±1.5) kg, and (35.1±1.6) kg, respectively. The values in the control side were 70.2°±1.4°, 55.3°±2.0°, 42.3°±1.6°, 15.3°±1.5°, (11.3±1.3) kg, and (35.9±1.5) kg, respectively. No significant difference was found between the affected side and the control side (all P values >0.05). The VAS scores of active wrist pain were 0-2 and 0.88, and the VAS scores of passive wrist pain were 0-2 and 0.98. The modified Mayo wrist function scores ranged from 89 to 100 points, with an average of 94.5 points, including 20 excellent cases and 1 good case. Conclusion The application of robot navigation and positioning system-assisted percutaneous minimally invasive internal fixation for the treatment of undisplaced unhook fracture has the advantages of precise positioning, precise nail placement, and lack of damage to the ulnar nerve and flexor tendon of the ring little finger. The system is clinically reliable and can be a priority choice for the treatment of undisplaced unhook fracture.

Key words： Fracture fixation,internal Fracture of the hook bone Surgery Computer-assisted Navigation technology Minimally invasive surgery

收稿日期: 2021-05-19

通讯作者: 江起庭,Email：13856568108@163.com

引用本文:

唐洪伟, 齐伟亚, 朱辉, 方杰, 郑大伟, 江起庭. 机器人导航经皮微创内固定术治疗钩骨钩骨折的临床效果观察[J]. 中华解剖与临床杂志, 2022, 27(5): 331-336.
Tang Hongwei, Qi Weiya, Zhu Hui, Fang Jie, Zheng Dawei, Jiang Qiting. Clinical study of minimally invasive treatment of unhook fracture with robot-guided percutaneous internal fixation. Chinese Journal of Anatomy and Clinics, 2022, 27(5): 331-336.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20210519-00135 或 http://www.cjac.com.cn/CN/Y2022/V27/I5/331

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