电磁导航机器人联合三维透视在骨盆后环骨折中的应用

作者	单位	邮编
贺晓龙^*	山东第一医科大学研究生院,山东济南,250000	250000
丛海波^*	山东第一医科大学研究生院,山东济南,250000 威海高区利民医院创伤骨科,山东威海,264299	264299
王海涛	威海高区利民医院创伤骨科,山东威海,264299	264299
余志平	威海高区利民医院创伤骨科,山东威海,264299	264299
董桂鑫	威海高区利民医院创伤骨科,山东威海,264299	264299
胡鹏宇	威海高区利民医院创伤骨科,山东威海,264299	264299

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中文摘要:

目的探究电磁导航机器人联合三维透视在治疗骨盆后环骨折中的临床疗效。方法采用回顾性研究分析2021年7月至2023年7月威海高区利民医院收治28例接受经皮微创骶髂关节螺钉内固定治疗的骨盆后环骨折患者临床资料。其中，男17例，女11例；年龄26～67岁，平均（50.1±10.2）岁。根据是否使用电磁导航机器人辅助骶髂螺钉置入分为徒手组（12例）及电磁导航组（16例），比较两组的导针调整次数、单枚螺钉置入时间、术中出血量、手术时间、改良Gertzbein-Robbins分类标准、术后Matta标准优良率、末次随访Majeed功能评分。结果所有患者均获随访12～24个月，平均（16.5±3.1）个月。电磁导航组与徒手组分别置入螺钉32枚、24枚，电磁导航组的导针调整次数［（0.9±0.7）次］及单枚螺钉置入时间［（11.5±1.1）min］显著短于徒手组［（5.8±1.5）次、（18.0±1.0）min］，术中出血量［（13.0±2.9）mL］和手术时间［（56.5±3.3）min］显著少于徒手组［（19.3±3.4）mL、（68.0±1.9）min］，差异均有统计学意义（P＜0.05）。根据改良Gertzbein-Robbins分类标准，电磁导航组的置钉准确率94%，显著优于徒手组的置钉准确率71%，差异有统计学意义（P＜0.05）。术后Matta标准优良率：电磁导航组为88%，徒手组为83%。末次随访的Majeed功能评分：电磁导航组优15例、良1例，徒手组优9例、良3例。术后Matta标准优良率和末次随访的Majeed功能评分，两组比较差异均无统计学意义（P＞0.05）。结论与徒手组相比，电磁导航组通过电磁导航机器人术前规划置钉路线，三维透视进行螺钉位置验证，减少了手术时间、螺钉置入时间，患者术中出血量更少，并且置钉准确率高，手术效果好。

英文摘要:

Objective To investigate the clinical efficacy of electromagnetic navigation robot combined with three-dimensional fluoroscopy in the treatment of posterior pelvic ring fractures.Methods A retrospective analysis was conducted on 28 patients with posterior pelvic ring fractures who underwent percutaneous minimally invasive sacroiliac joint screw internal fixation at Limin Hospital of Weihai High District from June 2020 to June 2022. The cohort included 17 males and 11 females, aged 26-67 years (mean age: 50.1±10.2). Patients were divided into a freehand group and an electromagnetic navigation group based on whether electromagnetic navigation-assisted screw placement was utilized. Parameters compared included the number of guide pin adjustments, per-screw insertion time, intraoperative blood loss, operative time, modified Gertzbein-Robbins classification accuracy, postoperative Matta criteria excellence rate, and final follow-up Majeed functional scores.Results All patients were followed up for 12 to 24 months, with an average follow-up period of (16.5±3.1) months. A total of 32 and 24 screws were implanted in the electromagnetic navigation group and freehand group, respectively. The electromagnetic navigation group exhibited significantly fewer guide pin adjustments [(0.9±0.7) vs. (5.8±1.5) times], shorter per-screw insertion time [(11.5±1.1) vs. (18.0±1.0) min], reduced intraoperative blood loss [(13.0±2.9) vs. (19.3±3.4) mL], and shorter total operative duration [(56.5±3.3) vs. (68.0±1.9) min] compared to the freehand group (P<0.05). According to the modified Gertzbein-Robbins classification, the electromagnetic navigation group achieved a significantly higher screw placement accuracy (94% vs. 71%, P=0.042). Postoperative Matta criteria excellence rates were 88% (14/16) in the electromagnetic navigation group and 83% (10/12) in the freehand group. At final follow-up, Majeed scores were rated as "excellent" in 15 cases and "good" in 1 case for the electromagnetic navigation group, versus "excellent" in 9 cases and "good" in 3 cases for the freehand group, with no statistically significant differences in these outcomes (P>0.05).Conclusion Compared to the freehand method, electromagnetic navigation robot-assisted preoperative trajectory planning combined with three-dimensional fluoroscopic verification reduces operative time, screw insertion time, intraoperative blood loss, and improves screw placement accuracy, demonstrating superior clinical efficacy.

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