Ma Hong,Tang Xianneng,Guo Yueming.Comparative study of percutaneous in stu fixation of slipped capital femoral epiphysis assisted by surgical robotic system[J].Journal of Clinical Pediatric Surgery,2021,20(08):724-730.[doi:10.12260/lcxewkzz.2021.08.005]
机器人手术系统辅助经皮原位固定术治疗儿童股骨头骨骺滑脱的比较研究
- Title:
- Comparative study of percutaneous in stu fixation of slipped capital femoral epiphysis assisted by surgical robotic system
- 关键词:
- 机器人手术; 股骨头骨骺滑脱症/外科学; 临床研究
- 分类号:
- R681.8;R726.8
- 摘要:
- 目的 观察儿童股骨头骨骺滑脱在机器人导航下经皮原位固定的临床应用效果。方法 以2010年1月至2021年1月佛山市中医院收治的20例儿童股骨头骨骺滑脱病例为研究对象。根据治疗方法不同分为试验组（n=8）和对照组（n=12）。试验组患者采用机器人导航下经皮原位固定治疗，共8例（8髋），其中男5例（62.5%），女3例（37.5%），平均年龄为（10.7±2.9）岁；对照组患者采用传统经皮闭合原位固定治疗，共12例（12髋），其中男8例（67%），女4例（33%），平均年龄（11.9±1.6）岁。术前及末次随访时，采用Harris髋关节评分评估髋关节功能，测量术后X线片上的Southwick角。结果 20例（20髋）均获得随访，随访时间最短2个月，最长37个月，平均随访时间（15.3±6.0）个月。试验组Harris髋关节功能评分从术前的（35.1±15.7）分提高到末次随访时的（86.6±8.60）分，髋关节功能改善，差异有统计学意义（t=-8.23，P<0.05）；术后Southwick角较术前平均减小29.7°（95%CI：16.9°~42.4°，P<0.05）。对照组Harris髋关节功能评分从术前（50.8±22.2）分提高到末次随访时（82.2±7.9）分，髋关节功能改善，差异有统计学意义（t=5.50，P<0.05）；术后Southwick角较术前平均减小16.5°（95%CI：2.2°~30.8°，P<0.05）。截至末次随访时无一例伤口感染、断钉、骨不连、股骨头缺血坏死等不良事件及并发症发生。结论 机器人导航下经皮原位固定治疗儿童股骨头骨骺滑脱安全有效，具有精准、微创、操作方便的优势，可最大程度减少儿童髋部医源性损伤，预后优良。
- Abstract:
- Objective To evaluate the clinical efficacy of percutaneous in situ fixation of femoral head epiphyseal slip in children under robot navigation. Methods From January 2010 to January 2021, a total of 20 children with femoral head epiphyseal slippage were recruited. According to different treatment, they were divided into experimental group:8 children (8 hips) undergoing percutaneous orthotopic fixation under robot navigation, including 5 males (62.5%) and 3 females (37.5%);The mean age was (10.7±2.9) years. Control group:12 children (12 hips) traditional percutaneous orthotopic fixation, including 8 males (67%) and 4 females (33%);The mean age was (11.9±1.6) years. At preoperation and the final follow-up, hip function was assessed using the Harris hip score and Southwick Angle on postoperative radiographs was measured. Results All 20 patients (20 hips) were followed up for a mean period of (2-37)(15.3±6.0) months. At the last follow-up, Harris hip function score in experimental group recovered from (35.1±15.7) points preoperative surgery to (86.6±8.60) points and hip function significantly improved with statistical significance (P<0.05). Postoperative Southwick Angle declined by 29.7°(95%CI:16.9°-42.4°) as compared with pre-operation (P<0.05). Harris hip function score in control group recovered from (50.8±22.2) points at pre-operation to (82.2±7.9) points at the last follow-up and hip function improved with statistical significance (P<0.05). Postoperative Southwick Angle dropped by 16.5°(95%CI:2.2°-30.8°) as compared with pre-operation (P<0.05). Until the last follow-up, there was no occurrence of such adverse complications as wound infection, screw fracture, bone nonunion and necrosis of femoral head. Conclusion Percutaneous in situ fixation of pediatric femoral head epiphyseal spondylolisthesis under robot navigation is both safe and effective. With a decent prognosis, it offers the advantages of precision, mini-invasiveness and operative convenience. Compared with traditional operation, it may reduce the number of anesthetics, minimize blood loss and iatrogenic hip injury and lower the frequency of C-arm fluoroscopy in children.
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备注/Memo
收稿日期:2021-02-25。
基金项目:佛山市卫生健康委员会科研课题（编号：20200446）
通讯作者:郭跃明,Email:guo_yueming2008@126.com