Zheng Yugeng,Ma Hong,Li Liuyang,et al.Closed reduction and internal fixation for Delbet type Ⅱ/Ⅲ femoral neck fractures in children assisted by surgical robotic system[J].Journal of Clinical Pediatric Surgery,2023,22(12):1164-1169.[doi:10.3760/cma.j.cn101785-202303002-013]
机器人手术系统辅助闭合复位内固定术治疗儿童Delbet Ⅱ型及Ⅲ型股骨颈骨折
- Title:
- Closed reduction and internal fixation for Delbet type Ⅱ/Ⅲ femoral neck fractures in children assisted by surgical robotic system
- Keywords:
- Femoral Neck Fractures; Robotic Surgical Procedures; Closed Fracture Reduction; Fracture Fixation; Internal; Child
- 摘要:
- 目的 初步分析应用机器人手术系统辅助闭合复位内固定术治疗儿童Delbet Ⅱ型及Ⅲ型股骨颈骨折的临床效果。方法 本研究为回顾性研究,以2018年1月至2022年2月在广州中医药大学附属佛山市中医院小儿骨科住院治疗的54例(54髋)儿童股骨颈骨折患者为研究对象,收集患儿一般资料(包括性别、年龄、患侧、骨折分型、受伤至手术的时间、随访时间等)。根据手术方式将患儿分为观察组和对照组,观察组接受机器人手术系统辅助闭合复位内固定术治疗,对照组接受传统闭合复位内固定术治疗;收集两组患儿手术时长、术中穿针次数、术后第1次X线复查时置入螺钉与股骨颈干角的偏离角度、螺钉间平行度、末次随访时疗效以及随访期间并发症情况。结果 共54例(54髋)患儿纳入本研究并获得随访,其中观察组26例,对照组28例,两组患儿一般资料、平均手术时长差异无统计学意义(P＞0.05)。观察组术中穿针次数[(4.15±1.74)次]明显少于对照组[(10.93±2.91)次],差异有统计学意义(t=-10.301,P＜0.05);术后第1次X线复查时置入螺钉与股骨颈干角的偏离角度[0.87°(0.51°,1.53°)]优于对照组[3.57°(2.45°,5.57°)],差异有统计学意义(Z=-5.523,P＜0.05);观察组螺钉间的平行度[0.93°(0.52°,1.65°)]优于对照组[2.44°(1.50°,3.13°)],差异有统计学意义(Z=-4.025,P＜0.05);末次随访时依照Ratliff标准,观察组(优20例,良3例,差3例)与对照组(优17例,良6例,差5例)疗效差异无统计学意义(χ2=1.671,P＞0.05);随访期间观察组并发症的发生率[23.1%(6/26)]低于对照组[39.3%(11/28)], 但差异无统计学意义(χ2=1.642,P＞0.05)。结论 应用机器人手术系统辅助闭合复位内固定术治疗儿童股骨颈骨折可以减少术中穿针次数,提高置钉的准确性,置钉效果更满意,可取得良好的治疗效果。
- Abstract:
- Objective To evaluate the clinical effect of closed reduction and internal fixation surgery for the treatment of Delbet type II and III femoral neck fractures in children assisted by surgical robotic system.Methods A total of 54 children (54 hips) with femoral neck fracture who were hospitalized in Foshan Hospital of Traditional Chinese Medicine from January 2018 to August 2022 were enrolled in this study.The general clinical data of the patients were recorded,such as follow-up time,gender,age,affected side,fracture classification,the time from injury to surgery,and the above data were statistically analyzed.Patients were divided into the observation group and the control group according to different surgical methods.The observation group underwent robot-assisted closed reduction and internal fixation surgery,while the control group underwent traditional closed reduction and internal fixation surgery.The duration of operation,the guide needle threading times,the deviation angle between the inserted screws and the femoral neck-shaft angle,the parallelism between the inserted screws,the therapeutic effect was evaluated at the last follow-up,and the occurrence of complications were statistically analyzed in the two groups.Results A total of 54 cases (54 hips) were included in this study and followed up,with 26 cases in the observation group and 28 cases in the control group.There was no statistically significant difference in the general clinical data between the two groups (P>0.05).There was no significant difference in the average operation duration between the two groups (P>0.05).The average guide needle threading times in observation group(4.15±1.74) was significantly lower than that in control group(10.93±2.91),the difference was statistically significant(t=-10.301,P<0.05).The deviation angle between the inserted screws and the femoral neck-shaft angle on the first postoperative X-ray in the observation group 0.87°(0.51°,1.53°) was better than that in the control group3.57°(2.45°,5.57°),the difference was statistically significant(Z=-5.523,P<0.05).The parallelism between screws on the first postoperative X-ray in the observation group0.93°(0.52°,1.65°) was better than that in the control group2.44°(1.50°,3.13°),the difference was statistically significant(Z=-4.025,P<0.05).At the last follow-up,according to Ratliff criteria,there was no significant difference(χ2=1.671,P>0.05) in the treatment effect between the observation group(excellent 20 cases,good 3 cases,poor 3 cases) and the control group (excellent 17 cases,good 6 cases,poor 5 cases).During the follow-up period,the incidence of complications in the observation group was 23.1% (6/26),which was lower than 39.3% (11/28) in the control group,but the difference was no statistical significance(χ2=1.642,P>0.05).Conclusions The closed reduction and internal fixation surgery assisted by surgical robotic system in the treatment of femoral neck fractures in children can reduce the guide needle threading times,improve the accuracy of screws placement,and achieve good therapeutic effect.
参考文献/References:
[1] Beaty JH,Kasser JR,Flynn JM,等.洛克伍德-威尔金斯儿童骨折[M].黄耀添,颉强,赵黎,等译.第7版.北京:人民军医出版社,2014:725-731. Beaty JH,Kasser JR,Flynn JM,et al.Rockwood & Wilkins’ Fractures in Children[M].Huang YT,Jie Q,Zhao L,et al,translated.7th ed.Beijing:People’s Military Medical Press,2014:725-731.
[2] Ratliff AH.Fractures of the neck of the femur in children[J].J Bone Joint Surg Br,1962,44-B:528-542.DOI:10.1302/0301-620X.44B3.528.
[3] Palocaren T.Femoral neck fractures in children:a review[J].Indian J Orthop,2018,52(5):501-506.DOI:10.4103/ortho.IJOrtho_404_17.
[4] Colonna PC.Fracture of the neck of the femur in childhood:a report of six cases[J].Ann Surg,1928,88(5):902-907.DOI:10.1097/00000658-192811000-00012.
[5] Moon ES,Mehlman CT.Risk factors for avascular necrosis after femoral neck fractures in children:25 Cincinnati cases and meta-analysis of 360 cases[J].J Orthop Trauma,2006,20(5):323-329.DOI:10.1097/00005131-200605000-00005.
[6] Lim EJ,Kim BS,Kim M,et al.Open reduction versus closed reduction in internal fixation of displaced femoral neck fracture in children:a systematic review and meta-analysis[J].J Orthop Surg Res,2023,18(1):49.DOI:10.1186/s13018-023-03525-x.
[7] Patterson JT,Tangtiphaiboontana J,Pandya NK.Management of pediatric femoral neck fracture[J].J Am Acad Orthop Surg,2018,26(12):411-419.DOI:10.5435/JAAOS-D-16-00362.
[8] Xu D,Lou WG,Li M,et al.Current status of robot-assisted surgery in the clinical application of trauma orthopedics in China:a systematic review[J].Health Sci Rep,2022,5(6):e930.DOI:10.1002/hsr2.930.
[9] Wang WT,Li YQ,Guo YM,et al.Risk factors for the development of avascular necrosis after femoral neck fractures in children:a review of 239 cases[J].Bone Joint J,2019,101-B(9):1160-1167.DOI:10.1302/0301-620X.101B9.BJJ-2019-0275.R1.
[10] Yerli M,Ocak O,Yüce A,et al.Retrospective analysis of 35 pediatric femoral neck fractures[J].Eur J Orthop Surg Traumatol,2022,32(7):1385-1390.DOI:10.1007/s00590-021-03126-6.
[11] Barreto Rocha DF,Horwitz DS,Sintenie JB.Femoral neck fractures in children:issues,challenges,and solutions[J].J Orthop Trauma,2019,33(Suppl 8):S27-S32.DOI:10.1097/BOT.0000000000001645.
[12] Song KS.Displaced fracture of the femoral neck in children:open versus closed reduction[J].J Bone Joint Surg Br,2010,92(8):1148-1151.DOI:10.1302/0301-620X.92B8.24482.
[13] Pandey RA,John B.Current controversies in management of fracture neck femur in children:a review[J].J Clin Orthop Trauma,2020,11(Suppl 5):S799-S806.DOI:10.1016/j.jcot.2020.05.029.
[14] Forster NA,Ramseier LE,Exner GU.Undisplaced femoral neck fractures in children have a high risk of secondary displacement[J].J Pediatr Orthop B,2006,15(2):131-133.DOI:10.1097/01.bpb.0000188249.17148.eb.
[15] Bali K,Sudesh P,Patel S,et al.Pediatric femoral neck fractures:our 10 years of experience[J].Clin Orthop Surg,2011,3(4):302-308.DOI:10.4055/cios.2011.3.4.302.
[16] Wang XD,Lan H,Li KN.Treatment of femoral neck fractures with cannulated screw invasive internal fixation assisted by orthopaedic surgery robot positioning system[J].Orthop Surg,2019,11(5):864-872.DOI:10.1111/os.12548.
[17] Liebergall M,Ben-David D,Weil Y,et al.Computerized navigation for the internal fixation of femoral neck fractures[J].J Bone Joint Surg Am,2006,88(8):1748-1754.DOI:10.2106/JBJS.E.00137.
[18] Wang WT,Li YQ,Xiong Z,et al.Effect of the number,size,and location of cannulated screws on the incidence of avascular necrosis of the femoral head in pediatric femoral neck fractures:a review of 153 cases[J].J Pediatr Orthop,2022,42(3):149-157.DOI:10.1097/BPO.0000000000002018.
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备注/Memo
收稿日期:2023-3-1。
通讯作者:郭跃明,Email:guo_yuemming2008@126.com