机器人辅助下拉力螺钉内固定治疗对骨盆脆性骨折患者术后疼痛和骨盆恢复情况的影响

The impact of robot-assisted tension screw fixation on postoperative pain and pelvic recovery in patients with fragility pelvic fractures

摘要:

目的 评估HoloSight知见创伤骨科手术机器人（以下简称HoloSight系统）导航下拉力螺钉内固定对骨盆脆性骨折患者的治疗效果。方法 选取2021年1月—2023年1月天津市宝坻区人民医院收治的74例骨盆脆性骨折患者。采用摸球法将患者随机分为对照组和观察组，每组37例。对照组采用闭合复位徒手置钉，观察组采用HoloSight系统辅助的拉力螺钉内固定。记录患者围手术期指标（手术时间、术中出血量、螺钉调整次数、首次下床时间、住院时间）；采用视觉模拟评分法（VAS）评估两组术后6、12、24、48、72 h的疼痛情况；比较术前和术后24 h的应激指标［血管紧张素Ⅱ（AngⅡ）、促肾上腺皮质激素（ACTH）、皮质醇（Cor）］；比较术前和术后6个月患者的Harris髋关节功能评分、Majeed骨盆骨折系统评分、Berg平衡量表评分、骨代谢指标［碱性磷酸酶（ALP）、骨钙素（BGP）、骨保护素（OPG）］。记录术后6个月内的并发症（螺钉松动、钉道感染、关节僵硬）发生情况。结果 观察组手术时间短于对照组，术中出血量少于对照组，螺钉调整次数低于对照组，首次下床时间和住院时间均短于对照组（P <0.05）。观察组与对照组术后6、12、24、48、72 h静息状态下VAS评分比较，采用重复测量设计的方差分析，结果 ①不同时间点VAS评分比较，差异有统计学意义（F =120.930，P =0.000）；②观察组与对照组VAS评分比较，差异有统计学意义（F =172.400，P =0.000），观察组VAS评分较低；③两组VAS评分变化趋势比较，差异有统计学意义（F =6.002，P =0.000）。观察组术前和术后24 h的AngⅡ、ACTH和Cor差值均低于对照组（P <0.05）。观察组术前和术后6个月的Harris、Majeed、BBS评分差值均高于对照组（P <0.05）。观察组术前和术后6个月的ALP、BGP、OPG差值均高于对照组（P <0.05）。术后6个月内观察组的并发症总发生率低于对照组（P <0.05）。结论 HoloSight辅助下拉力螺钉内固定有助于降骨盆脆性骨折患者术后疼痛，促进患者术后恢复。

Abstract:

Objective To evaluate the therapeutic effects of the HoloSight orthopedic trauma surgery robot (hereafter referred to as the HoloSight system) in tension screw fixation for patients with pelvic fragility fractures.Methods A total of 74 patients with fragility pelvic fractures admitted to our hospital from January 2021 to January 2023 were selected for the study. Patients were randomly divided into a control group and an observation group, with 37 patients in each group, using a ball-drawing method. The control group received closed reduction and manual screw placement, while the observation group underwent tension screw fixation assisted by the HoloSight visualization system. Perioperative indicators (surgery time, intraoperative blood loss, number of screw adjustments, first ambulation time, hospital stay) were recorded. Pain scores (VAS) were compared at 6, 12, 24, 48 and 72 h postoperatively. Stress indicators [angiotensin Ⅱ (Ang Ⅱ), adrenocorticotropic hormone (ACTH), cortisol (Cor) ] were compared preoperatively and 24h postoperatively. Harris hip joint function scores, majeed pelvic fracture system scores, berg balance scale scores, and bone metabolism indicators [alkaline phosphatase (ALP), osteocalcin (BGP), osteoprotegerin (OPG) ] were compared preoperatively and 6 months postoperatively.Results The operative time for the observation group was shorter than that for the control group, with less intraoperative blood loss, fewer screw adjustments, and shorter initial out-of-bed and hospitalization times (P <0.05). The postoperative VAS scores at rest at 6, 12, 24, 48, and 72 hours were compared between the observation group and the control group using repeated measures ANOVA, which showed: (1) significant differences in VAS scores at different time points (F =120.930, P =0.000); (2) significant differences in VAS scores between the observation and control groups, with lower scores observed in the observation group (F =172.400, P =0.000); (3) significant differences in the trends of VAS score changes between the two groups (F =6.002, P =0.000). The differences in Ang Ⅱ, ACTH, and Cor levels preoperatively and 24 hours postoperatively were lower in the observation group than in the control group (P <0.05). The differences in Harris, Majeed, and BBS scores preoperatively and 6 months postoperatively were higher in the observation group than in the control group (P <0.05). Similarly, the differences in ALP, BGP, and OPG levels preoperatively and 6 months postoperatively were higher in the observation group than in the control group (P <0.05). The overall incidence of complications within 6 months postoperatively was lower in the observation group compared to the control group (P <0.05)Conclusion HoloSight-assisted tension screw fixation helps reduce postoperative pain in patients with fragility pelvic fractures and promotes postoperative recovery.