中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (18): 2938-2944.doi: 10.3969/j.issn.2095-4344.3849

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

机器人辅助与传统徒手置入空心螺钉治疗股骨颈骨折疗效对比的Meta分析

杨  琨1，费  晨1，王鹏飞2，张斌飞2，杨  娜 2，田  丁2，庄  岩2，张  堃2    

  1. 1西安医学院研究生学院，陕西省西安市   710068；2西安交通大学附属西安市红会医院创伤骨科，陕西省西安市   710054
  • 收稿日期:2020-07-13 修回日期:2020-07-17 接受日期:2020-09-05 出版日期:2021-06-28 发布日期:2021-01-12
  • 通讯作者: 张堃，男，主任医师，硕士生导师，西安交通大学附属西安市红会医院创伤骨科，陕西省西安市 710054
  • 作者简介:杨琨，男，1995年生，陕西省榆林市人，汉族，西安医学院在读硕士，医师，主要从事创伤骨科方面的研究。
  • 基金资助:
    陕西省自然科学基金(2017ZDXM-SF-009)，负责人：张堃

Meta-analysis of the efficacy of robot-assisted and traditional manual implantation of cannulated screws in the treatment of femoral neck fracture

Yang Kun1, Fei Chen1, Wang Pengfei2, Zhang Binfei2, Yang Na2, Tian Ding2, Zhuang Yan2, Zhang Kun2    

  1. 1Graduate School of Xi’an Medical University, Xi’an 710068, Shaanxi Province, China; 2Department of Orthopedics Trauma, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • Received:2020-07-13 Revised:2020-07-17 Accepted:2020-09-05 Online:2021-06-28 Published:2021-01-12
  • Contact: Zhang Kun, Chief physician, Master’s supervisor, Department of Orthopedics Trauma, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • About author:Yang Kun, Master candidate, Physician, Graduate School of Xi’an Medical University, Xi’an 710068, Shaanxi Province, China
  • Supported by:
    the Natural Science Foundation of Shaanxi Province, No. 2017ZDXM-SF-009 (to ZK)

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摘要：

文题释义：
机器人辅助微创内固定的优势：该治疗方式具有较好的精准定位和较少的侵袭性，以及较短的操作时间和较少的辐射损伤。
股骨颈骨折的修复方法：对于老年患者(>65岁)的移位股骨颈骨折选择人工髋关节置换，对于无移位的股骨颈骨折、不能耐受髋关节置换的老年患者以及年轻患者(<65岁)的移位股骨颈骨折则多选择骨折复位内固定修复。

目的：目前股骨颈骨折行空心螺钉内固定主要是靠临床医生在透视监测下徒手置入螺钉，由于每位医生的经验不同以及徒手操作的不稳定性，很难保证每枚螺钉都能取得满意的位置，同时反复透视增加了医护人员和患者的辐射伤害。文章比较机器人辅助与传统徒手置入空心钉内固定治疗股骨颈骨折的临床疗效。
方法：使用计算机检索PubMed、Embase、Cochrane Library、中国知网、万方和维普数据库，检索时间均从建库到2020年7月。检索关于对比研究机器人辅助与传统徒手植入空心钉内固定治疗股骨颈骨折疗效的国内外文献。由2名研究员根据纳入和排除标准分别独立筛选文献并提取数据，对所纳入的文献进行严格的质量评价。使用RevMan 5.3软件对相关指标进行Meta分析，结局指标包括手术时间、术中出血量、功能评分、骨折愈合时间及并发症。
结果：①通过文献检索、严格按照纳入和排除标准筛选后，纳入8篇回顾性队列研究；②共纳入659例患者，其中机器人辅助组315例，传统手术组344例；③Meta分析结果显示，机器人辅助组手术时间(MD=-8.71，95%CI：-12.08至-5.34)、术中出血量(MD=-18.17，95%CI： -27.55至-8.80)、术中透视次数(MD=-20.86，95%CI：-31.68至-10.04)、术中导针钻孔次数(MD=-9.64，95%CI：-13.23至-6.06)和末次随访髋关节Harris评分(MD=2.87，95%CI：0.56-5.18)均明显优于传统手术组(P < 0.05)，两组骨折愈合时间(MD=-0.24，95%CI：-0.47至-0.000)可能存在显著性差异(P=0.05)，两组优良率(OR=2.25，95%CI：0.88-5.73)、螺钉松动发生率(OR=0.19，95%CI：0.02-1.59)和骨折愈合率(OR=2.41，95%CI：0.68-8.52)比较差异无显著性意义(P > 0.05)。
结论：利用机器人辅助置入空心螺钉内固定修复股骨颈骨折可以降低术中透视次数从而减少医护人员和患者的辐射伤害，同时可以缩短手术时间和减少术中出血量，在减少手术创伤方面更具有优势，更有利于术后髋关节功能恢复，但此方法并不能提高骨折的愈合效果，未来还需要更多高质量的随机对照试验来验证。

https://orcid.org/0000-0002-4629-4118 (杨琨) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨, 股骨, 股骨颈骨折, 髋关节, 机器人, 螺钉, 内固定, Meta分析

Abstract: OBJECTIVE: At present, the hollow screw internal fixation of femoral neck fracture mainly depends on the bare-handed placement of screws by clinicians under fluoroscopic monitoring. Due to the different experience of each doctor and the instability of manual operation, it is difficult to ensure that each screw can obtain a satisfactory position. At the same time, repeated fluoroscopy increases radiation damage to medical staff and patients. This paper compares the clinical efficacy of robot-assisted and traditional manual hollow nail internal fixation in the treatment of femoral neck fracture.
METHODS: A computer was used to retrieve the PubMed, Embase, Cochrane Library, CNKI, Wanfang, and VIP databases. The retrieval time was from the inception of the database to July 2020. To search the literature at home and abroad on the comparative study of the efficacy of robot-assisted and traditional hand-implanted hollow nail internal fixation in the treatment of femoral neck fracture. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and strictly evaluated the quality of the included literature. Meta-analysis was performed with RevMan 5.3 software, including operation time, intraoperative blood loss, functional score, fracture healing time and complications.
RESULTS: (1) Through literature retrieval and according to inclusion and exclusion criteria, eight retrospective cohort studies were included in the study. (2) A total of 659 patients were included in the robot assisted group (n=315) and traditional operation group (n=344). (3) The results of meta-analysis showed that in the robot assisted group, the operation time (MD=-8.71, 95%CI:-12.08 to -5.34), the amount of intraoperative blood loss (MD=-18.17, 95%CI:-27.55 to -8.80), the number of intraoperative fluoroscopy (MD=-20.86, 95%CI:-31.68 to -10.04), the number of intraoperative guide needle drilling (MD=-9.64, 95%CI:-13.23 to -6.06), and the final follow-up hip Harris score (MD=2.87, 95%CI:0.56 to 5.18) were significantly better than those in the traditional operation group (P < 0.05). There may be a significant difference in the fracture healing time (MD=-0.24, 95%CI:-0.47 to -0.000) between the two groups (P=0.05). There was no significant difference in the excellent and good rate (OR=2.25, 95%CI:0.88-5.73), screw loosening rate (OR=0.19, 95%CI:0.02-1.59), and fracture healing rate (OR=2.41, 95%CI:0.68-8.52) between the two groups (P > 0.05).
CONCLUSION: The use of robot-assisted cannulated screw internal fixation in the repair of femoral neck fracture can reduce the number of intraoperative fluoroscopy so as to reduce the radiation injury to medical staff and patients, shorten the operation time and reduce the amount of intraoperative blood loss during operation. It has more advantages in reducing surgical trauma and is more conducive to the recovery of postoperative hip joint function, but this method cannot improve the fracture healing effect; more high-quality randomized controlled trials are needed for verification in the future.

Key words: bone, femur, femoral neck fracture, hip joint, robot, screw, internal fixation, meta-analysis

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