【摘要】 目的 比较骨科机器人辅助经皮空心钉内固定与切开复位内固定治疗跟骨骨折的疗效。方法 2022年1月至2023年1月间北京积水潭医院创伤骨科连续收治的新鲜跟骨骨折患者32例。根据手术方式分为骨科机器人辅助经皮空心钉内固定组（RA）(18例)和传统切开复位内固定组（ORIF）(14例)；其中RA组采用闭合复位或结合跗骨窦入路辅助闭合复位，门诊复查、随访3个月。比较两组患者手术时间、术中出血量、术中透视次数、住院时间、术后影像学指标（跟骨长度、宽度、高度，B?hler角）、术后并发症、术后3个月美国足踝学会踝与后足功能评分（AOFAS）。结果 与ORIF组相比，RA组患者的中位手术时间更短[63.0(48.8, 90.0)min比86.0(64.8, 95.0)min, Z=1.722, P=0.085];RA组患者的术中出血量低于ORIF组[5.0(3.0, 6.0)ml比16.0(11.5, 19.3)ml, Z=4.698, P <0.001]。RA组术中透视次数少于ORIF组[3.5(3.0, 6.0)次比9.0(7.0, 9.3)次，Z=4.444, P <0.001]。RA组的住院时间短于ORIF组[5.0(3.0, 6.0)d比6.0(4.0, 8.0)d, Z=2.152, P=0.031]。术后3个月随访时两组患者之间的跟骨宽度、跟骨高度和跟骨B?hler角差异均无统计学意义（均P> 0.05）；但两组患者跟骨宽度均较术前减小，跟骨高度均较术前增加，跟骨B?hler角均较术前增加（均P <0.001）。ORIF组有5例（35.7%）出现皮肤坏死、3例（21.4%）发生术后切口感染，RA组患者均未发生；两组之间差异有统计学意义（P=0.027,0.022）。RA组患者的AOFAS对线评分高于ORIF组[（7.2±1.4）分比（6.1±1.4）分，t=2.322, P=0.027]。RA组患者的AOFAS总分高于ORIF组[（84.2±5.5）分比（79.2±6.2）分，t=2.423, P=0.022]。结论 骨科机器人辅助经皮空心钉内固定治疗SanderⅡ/Ⅲ型跟骨骨折安全有效，有利于缩短住院时间，减少术中出血、术中透视次数及术后并发症的发生。更多还原

【Abstract】 Objective To compare the efficacy of orthopedic robot assisted percutaneous cannulated screws fixation and open reduction internal fixation in the treatment of calcaneal fractures. Method A retrospective analysis was conducted on the clinical data of 32 consecutive patients with fresh calcaneal fractures admitted to the Department of Trauma and Orthopedics at Beijing Jishuitan Hospital from January 2022 to January 2023. According to the surgery, they were divided into the orthopedic robot assisted percutaneous cannulated screw fixation group(RA, n = 18) and the traditional open reduction and internal fixation group( ORIF, n = 14). The RA group used closed reduction or combined with tarsal sinus approach to assist closed reduction. The two groups of patients were followed up 3 months after surgery. Compare the surgical time, intraoperative bleeding volume, intraoperative fluoroscopy frequency, hospital stay, postoperative imaging indicators( calcaneal length, width, height, B?hler angle), postoperative complications, and American orthopaedic foot and ankle score( AOFAS) at 3 months after surgery between the two groups of patients. Result In terms of perioperative indicators, compared with the ORIF group, the RA group had a shorter median surgical time, but the difference was not statistically significant[ 63. 0( 48. 8, 90. 0) min vs. 86. 0( 64. 8, 95. 0) min, Z = 1. 722, P = 0. 085]. The intraoperative blood output of patients in the RA group was lower than that in the ORIF group and the difference was statistically significant [5. 0( 3. 0, 6. 0) ml vs. 16. 0( 11. 5, 19. 3) ml, Z = 4. 698, P < 0. 001]. The intraoperative fluoroscopy frequency in the RA group was lower than that in the ORIF group and the difference was statistically significant [3. 5( 3. 0, 6. 0) times vs. 9. 0(7. 0, 9. 3) times, Z = 4. 444, P < 0. 001]. The hospitalization time of the RA group was shorter than that of the ORIF group and the difference was statistically significant [5. 0(3. 0, 6. 0) days vs. 6. 0(4. 0, 8. 0) days, Z = 2. 152, P = 0. 031]. In terms of postoperative imaging indicators, there was no significant difference in the width, height, and B ? hler angle of the calcaneus between the two groups of patients at a 3-month follow-up( all P > 0. 05). However, the width of the calcaneus in both groups of patients decreased compared to before surgery, the height of the calcaneus increased compared to before surgery, and the B?hler angle of the calcaneus increased compared to before surgery, with statistically significant differences(all P < 0. 001). In terms of postoperative complications, there were 5 cases(35. 7%) of skin necrosis and 3 cases(21. 4%) of postoperative incision infection in the ORIF group at a 3-month follow-up, while no cases occurred in the RA group. The difference between the two groups was statistically significant(P = 0. 027, 0. 022). In terms of postoperative function, the AOFAS baseline score of patients in the RA group was higher than that in the ORIF group, with a statistically significant difference [(7. 2 ± 1. 4) points vs.(6. 1 ± 1. 4) points, t = 2. 322, P = 0. 027]. The total AOFAS score of patients in the RA group was higher than that in the ORIF group, with a statistically significant difference[(84. 2 ± 5. 5) points vs.( 79. 2 ± 6. 2) points, t = 2. 423, P = 0. 022]. Conclusion Orthopedic robot assisted percutaneous hollow nail internal fixation for Sander Ⅱ/Ⅲ type calcaneal fractures is safe and effective, which is beneficial for shortening surgical time, hospitalization time, reducing intraoperative bleeding, intraoperative fluoroscopy frequency, and reducing postoperative complications.更多还原