[1]彭锋李龙付季一东袁玉成.机器人辅助TightRope带襻钢板内固定在急性肩锁关节脱位的初步应用[J].中国微创外科杂志,2025,01(7):423-428.
　Peng Feng,Li Longfu,Ji Yidong,et al.Preliminary Application of Internal Fixation of TightRope Buckle Steel Plate With Robot Assitance for Acute Acromioclavicular Joint Dislocation[J].Chinese Journal of Minimally Invasive Surgery,2025,01(7):423-428.
点击复制

机器人辅助TightRope带襻钢板内固定在急性肩锁关节脱位的初步应用()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年7期
页码:
423-428
栏目:
短篇论著
出版日期:
2025-07-30

文章信息/Info

Title:
Preliminary Application of Internal Fixation of TightRope Buckle Steel Plate With Robot Assitance for Acute Acromioclavicular Joint Dislocation
作者:
彭锋李龙付季一东袁玉成
(湖州邦尔骨科医院骨科，湖州313000)
Author(s):
Peng Feng;  Li Longfu;  Ji Yidong;  et al.
Department of Orthopedics, Huzhou Bang’er Orthopedic Hospital, Huzhou 313000, China
关键词:
肩锁关节脱位; 带襻钢板内固定; 机器人; TightRope技术
Keywords:
Acromioclavicular joint dislocation; Buckle steel plate internal fixation; Robots; TightRope technology
文献标志码:
A
摘要:
目的探讨在机器人辅助下TightRope带襻钢板内固定治疗急性肩锁关节脱位的疗效。方法2022年10月~2023年12月我院在机器人辅助下 TightRope带襻钢板内固定治疗急性肩锁关节脱位17例(Rockwood分型：Ⅱ型2例，Ⅲ型15例)，由机器人“超脑”进行术前规划，在机械臂引导下由锁骨向喙突钻孔，将带襻钢板一端推入喙突后收紧尾线，达到复位肩锁关节的目的。结果17例手术顺利完成，手术时间15~42 min(平均27.9 min)，术中出血量5~25 ml(平均10.4 ml)。术后DR显示肩锁关节均已复位。切口均一期愈合，无血管神经相关并发症发生。术后第2天CT评估锁骨钻孔位置准确性：优12例，良5例；喙突钻孔准确性：优9例，良7例，差1例。17例随访6~12个月，平均10.4月。术后第2天、6个月健患侧锁骨远端下皮质与肩峰下皮质距离比较差异无显著性［0.15(0.00，0.50)mm vs.-0.40(0.70，0.70)mm，Z=-1.553，P=0120；0.15(0.00，0.50)mm vs.0.20(-0.25，0.85)mm，Z=-0.466，P=0.641］;术后6个月患侧锁骨远端下皮质与肩峰下皮质距离显著高于术后第2天［0.20(-0.25，0.85)mm vs.-0.40(0.70，0.70)mm，Z=-3.426，P=0.001］。术后第2天疼痛视觉模拟评分(Visual Analogue Scale，VAS)3.0(3.0，4.0)分，显著低于术前4.0(3.5，5.5)分(Z=-2.716，P=0007)，第6个月疼痛VAS评分1.0(0.0，1.5)分，显著低于术前(Z=-3.649，P=0.000)，且术后第6个月VAS显著低于术后第2天(Z=-3.672，P=0.000)。末次随访时肩关节功能ConstantMurley评分91~100分，平均94.3分，均为优；美国肘肩关节外科医师协会(American Shoulder and Elbow Surgeons，ASES)评分87~100分，平均96.7分，优良率100%(优15例，良2例)。结论机器人辅助下TightRope带襻钢板内固定技术治疗急性Rockwood Ⅱ、Ⅲ型肩锁关节脱位效果良好。
Abstract:
ObjectiveTo explore the efficacy of internal fixation of TightRope buckle steel plate with robot assistance for acute acromioclavicular joint dislocation. MethodsFrom October 2022 to December 2023, 17 patients with acute acromioclavicular dislocation admitted to our hospital were treated with robot assisted TightRope buckle steel plate fixation. According to the Rockwood classification, there were 2 patients with type Ⅱ and 15 patients with type Ⅲ. Preoperative planning was carried out by the robot’s “super brain”. During the surgery, under the guidance of the robotic arm, a hole was drilled from the clavicle to the coracoid process, and one end of the loop steel plate was pushed into the coracoid process to tighten the tail line, achieving the goal of resetting the acromioclavicular joint.ResultsThe operations were successfully completed in all the 17 patients, with an operation time of 15-42 min (mean, 27.9 min) and intraoperative blood loss of 5-25 ml (mean, 10.4 ml). Postoperative DR showed that the acromioclavicular joint had been reduced. All incisions healed in one stage without any vascular or nerve related complications. On the second day after surgery, CT evaluation showed that the accuracy of clavicle drilling position was excellent in 12 cases and good in 5 cases and accuracy of coracoid process drilling was excellent in 9 cases, good in 7 cases, and poor in 1 case. All the 17 patients were followed up for 6-12 months, with an average of 10.4 months. On the second day and six months after surgery, there were no significant differences in the distance between the surface cortex below the acromion and the surface cortex below the distal clavicle on the affected and healthy side ［0.15 (0.00, 0.50) mm vs.-0.40 (0.70, 0.70) mm, Z=-1.553, P=0.120; 0.15 (0.00, 050) mm vs. 0.20 (-0.25, 0.85) mm, Z=-0.466, P=0.641］. At six months after surgery, the distance between the surface cortex below the acromion and the surface cortex below the distal clavicle on the affected side was significantly higher than on the second day ［0.20 (-0.25, 0.85) mm vs.-0.40 (0.70, 0.70) mm, Z=-3.426, P=0.001］. On the second day after surgery, the Visual Analogue Scale (VAS) score was 3.0 (3.0, 4.0) points, significantly lower than the preoperative score of 4.0 (3.5, 55) points (Z=-2.716, P=0.007). On the sixth month, the VAS score was 1.0 (0.0, 1.5) points, significantly lower than the preoperative score (Z=-3.649, P=0.000) and on the second day after surgery (Z=-3.672, P=0000). At the last followup, the Constant Murley score for shoulder joint function ranged 91-100 points, with an average of 94.3 points, all of which were excellent. The American Shoulder and Elbow Surgeons (ASES) score ranged 87-100 points, with an average of 96.7 points, the excellent and good rate being 100% (15 cases were excellent and 2 cases were good). ConclusionThe use of robot assisted TightRope buckle loop steel plate internal fixation technology for the treatment of acute Rockwood type Ⅱ and Ⅲ acromioclavicular dislocation has good therapeutic effects.

参考文献/References:

[1]Peng L, Zheng Y, Chen S, et al. Single tunnel technique versus coracoid sling technique for arthroscopic treatment of acute acromioclavicular joint dislocation. Sci Rep,2022,12(1):4244.
[2]Skjaker SA, Enger M, Engebretsen L, et al. Young men in sports are at highest risk of acromioclavicular joint injuries: a prospective cohort study. Knee Surg Sports Traumatol Arthrosc,2021,29(7):2039-2045.
[3]Beitzel K, Cote MP, Apostolakos J, et al. Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy,2013,29(2):387-397.
[4]Zhu NF, Rui BY, Zhang YL, et al. Anatomic study of coracoclavicular ligaments for reconstruction of acromioclavicular joint dislocations. J Orthop Sci,2016,21(6):749-752.
[5]Constant CR，Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop,1987,214:160-164.
[6]Michener LA, McClure PW, Sennett BJ. American shoulder and elbow surgeons standardized shoulder assessment form, patient selfreport section: reliability, validity, and responsiveness. J Shoulder Elbow Surg,2002,11(6):587-594.
[7]唐国龙,方加虎,李翔.急性Rockwood Ⅲ型肩锁关节脱位的治疗进展.中华创伤骨科杂志,2017,19(4):365-368.
[8]Balke M, Schneider MM, Akoto R, et al. Acute acromioclavicular joint injuries. Changes in diagnosis and therapy over the last 10 years. Unfallchirurg,2015,118(10):851-857.
[9]李晓东,李龙云,程勇杰,等.TightRope带袢钢板与锁骨钩钢板内固定治疗肩锁关节脱位疗效比较的Meta分析.中国骨与关节损伤杂志,2023,38(5):471-474.
[10]Sella GDV, Miyazaki AN, Nico MAC, et al.Study on the anatomic relationship between the clavicle and the coracoid process using computed tomography scans of the shoulder. J Shoulder Elbow Surg,2017,26(10):1740-1747.
[11]张广,肖爱国,王张伟,等.改良闭合复位联合机器人辅助置钉治疗跟骨骨折的疗效评价.实用骨科杂志,2024,30(7):649-652.
[12]肖爱国,张广,裴绍龙,等.骨科机器人辅助经皮钳夹和撬拨复位螺钉内固定术治疗髌骨骨折.中医正骨,2024,36(7):77-80.
[13]雷龙跃,郑标,张广.基层医院应用改良机器人辅助经皮椎弓根螺钉内固定治疗胸腰椎骨折的临床效果.中国现代手术学杂志,2024,28(2):104-110.
[14]雷龙跃,郑标,吴慕君.机器人辅助经皮伤椎置钉治疗胸腰椎爆裂骨折.临床骨科杂志,2024,27(4):466-470.
[15]Jin M, Lei L, Li F, et al. Does robot navigation and intraoperative computed tomography guidance help with percutaneous endoscopic lumbar discectomy? A matchpaired study. World Neurosurg,2021,147:e459-e467.
[16]Jin M, Ge M, Lei L, et al. Clinical and radiologic outcomes of robotassisted kyphoplasty versus fluoroscopyassisted kyphoplasty in the treatment of osteoporotic vertebral compression fractures: a retrospective comparative study. World Neurosurg,2022,158:e1-e9.
[17]van Bergen CJA, van Bemmel AF, Alta TDW, et al. New insights in the treatment of acromioclavicular separation. World J Orthop,2017,8(12):861-873.
[18]Hegazy G, Safwat H, Seddik M, et al. Modified WeaverDunn procedure versus the use of semitendinosus autogenous tendon graft for acromioclavicular joint reconstruction. Open Orthop J,2016,10:166-178.
[19]Li Q, Hsueh PL, Chen YF. Coracoclavicular ligament reconstruction: a systematic review and a biomechanical study of a triple endobutton technique. Medicine (Baltimore),2014,93(28):e193.
[20]潘昭勋,杜德凯,孙超,等.喙锁韧带解剖重建与垂直重建的生物力学对比.医用生物力学,2018,33(4):343-347.

备注/Memo

备注/Memo:
通讯作者，Email:13915422869@139.com
更新日期/Last Update: 2025-09-18