[Comparative efficacy of robot-assisted minimally invasive technique versus open reduction and internal fixation for Schatzker type I to III tibial plateau fractures].

OBJECTIVES

Precise minimally invasive treatment has gradually become a core concept in modern surgery, and the rapid development of intelligent robotic systems has further promoted precision minimally invasive fracture management as an inevitable trend. This study aimed to compare the clinical efficacy of robot-assisted minimally invasive techniques with conventional open reduction and internal fixation (ORIF) in the treatment of Schatzker type I to III tibial plateau fractures.

METHODS

Clinical data of patients with isolated Schatzker type I to III tibial plateau fractures who underwent surgical treatment at the Third Hospital of Changsha between June 2022 and August 2024 were retrospectively collected. According to the inclusion and exclusion criteria, 45 patients were enrolled and divided into a robot-assisted group (n=18) and an ORIF group (n=27) based on the treatment strategy. Surgical incision length, operative time, intraoperative blood loss, length of hospital stay, fracture reduction quality, fracture healing time, total hospitalization cost, and postoperative complications were compared between the 2 groups. Fracture reduction quality was evaluated using the Rasmussen radiological scoring system, and knee joint function was assessed using the Hospital for Special Surgery (HSS) knee scoring system.

RESULTS

The operative time was (133.56±24.09) min in the robot-assisted group and (132.19±27.28) min in the ORIF group, with no statistically significant difference (P=0.864). Intraoperative blood loss was 20.00 (8.75, 50.00) mL in the robot-assisted group and 100.00 (50.00, 100.00) mL in the ORIF group, showing a statistically significant difference (P=0.003). The incision length was (3.44±0.51) cm in the robot-assisted group and (10.89±3.27) cm in the ORIF group (P<0.001). Length of hospital stay was (6.44±1.25) d in the robot-assisted group and (11.48±1.89) d in the ORIF group (P<0.001). Fracture healing time was (11.94±1.26) weeks in the robot-assisted group and (12.96±0.90) weeks in the ORIF group (P=0.006). Time to full weight-bearing was (13.17±1.15) weeks in the robot-assisted group and (14.33±0.96) weeks in the ORIF group (P=0.001). The total hospitalization cost was (17 760.45±2 975.69) yuan in the robot-assisted group and (21 631.17±1 911.76) yuan in the ORIF group (P<0.001). The HSS score was (90.17±8.07) in the robot-assisted group and (84.22±8.05) in the ORIF group, with a statistically significant difference (P=0.020). The Rasmussen radiological score was (16.33±1.78) in the robot-assisted group and (15.15±2.09) in the ORIF group, without statistical significance (P=0.055). The overall excellent-to-good rates of Rasmussen radiological scores were 94.44% (17/18) and 92.59% (25/27) in the robot-assisted and the ORIF groups, respectively. The overall excellent-to-good rates of HSS scores were 94.44% (17/18) and 88.89% (24/27), respectively. No statistically significant differences were observed between groups (all P>0.05). No postoperative complications such as infection, fracture nonunion, or internal fixation loosening occurred in the robot-assisted group. In the ORIF group, 1 patient developed superficial incision infection postoperatively, which healed after oral antibiotics and wound dressing changes; another patient developed peroneal vein thrombosis, which resolved after anticoagulant therapy. The overall complication rate was 0% in the robot-assisted group and 7.41% (2/27) in the ORIF group, with no statistically significant difference (P>0.05).

CONCLUSIONS

Robot-assisted minimally invasive techniques achieved satisfactory clinical outcomes in the treatment of Schatzker type I to III tibial plateau fractures, with advantages including reduced surgical trauma, faster recovery, and fewer complications. However, larger-scale studies are still required to further validate these advantages.