Efficacy of orthopedic robot-assisted sacroiliac joint screws in the treatment of posterior pelvic ring fractures_West China Medical Journal

Authors：

 JIANG Wei , YANG Ling , WANG Hong , GAO Bo

Department of Orthopedics, People’s Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;

Corresponding?author：

JIANG Wei, Email: 3208969049@qq.com

Keywords：

Robot; pelvic; fracture; internal fixator

DOI：

10.7507/1002-0179.202108298

Video：

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Objective To investigate the clinical effect of orthopedic robot-assisted sacroiliac joint screws in the treatment of posterior pelvic ring fractures. Methods Patients who underwent sacroiliac joint screw fixation in People’s Hospital of Deyang City between January 2018 and August 2021 were included, and the patients were divided intoa robotic group and a manual group by randomization. The robot group used robot-assisted insertion of sacroiliac joint screws, and the manual group used manual insertion of sacroiliac joint screws. The general condition, time of sacroiliac joint screw placement, intraoperative fluoroscopy times, guide needle drilling times, surgical blood loss, and Majeed pelvic function score were compared between the two groups. Results A total of 42 patients were included, and there was no significant difference in gender, age, body mass index , injury type or injury cause between the two groups (P>0.05). Finally, 21 screws were placed in 19 patients in the robotic group and 23 screws in 23 patients in the manual group. The wounds of the two groups were completely healed after operation, and there was no wound infection, iatrogenic vascular and nerve injury, and no loosening of internal fixation. There was no significant difference in screw placement time, blood loss or Majeed score between the two groups (P>0.05). The number of fluoroscopy (14.53±4.54 vs. 19.87±5.48) and drilling times (1.00±0.00 vs. 7.24±3.77) in the robotic group were less than those in the manual group, and the differences were statistically significant (P<0.05). Conclusion Orthopedic surgical robots have the advantages of minimally invasive, less fluoroscopy, and accurate screw placement in sacroiliac joint screw placement, and have good clinical results in the treatment of pelvic fractures.

Citation： JIANG Wei, YANG Ling, WANG Hong, GAO Bo. Efficacy of orthopedic robot-assisted sacroiliac joint screws in the treatment of posterior pelvic ring fractures. West China Medical Journal, 2022, 37(4): 550-555. doi: 10.7507/1002-0179.202108298 Copy

1.	龍濤, 彭超, 何智勇, 等. 機器人輔助下經皮骶髂螺釘固定手術的優勢及安全性研究. 中華創傷骨科雜志, 2019, 21(1): 10-15.
2.	Tile M. Pelvic ring fractures: should they be fixed?. J Bone Joint Surg Br, 1988, 70(1): 1-12.
3.	Santoro G, Braidotti P, Gregori F, et al. Traumatic sacral fractures: navigation technique in instrumented stabilization. World Neurosurg, 2019, 131: 399-407.
4.	Eastman JG, Kuehn RJ, Chip Routt ML Jr. Useful intraoperative technique for percutaneous stabilization of bilateral posterior pelvic ring injuries. J Orthop Trauma, 2018, 32(5): e191-e197.
5.	郭曉山. 骨盆骨折微創手術的問題及展望. 中華創傷骨科雜志, 2019, 21(1): 90-92.
6.	Cai L, Zhang Y, Zheng W, et al. A novel percutaneous crossed screws fixation in treatment of day type Ⅱ crescent fracture-dislocation: a finite element analysis. J Orthop Translat, 2019, 20: 37-46.
7.	Mirkovic S, Abitbol JJ, Steinman J, et al. Anatomic consideration for sacral screw placement. Spine (Phila Pa 1976). 1991, 16(Suppl 6): S289-S294.
8.	Hoernschemeyer DG, Pashuck TD, Pfeiffer FM. Analysis of the S2 alar-iliac screw as compared with the traditional iliac screw: does it increase stability with sacroiliac fixation of the spine?. Spine J, 2017, 17(6): 875-879.
9.	師述昌, 朱罡, 王豫, 等. 計算機輔助骶髂關節螺釘最優通道自動規劃技術研究. 北京生物醫學工程, 2018, 37(6): 551-558, 565.
10.	王剛, 張月雷, 章樂成, 等. 骨科機器人聯合骨盆解鎖復位架輔助下經皮螺釘固定治療骨盆骨折. 中華創傷骨科雜志, 2020, 22(6): 475-481.
11.	Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg Br, 1989, 71(2): 304-306.
12.	Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop Relat Res, 1989(242): 83-97.
13.	Mendel T, Radetzki F, Wohlrab D, et al. CT-based 3-D visualisation of secure bone corridors and optimal trajectories for sacroiliac screws. Injury, 2013, 44(7): 957-963.
14.	王祎, 張立峰, 王斌, 等. 骶髂關節螺釘新型輔助置釘技術的研究進展. 中華創傷骨科雜志, 2020, 22(6): 507-511.
15.	Matityahu A, Kahler D, Krettek C, et al. Three-dimensional navigation is more accurate than two-dimensional navigation or conventional fluoroscopy for percutaneous sacroiliac screw fixation in the dysmorphic sacrum: a randomized multicenter study. J Orthop Trauma, 2014, 28(12): 707-710.
16.	譚山, 高仕長, 張安維. 經皮骶髂關節螺釘固定變異骶骨的影像學初步研究. 重慶醫科大學學報, 2018, 43(10): 1388-1393.
17.	Gardner MJ, Morshed S, Nork SE, et al. Quantification of the upper and second sacral segment safe zones in normal and dysmorphic sacra. J Orthop Trauma, 2010, 24(10): 622-629.
18.	黃俊鋒, 劉黎軍, 韓云, 等. 機器人導航定位系統輔助經皮骶髂螺釘治療骨盆后環不穩定型損傷的臨床研究. 中華骨與關節外科雜志, 2020, 13(2): 148-153.
19.	韓巍, 張騰, 蘇永剛, 等. 天璣^?骨科手術機器人輔助經皮固定骶髂螺釘治療不穩定骨盆后環骨折的臨床研究. 北京生物醫學工程, 2021, 40(3): 257-262.
20.	鄧寧, 吳偉堅, 梁國穗. 機器人和計算機輔助骨科手術. 中華創傷骨科雜志, 2005, 7(7): 620-624.
21.	Conflitti JM, Graves ML, Chip Routt ML Jr. Radiographic quantification and analysis of dysmorphic upper sacral osseous anatomy and associated iliosacral screw insertions. J Orthop Trauma, 2010, 24(10): 630-636.
22.	Wu XB, Wang JQ, Sun X, et al. Guidance for the treatment of femoral neck fracture with precise minimally invasive internal fixation based on the orthopaedic surgery robot positioning system. Orthop Surg, 2019, 11(3): 335-340.

1. 龍濤, 彭超, 何智勇, 等. 機器人輔助下經皮骶髂螺釘固定手術的優勢及安全性研究. 中華創傷骨科雜志, 2019, 21(1): 10-15.
2. Tile M. Pelvic ring fractures: should they be fixed?. J Bone Joint Surg Br, 1988, 70(1): 1-12.
3. Santoro G, Braidotti P, Gregori F, et al. Traumatic sacral fractures: navigation technique in instrumented stabilization. World Neurosurg, 2019, 131: 399-407.
4. Eastman JG, Kuehn RJ, Chip Routt ML Jr. Useful intraoperative technique for percutaneous stabilization of bilateral posterior pelvic ring injuries. J Orthop Trauma, 2018, 32(5): e191-e197.
5. 郭曉山. 骨盆骨折微創手術的問題及展望. 中華創傷骨科雜志, 2019, 21(1): 90-92.
6. Cai L, Zhang Y, Zheng W, et al. A novel percutaneous crossed screws fixation in treatment of day type Ⅱ crescent fracture-dislocation: a finite element analysis. J Orthop Translat, 2019, 20: 37-46.
7. Mirkovic S, Abitbol JJ, Steinman J, et al. Anatomic consideration for sacral screw placement. Spine (Phila Pa 1976). 1991, 16(Suppl 6): S289-S294.
8. Hoernschemeyer DG, Pashuck TD, Pfeiffer FM. Analysis of the S2 alar-iliac screw as compared with the traditional iliac screw: does it increase stability with sacroiliac fixation of the spine?. Spine J, 2017, 17(6): 875-879.
9. 師述昌, 朱罡, 王豫, 等. 計算機輔助骶髂關節螺釘最優通道自動規劃技術研究. 北京生物醫學工程, 2018, 37(6): 551-558, 565.
10. 王剛, 張月雷, 章樂成, 等. 骨科機器人聯合骨盆解鎖復位架輔助下經皮螺釘固定治療骨盆骨折. 中華創傷骨科雜志, 2020, 22(6): 475-481.
11. Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg Br, 1989, 71(2): 304-306.
12. Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop Relat Res, 1989(242): 83-97.
13. Mendel T, Radetzki F, Wohlrab D, et al. CT-based 3-D visualisation of secure bone corridors and optimal trajectories for sacroiliac screws. Injury, 2013, 44(7): 957-963.
14. 王祎, 張立峰, 王斌, 等. 骶髂關節螺釘新型輔助置釘技術的研究進展. 中華創傷骨科雜志, 2020, 22(6): 507-511.
15. Matityahu A, Kahler D, Krettek C, et al. Three-dimensional navigation is more accurate than two-dimensional navigation or conventional fluoroscopy for percutaneous sacroiliac screw fixation in the dysmorphic sacrum: a randomized multicenter study. J Orthop Trauma, 2014, 28(12): 707-710.
16. 譚山, 高仕長, 張安維. 經皮骶髂關節螺釘固定變異骶骨的影像學初步研究. 重慶醫科大學學報, 2018, 43(10): 1388-1393.
17. Gardner MJ, Morshed S, Nork SE, et al. Quantification of the upper and second sacral segment safe zones in normal and dysmorphic sacra. J Orthop Trauma, 2010, 24(10): 622-629.
18. 黃俊鋒, 劉黎軍, 韓云, 等. 機器人導航定位系統輔助經皮骶髂螺釘治療骨盆后環不穩定型損傷的臨床研究. 中華骨與關節外科雜志, 2020, 13(2): 148-153.
19. 韓巍, 張騰, 蘇永剛, 等. 天璣^?骨科手術機器人輔助經皮固定骶髂螺釘治療不穩定骨盆后環骨折的臨床研究. 北京生物醫學工程, 2021, 40(3): 257-262.
20. 鄧寧, 吳偉堅, 梁國穗. 機器人和計算機輔助骨科手術. 中華創傷骨科雜志, 2005, 7(7): 620-624.
21. Conflitti JM, Graves ML, Chip Routt ML Jr. Radiographic quantification and analysis of dysmorphic upper sacral osseous anatomy and associated iliosacral screw insertions. J Orthop Trauma, 2010, 24(10): 630-636.
22. Wu XB, Wang JQ, Sun X, et al. Guidance for the treatment of femoral neck fracture with precise minimally invasive internal fixation based on the orthopaedic surgery robot positioning system. Orthop Surg, 2019, 11(3): 335-340.

West China Medical Journal

Efficacy of orthopedic robot-assisted sacroiliac joint screws in the treatment of posterior pelvic ring fractures

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