Orthopedic robot based on 5G technology for remote navigation of percutaneous screw fixation in pelvic and acetabular fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Bin , LI Jinqi , ZHAO Chunpeng , SU Yonggang , HAN Wei , WU Xinbao , JIANG Xieyuan ,  WANG Junqiang

Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China;

Corresponding?author：

WANG Junqiang, Email: drw-jq1997@163.com

Keywords：

Orthopedic robot; 5G technology; remote surgery; percutaneous screw; pelvic fracture; acetabular fracture

DOI：

10.7507/1002-1892.202204073

Video：

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Objective To investigate the accuracy and safety of percutaneous screw fixation for pelvic and acetabular fractures with remote navigation of orthopedic robot based on 5G technology. Methods Between January 2021 and December 2021, 15 patients with pelvic and/or acetabular fractures were treated with percutaneous screws fixation which were placed by remote navigation of orthopedic robot based on 5G technology. There were 8 males and 7 females. The age ranged from 20 to 98 years, with an average of 52.1 years. The causes of trauma included traffic accident injury in 6 cases, falling from height injury in 6 cases, fall injury in 2 cases, and heavy object smashing injury in 1 case. The time from injury to operation ranged from 3 to 32 days, with an average of 10.9 days. There were 8 cases of simple pelvic fractures, 2 simple acetabular fractures, and 5 both pelvic and acetabular fractures. There were 7 cases of pelvic fractures of Tile type B2, 2 type B3, 1 type C1, and 3 type C2; 4 cases of unilateral anterior column fracture of the acetabulum, 2 bilateral anterior column fractures, and 1 anterior wall fracture. CT images within 5 days after operation were collected for screw position assessment. The screw planning time and guidewire placement time were recorded, as well as the presence of intraoperative adverse events and complications within 5 days after operation. Results All patients achieved satisfactory surgical results. A total of 36 percutaneous screws were inserted (20 sacroiliac screws, 6 LC Ⅱ screws, 9 anterior column screws, and 1 acetabular apical screw). In terms of screw position evaluation, 32 screws (88.89%) were excellent and 4 screws (11.11%) were good; there was no screw penetrating cortical bone. The screw planning time ranged from 4 to 15 minutes, with an average of 8.7 minutes. The guidewire placement time ranged from 3 to 10 minutes, with an average of 6.8 minutes. The communication delayed in 2 cases, but the operation progress was not affected, and no serious intraoperative adverse events occurred. No delayed vascular or nerve injury, infection, or other complications occurred within 5 days after operation. No cases need surgical revision. Conclusion The fixation of pelvic and acetabular fractures by percutaneous screw with remote navigation of orthopedic robot based on 5G technology is accurate, safe, and reliable.

Citation： ZHAO Bin, LI Jinqi, ZHAO Chunpeng, SU Yonggang, HAN Wei, WU Xinbao, JIANG Xieyuan, WANG Junqiang. Orthopedic robot based on 5G technology for remote navigation of percutaneous screw fixation in pelvic and acetabular fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(8): 923-928. doi: 10.7507/1002-1892.202204073 Copy

1.	Yu T, Cheng XL, Qu Y, et al. Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures. World J Clin Cases, 2020, 8(12): 2464-2472.
2.	Wahab H, Hashmi P, Kasi H, et al. Outcome of percutaneous screw fixation of posterior pelvic ring injuries. J Pak Med Assoc, 2021, 71(Suppl 5): S70-S74.
3.	Al-Naseem A, Sallam A, Gonnah A, et al. Robot-assisted versus conventional percutaneous sacroiliac screw fixation for posterior pelvic ring injuries: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol, 2021. doi: 10.1007/s00590-021-03167-x.
4.	Routt ML, Kregor PJ, Simonian PT, et al. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma, 1995, 9(3): 207-214.
5.	Marescaux J, Leroy J, Gagner M, et al. Transatlantic robot-assisted telesurgery. Nature, 2001, 413(6854): 379-380.
6.	張輝. 加快5G網絡建設及應用支撐經濟高質量發展—工業和信息化部發布《關于推動5G加快發展的通知》. 網信軍民融合, 2020, (4): 37-39.
7.	趙春鵬, 王軍強, 蘇永剛, 等. 機器人輔助經皮螺釘內固定治療骨盆和髖臼骨折. 北京大學學報 (醫學版), 2017, 49(2): 274-280.
8.	Wang JQ, Wang Y, Feng Y, et al. Percutaneous sacroiliac screw placement: A prospective randomized comparison of robot-assisted navigation procedures with a conventional technique. Chin Med J (Engl), 2017, 130(21): 2527-2534.
9.	Wang J, Zhang T, Han W, et al. Robot-assisted S₂ screw fixation for posterior pelvic ring injury. Injury, 2020, 17: S0020-1383(20)30969-4.
10.	Han W, Zhang T, Su YG, et al. Percutaneous robot-assisted versus freehand S₂ iliosacral screw fixation in unstable posterior pelvic ring fracture. Orthop Surg, 2022, 14(2): 221-228.
11.	楊光, 祁寶昌, 趙天昊, 等. TiRobot骨科手術機器人輔助下微創經皮通道螺釘固定治療骨盆骨折的療效分析. 中華創傷骨科雜志, 2022, 24(3): 200-205.
12.	田偉, 張琦, 李祖昌, 等. 一站對多地5G遠程控制骨科機器人手術的臨床應用. 骨科臨床與研究雜志, 2019, 4(06): 349-354.
13.	Tian W, Fan M, Zeng C, et al. Telerobotic spinal surgery based on 5G network: the first 12 cases. Neurospine, 2020, 17(1): 114-120.
14.	Gras F, Marintschev I, Wilharm A, et al. 2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries—a case series. BMC Musculoskelet Disord, 2010, 11: 153. doi: 10.1186/1471-2474-11-153.
15.	Butner SE, Ghodoussi M Transforming a surgical robot for human telesurgery. IEEE Transactions on Robotics & Automation, 2003, 19(5): 818-824.
16.	葉青, 陳寧, 林明, 等. 5G通信技術應用場景及關鍵技術分析. 信息系統工程, 2021, (5): 17-19.
17.	Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
18.	Tsai TH, Tzou RD, Su YF, et al. Pedicle screw placement accuracy of bone-mounted miniature robot system. Medicine (Baltimore), 2017, 96(3): e5835. doi: 10.1097/MD.0000000000005835.
19.	Zheng J, Wang Y, Zhang J, et al. 5G ultra-remote robot-assisted laparoscopic surgery in China. Surg Endosc, 2020, 34(11): 5172-5180.
20.	王軍強, 趙春鵬, 胡磊, 等. 遠程外科機器人輔助脛骨髓內釘內固定系統的初步應用. 中華骨科雜志, 2006, 26(10): 682-686.
21.	Wu XB, Wang JQ, Sun X, et al. Guidance for treatment of pelvic acetabular injuries with precise minimally invasive internal fixation based on the orthopaedic surgery robot positioning system. Orthop Surg, 2019, 11(3): 341-347.
22.	Matta JM, Yerasimides JG. Table-skeletal fixation as an adjunct to pelvic ring reduction. J Orthop Trauma, 2007, 21(9): 647-656.
23.	Xu L, Xie K, Zhu W, et al. Starr frame-assisted and minimally invasive internal fixation for pelvic fractures: Simultaneous anterior and posterior ring stability. Injury, 2022, 10: S0020-1383(22)00122-X.
24.	楊成亮, 楊曉東, 劉佳, 等. 骨盆解鎖復位架輔助微創治療Tile C2、C3型骨盆骨折. 中華骨科雜志, 2021, 41(19): 1380-1386.
25.	Bai L, Yang J, Chen X, et al. Medical robotics in bone fracture reduction surgery: A review. Sensors (Basel), 2019, 19(16): 3593. doi: 10.3390/s19163593.
26.	Zhao JX, Li C, Ren H, et al. Evolution and current applications of robot-assisted fracture reduction: A comprehensive review. Ann Biomed Eng, 2020, 48(1): 203-224.
27.	趙春鵬, 王豫, 孫旭, 等. 智能化骨折復位機器人系統輔助骨盆骨折微創復位的解剖學研究. 中華創傷骨科雜志, 2022, 24(5): 372-379.

1. Yu T, Cheng XL, Qu Y, et al. Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures. World J Clin Cases, 2020, 8(12): 2464-2472.
2. Wahab H, Hashmi P, Kasi H, et al. Outcome of percutaneous screw fixation of posterior pelvic ring injuries. J Pak Med Assoc, 2021, 71(Suppl 5): S70-S74.
3. Al-Naseem A, Sallam A, Gonnah A, et al. Robot-assisted versus conventional percutaneous sacroiliac screw fixation for posterior pelvic ring injuries: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol, 2021. doi: 10.1007/s00590-021-03167-x.
4. Routt ML, Kregor PJ, Simonian PT, et al. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma, 1995, 9(3): 207-214.
5. Marescaux J, Leroy J, Gagner M, et al. Transatlantic robot-assisted telesurgery. Nature, 2001, 413(6854): 379-380.
6. 張輝. 加快5G網絡建設及應用支撐經濟高質量發展—工業和信息化部發布《關于推動5G加快發展的通知》. 網信軍民融合, 2020, (4): 37-39.
7. 趙春鵬, 王軍強, 蘇永剛, 等. 機器人輔助經皮螺釘內固定治療骨盆和髖臼骨折. 北京大學學報 (醫學版), 2017, 49(2): 274-280.
8. Wang JQ, Wang Y, Feng Y, et al. Percutaneous sacroiliac screw placement: A prospective randomized comparison of robot-assisted navigation procedures with a conventional technique. Chin Med J (Engl), 2017, 130(21): 2527-2534.
9. Wang J, Zhang T, Han W, et al. Robot-assisted S₂ screw fixation for posterior pelvic ring injury. Injury, 2020, 17: S0020-1383(20)30969-4.
10. Han W, Zhang T, Su YG, et al. Percutaneous robot-assisted versus freehand S₂ iliosacral screw fixation in unstable posterior pelvic ring fracture. Orthop Surg, 2022, 14(2): 221-228.
11. 楊光, 祁寶昌, 趙天昊, 等. TiRobot骨科手術機器人輔助下微創經皮通道螺釘固定治療骨盆骨折的療效分析. 中華創傷骨科雜志, 2022, 24(3): 200-205.
12. 田偉, 張琦, 李祖昌, 等. 一站對多地5G遠程控制骨科機器人手術的臨床應用. 骨科臨床與研究雜志, 2019, 4(06): 349-354.
13. Tian W, Fan M, Zeng C, et al. Telerobotic spinal surgery based on 5G network: the first 12 cases. Neurospine, 2020, 17(1): 114-120.
14. Gras F, Marintschev I, Wilharm A, et al. 2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries—a case series. BMC Musculoskelet Disord, 2010, 11: 153. doi: 10.1186/1471-2474-11-153.
15. Butner SE, Ghodoussi M Transforming a surgical robot for human telesurgery. IEEE Transactions on Robotics & Automation, 2003, 19(5): 818-824.
16. 葉青, 陳寧, 林明, 等. 5G通信技術應用場景及關鍵技術分析. 信息系統工程, 2021, (5): 17-19.
17. Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
18. Tsai TH, Tzou RD, Su YF, et al. Pedicle screw placement accuracy of bone-mounted miniature robot system. Medicine (Baltimore), 2017, 96(3): e5835. doi: 10.1097/MD.0000000000005835.
19. Zheng J, Wang Y, Zhang J, et al. 5G ultra-remote robot-assisted laparoscopic surgery in China. Surg Endosc, 2020, 34(11): 5172-5180.
20. 王軍強, 趙春鵬, 胡磊, 等. 遠程外科機器人輔助脛骨髓內釘內固定系統的初步應用. 中華骨科雜志, 2006, 26(10): 682-686.
21. Wu XB, Wang JQ, Sun X, et al. Guidance for treatment of pelvic acetabular injuries with precise minimally invasive internal fixation based on the orthopaedic surgery robot positioning system. Orthop Surg, 2019, 11(3): 341-347.
22. Matta JM, Yerasimides JG. Table-skeletal fixation as an adjunct to pelvic ring reduction. J Orthop Trauma, 2007, 21(9): 647-656.
23. Xu L, Xie K, Zhu W, et al. Starr frame-assisted and minimally invasive internal fixation for pelvic fractures: Simultaneous anterior and posterior ring stability. Injury, 2022, 10: S0020-1383(22)00122-X.
24. 楊成亮, 楊曉東, 劉佳, 等. 骨盆解鎖復位架輔助微創治療Tile C2、C3型骨盆骨折. 中華骨科雜志, 2021, 41(19): 1380-1386.
25. Bai L, Yang J, Chen X, et al. Medical robotics in bone fracture reduction surgery: A review. Sensors (Basel), 2019, 19(16): 3593. doi: 10.3390/s19163593.
26. Zhao JX, Li C, Ren H, et al. Evolution and current applications of robot-assisted fracture reduction: A comprehensive review. Ann Biomed Eng, 2020, 48(1): 203-224.
27. 趙春鵬, 王豫, 孫旭, 等. 智能化骨折復位機器人系統輔助骨盆骨折微創復位的解剖學研究. 中華創傷骨科雜志, 2022, 24(5): 372-379.

Chinese Journal of Reparative and Reconstructive Surgery

Orthopedic robot based on 5G technology for remote navigation of percutaneous screw fixation in pelvic and acetabular fractures

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