In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were ...In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were placed with navigation in five patients. Intact specimens were mounted onto a six-degrees-of-freedom spine motion simulator. Long lumbosacral constructs using bilateral sacroiliac screws and bilateral S1 pedicle and iliac screws were tested in seven cadaveric spines. Nine sacroiliac screws were well-placed under an image guidance system(IGS);one was placed poorly without IGS with no symptoms. Both fixation techniques significantly reduced range of motion(P<0.05) at L5-S1. The research concluded that rigid lumbosacral fixation can be achieved with sacroiliac screws,and image guidance improves its safety and accuracy. This new technique of image-guided sacroiliac screw insertion should prove useful in many types of fusion to the sacrum, particularly for patients with poor bone quality,complicated anatomy, infection, previous failed fusion and iliac harvesting.展开更多
Background： Sacroiliac （SI） screw fixation is a demanding technique, with a high rate of screw malposition due to the complex pelvic anatomy. TiRobot- is an orthopedic surgery robot which can be used for SI screw f...Background： Sacroiliac （SI） screw fixation is a demanding technique, with a high rate of screw malposition due to the complex pelvic anatomy. TiRobot- is an orthopedic surgery robot which can be used for SI screw fixation. This study aimed to evaluate the accuracy of robot-assisted placement of SI screws compared with a freehand technique. Methods：Thirty patients requiring posterior pelvic ring stabilization were randomized to receive freehand or robot-assisted SI screw fixation, between January 2016 and June 2016 at Beijing Jishuitan Hospital. Forty-five screws were placed at levels S1 and S2. In both methods, the primary end point screw position was assessed and classified using postoperative computed tomography. Fisher＇s exact probability test was used to analyze the screws＇positions. Secondary end points, such as duration of trajectory planning, surgical time after reduction of the pelvis, insertion time for guide wire, number of guide wire attempts, and radiation exposure without pelvic reduction, were also assessed. Results： Twenty-three screws were placed in the robot-assisted group and 22 screws in the freehand group; no postoperative complications or revisions were reported. The excellent and good rate of screw placement was 100% in the robot-assisted group and 95% in the freehand group. The P value （0.009） showed the same superiority in screw distribution. The fluoroscopy time after pelvic reduction in the robot-assisted group was significantly shorter than that in the freehand group （median [Q1, Q3]： 6.0 [6.0, 9.0] s vs. median [Q1, Q3]： 36.0 [21.5, 48.0] s; χ2 = 13.590, respectively, P 〈 0.001）; no difference in operation time after reduction of the pelvis was noted （χ2 = 1.990, P = 0.158）. Time for guide wire insertion was significantly shorter for the robot-assisted group than that for the freehand group （median [Q1, Q3]： 2.0 [2.0, 2.7] min vs. median [Q1, Q3]： 19.0 [15.5, 45.0] min; χ2 = 20.952, respectively, P 〈 0.001）. The number of guide wire attempts in the robot-assisted group was significantly less than that in the freehand group （median [Q1, Q3]： 1.0 [1.0,1.0] time vs. median [Q1, Q3]： 7.0 [1.0, 9.0] times; χ2 = 15.771, respectively, P 〈 0.001）. The instrumented SI levels did not differ between both groups （from S1 to S2, χ2 = 4.760, P = 0.093）. Conclusions： Accuracy of the robot-assisted technique was superior to that of the freehand technique. Robot-assisted navigation is safe for unstable posterior pelvic ring stabilization, especially in S1, but also in S2. SI screw insertion with robot-assisted navigation is clinically feasible.展开更多
目的评价加速康复外科(ERAS)在双平面机器人辅助经皮骶髂关节螺钉固定治疗骶骨骨折中的临床效果。方法选取2018年12月至2020年12月内蒙古医科大学附属医院采用双平面机器人辅助经皮骶髂关节螺钉固定治疗的24例骶骨纵形骨折患者作为研究...目的评价加速康复外科(ERAS)在双平面机器人辅助经皮骶髂关节螺钉固定治疗骶骨骨折中的临床效果。方法选取2018年12月至2020年12月内蒙古医科大学附属医院采用双平面机器人辅助经皮骶髂关节螺钉固定治疗的24例骶骨纵形骨折患者作为研究对象,随机分为ERAS组与常规组(n=12),其中常规组采取常规围手术期管理模式,ERAS组在常规管理基础上实施ERAS精细化围手术期管理方案,对两组患者围手术期指标、影像学结果和疗效指标进行对比分析。结果对两组患者螺钉置入位置进行影像学检查(X线、CT扫描),均达到满意程度;Matta影像评分两组相近(P>0.05)。ERAS组术后2 d疼痛视觉模拟量表评分、术后3 d Braden压疮评分和末次随访Majeed评分均优于常规组,住院时间短于常规组,两组比较,差异具有统计学意义(P<0.05)。结论在机器人辅助经皮骶髂关节螺钉固定围手术期管理中运用ERAS理念,疼痛缓解更加有效、压疮风险更低、住院时间更短,更有利于骶骨骨折患者术后骨盆功能恢复,可在脊柱外科机器人手术中推广和应用。展开更多
文摘In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were placed with navigation in five patients. Intact specimens were mounted onto a six-degrees-of-freedom spine motion simulator. Long lumbosacral constructs using bilateral sacroiliac screws and bilateral S1 pedicle and iliac screws were tested in seven cadaveric spines. Nine sacroiliac screws were well-placed under an image guidance system(IGS);one was placed poorly without IGS with no symptoms. Both fixation techniques significantly reduced range of motion(P<0.05) at L5-S1. The research concluded that rigid lumbosacral fixation can be achieved with sacroiliac screws,and image guidance improves its safety and accuracy. This new technique of image-guided sacroiliac screw insertion should prove useful in many types of fusion to the sacrum, particularly for patients with poor bone quality,complicated anatomy, infection, previous failed fusion and iliac harvesting.
文摘Background： Sacroiliac （SI） screw fixation is a demanding technique, with a high rate of screw malposition due to the complex pelvic anatomy. TiRobot- is an orthopedic surgery robot which can be used for SI screw fixation. This study aimed to evaluate the accuracy of robot-assisted placement of SI screws compared with a freehand technique. Methods：Thirty patients requiring posterior pelvic ring stabilization were randomized to receive freehand or robot-assisted SI screw fixation, between January 2016 and June 2016 at Beijing Jishuitan Hospital. Forty-five screws were placed at levels S1 and S2. In both methods, the primary end point screw position was assessed and classified using postoperative computed tomography. Fisher＇s exact probability test was used to analyze the screws＇positions. Secondary end points, such as duration of trajectory planning, surgical time after reduction of the pelvis, insertion time for guide wire, number of guide wire attempts, and radiation exposure without pelvic reduction, were also assessed. Results： Twenty-three screws were placed in the robot-assisted group and 22 screws in the freehand group; no postoperative complications or revisions were reported. The excellent and good rate of screw placement was 100% in the robot-assisted group and 95% in the freehand group. The P value （0.009） showed the same superiority in screw distribution. The fluoroscopy time after pelvic reduction in the robot-assisted group was significantly shorter than that in the freehand group （median [Q1, Q3]： 6.0 [6.0, 9.0] s vs. median [Q1, Q3]： 36.0 [21.5, 48.0] s; χ2 = 13.590, respectively, P 〈 0.001）; no difference in operation time after reduction of the pelvis was noted （χ2 = 1.990, P = 0.158）. Time for guide wire insertion was significantly shorter for the robot-assisted group than that for the freehand group （median [Q1, Q3]： 2.0 [2.0, 2.7] min vs. median [Q1, Q3]： 19.0 [15.5, 45.0] min; χ2 = 20.952, respectively, P 〈 0.001）. The number of guide wire attempts in the robot-assisted group was significantly less than that in the freehand group （median [Q1, Q3]： 1.0 [1.0,1.0] time vs. median [Q1, Q3]： 7.0 [1.0, 9.0] times; χ2 = 15.771, respectively, P 〈 0.001）. The instrumented SI levels did not differ between both groups （from S1 to S2, χ2 = 4.760, P = 0.093）. Conclusions： Accuracy of the robot-assisted technique was superior to that of the freehand technique. Robot-assisted navigation is safe for unstable posterior pelvic ring stabilization, especially in S1, but also in S2. SI screw insertion with robot-assisted navigation is clinically feasible.
文摘目的评价加速康复外科(ERAS)在双平面机器人辅助经皮骶髂关节螺钉固定治疗骶骨骨折中的临床效果。方法选取2018年12月至2020年12月内蒙古医科大学附属医院采用双平面机器人辅助经皮骶髂关节螺钉固定治疗的24例骶骨纵形骨折患者作为研究对象,随机分为ERAS组与常规组(n=12),其中常规组采取常规围手术期管理模式,ERAS组在常规管理基础上实施ERAS精细化围手术期管理方案,对两组患者围手术期指标、影像学结果和疗效指标进行对比分析。结果对两组患者螺钉置入位置进行影像学检查(X线、CT扫描),均达到满意程度;Matta影像评分两组相近(P>0.05)。ERAS组术后2 d疼痛视觉模拟量表评分、术后3 d Braden压疮评分和末次随访Majeed评分均优于常规组,住院时间短于常规组,两组比较,差异具有统计学意义(P<0.05)。结论在机器人辅助经皮骶髂关节螺钉固定围手术期管理中运用ERAS理念,疼痛缓解更加有效、压疮风险更低、住院时间更短,更有利于骶骨骨折患者术后骨盆功能恢复,可在脊柱外科机器人手术中推广和应用。
文摘目的 探讨2根LC-Ⅱ螺钉与2块钢板在DayI型骨盆新月状骨折内固定中的应用。方法 选取一位志愿者的骨盆CT数据,通过数字医学软件建立骨盆三维模型;根据骨盆新月形骨折的Day分型,规划出DayⅠ型骨折。分别建立生理状态模型(intact),LC-Ⅱ螺钉固定模型(DayⅠ-螺钉)和骶髂关节钢板固定模型(DayⅠ-钢板)。对3组模型施加同样的载荷和约束,比较3种模型的变形和应力分布情况。结果 在各种荷载形式下,intact、DayⅠ-螺钉、DayⅠ-钢板模型的变形变化规律基本一致。在前屈载荷作用下,intact、DayⅠ-螺钉、DayⅠ-钢板模型的最大变形量为0.57 mm, 0.76 mm, 0.68 mm。与DayⅠ-螺钉试验模型比较,DayⅠ-钢板试验模型在各种载荷方式下,其应力值均有显著增加,在垂直载荷方式下,其应力值上升320%,前屈134%,后伸211%,左侧弯339%,右侧弯208%,左旋转321%,右旋转284%。结论 2根LC-Ⅱ螺钉和2块钢板都可以维持DayⅠ型骨盆骨折的稳定,但由于钢板受压过大,易发生疲劳破坏及螺钉松脱等问题,因此,如果能闭合复位成功,则宜采用2根LC-Ⅱ螺钉固定。
