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
Purpose: Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability.However,the posterior ring (PR) is the main weight bearing p...Purpose: Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability.However,the posterior ring (PR) is the main weight bearing portion that is responsible for weight transmission from the upper parts of the body to the lower limbs through the sacrum and the linea terminalis.It is hypothesized that isolated PR fixation can achieve comparable radiological and clinical outcomes to APR fixation.Therefore,we conducted this study to compare the two fixation principles in managing Tile B2 and C1 injuries.Methods: Our study included 20 patients with Tile B2 injuries and 20 patients with Tile C1 injuries.This study was a randomized control single-blinded study via computerized random numbers with a 1:1 allocation by using random block method.The study was performed at a level one trauma center.A total of 40 patients with Tile B2 and C1 injuries underwent combined APR or isolated PR fixation (Group A and B,respectively).Matta & Tornetta radiological principles and Majeed pelvic scoring system were used for the assessment of primary outcomes and postoperative complications.Secondary outcomes included operative time,amount of blood loss,intraoperative assessment of reduction,need of another operation,length of hospital stay,ability to weight bear postoperatively and pain control metrics.We used studentt-test to compare the difference in means between two groups,and Chi-square test to compare proportions between two qualitative parameters.We set the confidence interval to 95% and the margin of error accepted to 5%.So,p ≤ 0.05 was considered statistically significant.Results: The mean follow-up duration was 18 months.The operative time (mean difference 0.575 h) and the intraoperative blood loss (mean difference 97.5 mL) were lower in Group B.Also,despite the higher frequency of rami displacement before union in the same group,there were no significant differences in terms of radiological outcome (excellent outcome withOR = 2.357),clinical outcome (excellent outcome withOR = 2.852) and postoperative complications assessment (OR = 1.556) at last follow-up.Conclusion: The authors concluded that isolated PR fixation could favorably manage Tile B2 and C1 pelvic ring injuries with Nakatani zone II pubic rami fractures and intact inguinal ligament.Its final radiological and clinical outcomes and postoperative complications were comparable to combined APR fixation,but with less morbidity (shorter operation time,lower amount of blood,and no records of postoperative wound infection).展开更多
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Purpose: Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability.However,the posterior ring (PR) is the main weight bearing portion that is responsible for weight transmission from the upper parts of the body to the lower limbs through the sacrum and the linea terminalis.It is hypothesized that isolated PR fixation can achieve comparable radiological and clinical outcomes to APR fixation.Therefore,we conducted this study to compare the two fixation principles in managing Tile B2 and C1 injuries.Methods: Our study included 20 patients with Tile B2 injuries and 20 patients with Tile C1 injuries.This study was a randomized control single-blinded study via computerized random numbers with a 1:1 allocation by using random block method.The study was performed at a level one trauma center.A total of 40 patients with Tile B2 and C1 injuries underwent combined APR or isolated PR fixation (Group A and B,respectively).Matta & Tornetta radiological principles and Majeed pelvic scoring system were used for the assessment of primary outcomes and postoperative complications.Secondary outcomes included operative time,amount of blood loss,intraoperative assessment of reduction,need of another operation,length of hospital stay,ability to weight bear postoperatively and pain control metrics.We used studentt-test to compare the difference in means between two groups,and Chi-square test to compare proportions between two qualitative parameters.We set the confidence interval to 95% and the margin of error accepted to 5%.So,p ≤ 0.05 was considered statistically significant.Results: The mean follow-up duration was 18 months.The operative time (mean difference 0.575 h) and the intraoperative blood loss (mean difference 97.5 mL) were lower in Group B.Also,despite the higher frequency of rami displacement before union in the same group,there were no significant differences in terms of radiological outcome (excellent outcome withOR = 2.357),clinical outcome (excellent outcome withOR = 2.852) and postoperative complications assessment (OR = 1.556) at last follow-up.Conclusion: The authors concluded that isolated PR fixation could favorably manage Tile B2 and C1 pelvic ring injuries with Nakatani zone II pubic rami fractures and intact inguinal ligament.Its final radiological and clinical outcomes and postoperative complications were comparable to combined APR fixation,but with less morbidity (shorter operation time,lower amount of blood,and no records of postoperative wound infection).
