Highlights
- •TirobotTM is a Chinese independent development of universal orthopaedic surgery robot, can be used in spine, limbs, joints and other orthopaedic surgery. It is a representative work in the development of surgical robots in China. In this study, TirobotTM was used to assist S2 screws placement in treating unstable posterior pelvic fractures.
- •The clinical value of S2 screws in the treatment of pelvic posterior ring unstable fractures was systematically summarized, including S1 dysmorphia and biomechanical advantages, so as to provide a reference for the clinical treatment of such fractures.
- •We confirmed that robot-assisted S2 screw placement improved the safety and accuracy of surgery, reduced the radiation exposure, and improved the efficiency compared with traditional surgical methods.
Abstract
Background
Percutaneous sacroiliac screw is one of the main methods to treat unstable posterior
pelvic ring injury. However, complexity of pelvic anatomical structure increases the
difficulty and risk with freehand operation. Besides, S2 screw fixation began to receive
attention. The purpose of the current study was to evaluate the safety, accuracy,
efficiency and clinical outcome of robot-assisted S2 screw fixation for posterior
pelvic ring injury.
Methods
We reviewed 128 cases of unstable posterior pelvic ring injury treated by percutaneous
sacroiliac screw fixation in our hospital from January 2016 to January 2020. All cases
were divided into robot-assisted S1 group (RAS1), robot-assisted S2 group (RAS2),
freehand group S1 group (FHS1) and freehand group S2 group (FHS2). The mean times
of fluoroscopy per screw and adjustment per guide wire were used to evaluate radiation
exposure and the efficiency of screw placement, respectively. The final position of
the screw was evaluated with postoperative CT to illustrate security and accuracy.
108 patients (84.38%) were followed up for 5~24 months and the Majeed scores were
compared among groups.
Results
A total of 180 screws were inserted. In comparison of the mean times of fluoroscopy
per screw and adjustment per guide wire, RA group was significant less than FH group,
further comparison revealed that freehand S2 placement need more fluoroscopy and adjustment
times compared with freehand S1 placement, but for robot-assisted procedure, there
was no difference between placing S1 and S2. Screw penetration was found in the FHS1(3/48)
and FHS2(2/14) and none in RAS1 or RAS2, which means robot-assisted groups were more
safety and accurate (P<0.001). The mean Majeed score in RAS1 (83.33±13.47) and RAS2 (82.32±11.42) was higher
than in FHS1 (80.43±12.25) and FHS2 (75.08±18.47), but this difference failed to reach
significant.
Conclusion
Compared with the freehand operation, TiRobot increased the safety and accuracy, reduced
radiation exposure, and improved the efficiency. TiRobot could reduce the risk of
S2 placement and provide a safe and feasible way for clinical practice.
Keywords
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Article info
Publication history
Published online: November 16, 2020
Accepted:
November 15,
2020
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
