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Intelligent robot-assisted minimally invasive reduction system for reduction of unstable pelvic fractures

Published:November 04, 2022DOI:https://doi.org/10.1016/j.injury.2022.11.001

      Highlights

      • Accurate reduction for unstable pelvic fractures has been recognized as the cornerstone of treating unstable pelvic fractures.
      • Traditional minimally invasive fracture reduction needs continuous intraoperative fluoroscopy monitoring, leading to high intraoperative radiation exposure of the patient and medical staff.
      • Intelligent robot-assisted fracture reduction system can complete intelligent and minimally invasive fracture reduction for most patients with unstable pelvic fractures.
      • The robot-assisted fracture reduction system has intelligent reduction path planning and realizes stable pelvis control.
      • The robot-assisted fracture reduction system doesn't cause additional damage to the patient.

      Abstract

      Objective

      Currently, minimally invasive internal fixation is recommended for the surgical treatment of unstable pelvic fractures. The premise and difficulty of minimally invasive internal fixation are minimally invasive reduction of fractures. This review aimed to investigate the indications, surgical strategy and techniques, safety, and efficacy of intelligent robot-assisted fracture reduction (RAFR) system of pelvic ring injuries.

      Methods

      This retrospective study reviewed a case series from March 2021 to November 2021. A total of 22 patients with unstable pelvic fracture injuries underwent minimally invasive internal fixations. All pelvic ring fractures were reduced with our intelligent RAFR system. The robot system intelligently designs the optimal position and reduction path based on the patient's preoperative 3D CT. During the operation, the three-dimensional visualization of the fracture is realized through image registration, and the Robot completes the automatic reduction of the fracture. The global 3D point cloud error between the preoperative planning results and the actual postoperative reduction results was calculated. The postoperative reduction results of residual displacement were graded by the Matta Criteria.

      Results

      Minimally invasive closed reduction procedures were completed in all 22 cases with our RAFR system. The average global 3D point cloud reduction error between the preoperative planning results and the actual postoperative reduction results was 3.41mm±1.83mm. The mean residual displacement was 4.61mm±3.29mm. Given the Matta criteria, 16 cases were excellent, five were good, and one was fair, with an excellent and good rate of 95.5%.

      Conclusion

      Our new pelvic fracture reduction robot system can complete intelligent and minimally invasive fracture reduction for most patients with unstable pelvic fractures. The system has intelligent reduction position and path planning and realizes stable pelvis control through a unique holding arm and a robotic arm. The operation process will not cause additional damage to the patient, which fully meets the clinical requirements. Our study demonstrated the safety and effectiveness of our robotic reduction system and its applicability and usability in clinical practice, thus paving the way towards Robot minimally invasive pelvic fracture surgeries.

      Keywords

      Abbreviations:

      DOF (degree-of-freedom), CBCT (Cone-beam CT), 3D (three-dimensional), RAFR (robot-assisted fracture reduction)
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