TiRobot-assisted surgery by O-arm navigation system for percutaneous minimally invasive treatment of posterior pelvic ring injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GE Shuo , ZHANG Lei ^△ , ZHOU Zifei , JIA Shaohua ,  ZHENG Longpo

Department of Orthopaedics, Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, Shanghai Trauma Emergency Center, Shanghai, 200072, P. R. China;

Corresponding author：

ZHENG Longpo, Email: trauma_zlp@163.com

Keywords：

TiRobot; O-arm navigation system; posterior pelvic ring injury; sacroiliac screw; minimally treatment

DOI：

10.7507/1002-1892.202203135

Video：

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Objective To evaluate the effectiveness of TiRobot-assisted surgery by O-arm navigation system for percutaneous minimally invasive treatment of posterior pelvic ring injury. Methods The clinical data of 76 patients with posterior pelvic ring injury between January 2016 and June 2021 were retrospectively analyzed. Among them, 45 cases were treated with minimally invasive percutaneous sacroiliac screw fixation assisted by TiRobot and O-arm navigation system (study group), 31 cases were treated with minimally invasive percutaneous sacroiliac screw fixation under the guidance of C-arm X-ray machine (control group). There was no significant difference in gender, age, cause of injury, Tile classification, time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, the times of nail track adjustment, and intraoperative fluoroscopy times were recorded. The quality of fracture reduction was evaluated by Matta score. At last follow-up, Majeed score was used to evaluate the recovery of pelvic function. Results A total of 72 screws were implanted in the study group, with a median of 1 (1, 2) screws per patient. In the control group, 47 screws were implanted, with a median of 1 (1, 2) screws per patient. There was no significant difference in the number of screws between the two groups (Z=−0.392, P=0.695). The operation time, intraoperative blood loss, times of nail track adjustment, and intraoperative fluoroscopy times in the study group were significantly less than those in the control group (P<0.05). All patients were followed up 6-24 months (mean, 14 months). No serious complications was found after operation and during follow-up. Matta score was used to evaluate the quality of fracture reduction at 1 week after operation, and there was no significant difference between the two groups (Z=−1.135, P=0.256). At last follow-up, there was no significant difference of Majeed score between the two groups (Z=−1.279, P=0.201). Conclusion TiRobot-assisted surgery by O-arm navigation system is a reliable surgical method for the treatment of posterior pelvic ring injury, which can reduce the operation time and fluoroscopy times when compared with the traditional operation under the guidance of C-arm X-ray machine. The safety, accuracy, and efficiency of the operation were improved.

Citation： GE Shuo, ZHANG Lei, ZHOU Zifei, JIA Shaohua, ZHENG Longpo. TiRobot-assisted surgery by O-arm navigation system for percutaneous minimally invasive treatment of posterior pelvic ring injury. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(8): 934-939. doi: 10.7507/1002-1892.202203135 Copy

1.	Reilly MC, Bono CM, Litkouhi B, et al. The effect of sacral fracture malreduction on the safe placement of iliosacral screws. J Orthop Trauma, 2006, 20(1 Suppl): S37-S43.
2.	Moshirfar A, Rand FF, Sponseller PD, et al. Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques. J Bone Joint Surg (Am), 2005, 87 Suppl 2: 89-106.
3.	Templeman D, Schmidt A, Freese J, et al. Proximity of iliosacral screws to neurovascular structures after internal fixation. Clin Orthop Relat Res, 1996, (329): 194-198.
4.	Hinsche AF, Giannoudis PV, Smith RM. Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clin Orthop Relat Res, 2002, (395): 135-144.
5.	Stübig T, Windhagen H, Krettek C, et al. Computer-assisted orthopedic and trauma surgery. Dtsch Arztebl Int, 2020, 117(47): 793-800.
6.	Wang J, Zhang T, Han W, et al. Robot-assisted S₂ screw fixation for posterior pelvic ring injury. Injury, 2020. doi: 10.1016/j.injury.2020.11.044.
7.	林书, 胡豇, 万仑, 等. “天玑” 骨科机器人辅助下经皮椎弓根螺钉植钉安全性评价. 中国修复重建外科杂志, 2021, 35(7): 813-817.
8.	郑博隆, 郝定均, 林斌, 等. “天玑” 骨科手术机器人辅助与徒手穿刺椎体成形术治疗上胸椎骨质疏松性椎体压缩骨折的疗效比较. 中华创伤骨科杂志, 2021, 23(1): 20-26.
9.	陈华, 齐红哲, 朱正国, 等. 骨盆外架辅助复位联合通道螺钉固定治疗Tile C1型骨盆骨折. 中华创伤杂志, 2018, 34(10): 919-924.
10.	Tornetta P, Matta JM. Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res, 1996, (329): 186-193.
11.	Bajada S, Mohanty K. Psychometric properties including reliability, validity and responsiveness of the Majeed pelvic score in patients with chronic sacroiliac joint pain. Eur Spine J, 2016, 25(6): 1939-1944.
12.	Letournel E. Pelvic fractures. Injury, 1978, 10(2): 145-148.
13.	Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop Relat Res, 1989, 242: 83-97.
14.	吴新宝, 杨明辉, 朱仕文, 等. 不稳定骨盆骨折的手术治疗. 中华创伤骨科杂志, 2009, 11(7): 619-624.
15.	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.
16.	Zwingmann J, Konrad G, Kotter E, et al. Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res, 2009, 467(7): 1833-1838.
17.	Long T, Li KN, Gao JH, et al. Comparative study of percutaneous sacroiliac screw with or without TiRobot assistance for treating pelvic posterior ring fractures. Orthop Surg, 2019, 11(3): 386-396.
18.	Wang YC, Zhou ZZ, Wang B, et al. Occipitocervical fusion via cervical pedicle fixation assisted with O-arm navigation. Orthop Surg, 2020, 12(4): 1100-1107.
19.	Ghisla S, Napoli F, Lehoczky G, et al. Posterior pelvic ring fractures: Intraoperative 3D-CT guided navigation for accurate positioning of sacro-iliac screws. Orthop Traumatol Surg Res, 2018, 104(7): 1063-1067.

1. Reilly MC, Bono CM, Litkouhi B, et al. The effect of sacral fracture malreduction on the safe placement of iliosacral screws. J Orthop Trauma, 2006, 20(1 Suppl): S37-S43.
2. Moshirfar A, Rand FF, Sponseller PD, et al. Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques. J Bone Joint Surg (Am), 2005, 87 Suppl 2: 89-106.
3. Templeman D, Schmidt A, Freese J, et al. Proximity of iliosacral screws to neurovascular structures after internal fixation. Clin Orthop Relat Res, 1996, (329): 194-198.
4. Hinsche AF, Giannoudis PV, Smith RM. Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clin Orthop Relat Res, 2002, (395): 135-144.
5. Stübig T, Windhagen H, Krettek C, et al. Computer-assisted orthopedic and trauma surgery. Dtsch Arztebl Int, 2020, 117(47): 793-800.
6. Wang J, Zhang T, Han W, et al. Robot-assisted S₂ screw fixation for posterior pelvic ring injury. Injury, 2020. doi: 10.1016/j.injury.2020.11.044.
7. 林书, 胡豇, 万仑, 等. “天玑” 骨科机器人辅助下经皮椎弓根螺钉植钉安全性评价. 中国修复重建外科杂志, 2021, 35(7): 813-817.
8. 郑博隆, 郝定均, 林斌, 等. “天玑” 骨科手术机器人辅助与徒手穿刺椎体成形术治疗上胸椎骨质疏松性椎体压缩骨折的疗效比较. 中华创伤骨科杂志, 2021, 23(1): 20-26.
9. 陈华, 齐红哲, 朱正国, 等. 骨盆外架辅助复位联合通道螺钉固定治疗Tile C1型骨盆骨折. 中华创伤杂志, 2018, 34(10): 919-924.
10. Tornetta P, Matta JM. Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res, 1996, (329): 186-193.
11. Bajada S, Mohanty K. Psychometric properties including reliability, validity and responsiveness of the Majeed pelvic score in patients with chronic sacroiliac joint pain. Eur Spine J, 2016, 25(6): 1939-1944.
12. Letournel E. Pelvic fractures. Injury, 1978, 10(2): 145-148.
13. Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop Relat Res, 1989, 242: 83-97.
14. 吴新宝, 杨明辉, 朱仕文, 等. 不稳定骨盆骨折的手术治疗. 中华创伤骨科杂志, 2009, 11(7): 619-624.
15. 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.
16. Zwingmann J, Konrad G, Kotter E, et al. Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res, 2009, 467(7): 1833-1838.
17. Long T, Li KN, Gao JH, et al. Comparative study of percutaneous sacroiliac screw with or without TiRobot assistance for treating pelvic posterior ring fractures. Orthop Surg, 2019, 11(3): 386-396.
18. Wang YC, Zhou ZZ, Wang B, et al. Occipitocervical fusion via cervical pedicle fixation assisted with O-arm navigation. Orthop Surg, 2020, 12(4): 1100-1107.
19. Ghisla S, Napoli F, Lehoczky G, et al. Posterior pelvic ring fractures: Intraoperative 3D-CT guided navigation for accurate positioning of sacro-iliac screws. Orthop Traumatol Surg Res, 2018, 104(7): 1063-1067.

Chinese Journal of Reparative and Reconstructive Surgery

TiRobot-assisted surgery by O-arm navigation system for percutaneous minimally invasive treatment of posterior pelvic ring injury

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