Orthopedic robot based on 5G technology for remote navigation of percutaneous screw fixation in pelvic and acetabular fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Bin , LI Jinqi , ZHAO Chunpeng , SU Yonggang , HAN Wei , WU Xinbao , JIANG Xieyuan ,  WANG Junqiang

Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China;

Corresponding author：

WANG Junqiang, Email: drw-jq1997@163.com

Keywords：

Orthopedic robot; 5G technology; remote surgery; percutaneous screw; pelvic fracture; acetabular fracture

DOI：

10.7507/1002-1892.202204073

Video：

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Objective To investigate the accuracy and safety of percutaneous screw fixation for pelvic and acetabular fractures with remote navigation of orthopedic robot based on 5G technology. Methods Between January 2021 and December 2021, 15 patients with pelvic and/or acetabular fractures were treated with percutaneous screws fixation which were placed by remote navigation of orthopedic robot based on 5G technology. There were 8 males and 7 females. The age ranged from 20 to 98 years, with an average of 52.1 years. The causes of trauma included traffic accident injury in 6 cases, falling from height injury in 6 cases, fall injury in 2 cases, and heavy object smashing injury in 1 case. The time from injury to operation ranged from 3 to 32 days, with an average of 10.9 days. There were 8 cases of simple pelvic fractures, 2 simple acetabular fractures, and 5 both pelvic and acetabular fractures. There were 7 cases of pelvic fractures of Tile type B2, 2 type B3, 1 type C1, and 3 type C2; 4 cases of unilateral anterior column fracture of the acetabulum, 2 bilateral anterior column fractures, and 1 anterior wall fracture. CT images within 5 days after operation were collected for screw position assessment. The screw planning time and guidewire placement time were recorded, as well as the presence of intraoperative adverse events and complications within 5 days after operation. Results All patients achieved satisfactory surgical results. A total of 36 percutaneous screws were inserted (20 sacroiliac screws, 6 LC Ⅱ screws, 9 anterior column screws, and 1 acetabular apical screw). In terms of screw position evaluation, 32 screws (88.89%) were excellent and 4 screws (11.11%) were good; there was no screw penetrating cortical bone. The screw planning time ranged from 4 to 15 minutes, with an average of 8.7 minutes. The guidewire placement time ranged from 3 to 10 minutes, with an average of 6.8 minutes. The communication delayed in 2 cases, but the operation progress was not affected, and no serious intraoperative adverse events occurred. No delayed vascular or nerve injury, infection, or other complications occurred within 5 days after operation. No cases need surgical revision. Conclusion The fixation of pelvic and acetabular fractures by percutaneous screw with remote navigation of orthopedic robot based on 5G technology is accurate, safe, and reliable.

Citation： ZHAO Bin, LI Jinqi, ZHAO Chunpeng, SU Yonggang, HAN Wei, WU Xinbao, JIANG Xieyuan, WANG Junqiang. Orthopedic robot based on 5G technology for remote navigation of percutaneous screw fixation in pelvic and acetabular fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(8): 923-928. doi: 10.7507/1002-1892.202204073 Copy

1.	Yu T, Cheng XL, Qu Y, et al. Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures. World J Clin Cases, 2020, 8(12): 2464-2472.
2.	Wahab H, Hashmi P, Kasi H, et al. Outcome of percutaneous screw fixation of posterior pelvic ring injuries. J Pak Med Assoc, 2021, 71(Suppl 5): S70-S74.
3.	Al-Naseem A, Sallam A, Gonnah A, et al. Robot-assisted versus conventional percutaneous sacroiliac screw fixation for posterior pelvic ring injuries: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol, 2021. doi: 10.1007/s00590-021-03167-x.
4.	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.
5.	Marescaux J, Leroy J, Gagner M, et al. Transatlantic robot-assisted telesurgery. Nature, 2001, 413(6854): 379-380.
6.	张辉. 加快5G网络建设及应用支撑经济高质量发展—工业和信息化部发布《关于推动5G加快发展的通知》. 网信军民融合, 2020, (4): 37-39.
7.	赵春鹏, 王军强, 苏永刚, 等. 机器人辅助经皮螺钉内固定治疗骨盆和髋臼骨折. 北京大学学报 (医学版), 2017, 49(2): 274-280.
8.	Wang JQ, Wang Y, Feng Y, et al. Percutaneous sacroiliac screw placement: A prospective randomized comparison of robot-assisted navigation procedures with a conventional technique. Chin Med J (Engl), 2017, 130(21): 2527-2534.
9.	Wang J, Zhang T, Han W, et al. Robot-assisted S₂ screw fixation for posterior pelvic ring injury. Injury, 2020, 17: S0020-1383(20)30969-4.
10.	Han W, Zhang T, Su YG, et al. Percutaneous robot-assisted versus freehand S₂ iliosacral screw fixation in unstable posterior pelvic ring fracture. Orthop Surg, 2022, 14(2): 221-228.
11.	杨光, 祁宝昌, 赵天昊, 等. TiRobot骨科手术机器人辅助下微创经皮通道螺钉固定治疗骨盆骨折的疗效分析. 中华创伤骨科杂志, 2022, 24(3): 200-205.
12.	田伟, 张琦, 李祖昌, 等. 一站对多地5G远程控制骨科机器人手术的临床应用. 骨科临床与研究杂志, 2019, 4(06): 349-354.
13.	Tian W, Fan M, Zeng C, et al. Telerobotic spinal surgery based on 5G network: the first 12 cases. Neurospine, 2020, 17(1): 114-120.
14.	Gras F, Marintschev I, Wilharm A, et al. 2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries—a case series. BMC Musculoskelet Disord, 2010, 11: 153. doi: 10.1186/1471-2474-11-153.
15.	Butner SE, Ghodoussi M Transforming a surgical robot for human telesurgery. IEEE Transactions on Robotics & Automation, 2003, 19(5): 818-824.
16.	叶青, 陈宁, 林明, 等. 5G通信技术应用场景及关键技术分析. 信息系统工程, 2021, (5): 17-19.
17.	Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
18.	Tsai TH, Tzou RD, Su YF, et al. Pedicle screw placement accuracy of bone-mounted miniature robot system. Medicine (Baltimore), 2017, 96(3): e5835. doi: 10.1097/MD.0000000000005835.
19.	Zheng J, Wang Y, Zhang J, et al. 5G ultra-remote robot-assisted laparoscopic surgery in China. Surg Endosc, 2020, 34(11): 5172-5180.
20.	王军强, 赵春鹏, 胡磊, 等. 远程外科机器人辅助胫骨髓内钉内固定系统的初步应用. 中华骨科杂志, 2006, 26(10): 682-686.
21.	Wu XB, Wang JQ, Sun X, et al. Guidance for treatment of pelvic acetabular injuries with precise minimally invasive internal fixation based on the orthopaedic surgery robot positioning system. Orthop Surg, 2019, 11(3): 341-347.
22.	Matta JM, Yerasimides JG. Table-skeletal fixation as an adjunct to pelvic ring reduction. J Orthop Trauma, 2007, 21(9): 647-656.
23.	Xu L, Xie K, Zhu W, et al. Starr frame-assisted and minimally invasive internal fixation for pelvic fractures: Simultaneous anterior and posterior ring stability. Injury, 2022, 10: S0020-1383(22)00122-X.
24.	杨成亮, 杨晓东, 刘佳, 等. 骨盆解锁复位架辅助微创治疗Tile C2、C3型骨盆骨折. 中华骨科杂志, 2021, 41(19): 1380-1386.
25.	Bai L, Yang J, Chen X, et al. Medical robotics in bone fracture reduction surgery: A review. Sensors (Basel), 2019, 19(16): 3593. doi: 10.3390/s19163593.
26.	Zhao JX, Li C, Ren H, et al. Evolution and current applications of robot-assisted fracture reduction: A comprehensive review. Ann Biomed Eng, 2020, 48(1): 203-224.
27.	赵春鹏, 王豫, 孙旭, 等. 智能化骨折复位机器人系统辅助骨盆骨折微创复位的解剖学研究. 中华创伤骨科杂志, 2022, 24(5): 372-379.

1. Yu T, Cheng XL, Qu Y, et al. Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures. World J Clin Cases, 2020, 8(12): 2464-2472.
2. Wahab H, Hashmi P, Kasi H, et al. Outcome of percutaneous screw fixation of posterior pelvic ring injuries. J Pak Med Assoc, 2021, 71(Suppl 5): S70-S74.
3. Al-Naseem A, Sallam A, Gonnah A, et al. Robot-assisted versus conventional percutaneous sacroiliac screw fixation for posterior pelvic ring injuries: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol, 2021. doi: 10.1007/s00590-021-03167-x.
4. 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.
5. Marescaux J, Leroy J, Gagner M, et al. Transatlantic robot-assisted telesurgery. Nature, 2001, 413(6854): 379-380.
6. 张辉. 加快5G网络建设及应用支撑经济高质量发展—工业和信息化部发布《关于推动5G加快发展的通知》. 网信军民融合, 2020, (4): 37-39.
7. 赵春鹏, 王军强, 苏永刚, 等. 机器人辅助经皮螺钉内固定治疗骨盆和髋臼骨折. 北京大学学报 (医学版), 2017, 49(2): 274-280.
8. Wang JQ, Wang Y, Feng Y, et al. Percutaneous sacroiliac screw placement: A prospective randomized comparison of robot-assisted navigation procedures with a conventional technique. Chin Med J (Engl), 2017, 130(21): 2527-2534.
9. Wang J, Zhang T, Han W, et al. Robot-assisted S₂ screw fixation for posterior pelvic ring injury. Injury, 2020, 17: S0020-1383(20)30969-4.
10. Han W, Zhang T, Su YG, et al. Percutaneous robot-assisted versus freehand S₂ iliosacral screw fixation in unstable posterior pelvic ring fracture. Orthop Surg, 2022, 14(2): 221-228.
11. 杨光, 祁宝昌, 赵天昊, 等. TiRobot骨科手术机器人辅助下微创经皮通道螺钉固定治疗骨盆骨折的疗效分析. 中华创伤骨科杂志, 2022, 24(3): 200-205.
12. 田伟, 张琦, 李祖昌, 等. 一站对多地5G远程控制骨科机器人手术的临床应用. 骨科临床与研究杂志, 2019, 4(06): 349-354.
13. Tian W, Fan M, Zeng C, et al. Telerobotic spinal surgery based on 5G network: the first 12 cases. Neurospine, 2020, 17(1): 114-120.
14. Gras F, Marintschev I, Wilharm A, et al. 2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries—a case series. BMC Musculoskelet Disord, 2010, 11: 153. doi: 10.1186/1471-2474-11-153.
15. Butner SE, Ghodoussi M Transforming a surgical robot for human telesurgery. IEEE Transactions on Robotics & Automation, 2003, 19(5): 818-824.
16. 叶青, 陈宁, 林明, 等. 5G通信技术应用场景及关键技术分析. 信息系统工程, 2021, (5): 17-19.
17. Devito DP, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine (Phila Pa 1976), 2010, 35(24): 2109-2115.
18. Tsai TH, Tzou RD, Su YF, et al. Pedicle screw placement accuracy of bone-mounted miniature robot system. Medicine (Baltimore), 2017, 96(3): e5835. doi: 10.1097/MD.0000000000005835.
19. Zheng J, Wang Y, Zhang J, et al. 5G ultra-remote robot-assisted laparoscopic surgery in China. Surg Endosc, 2020, 34(11): 5172-5180.
20. 王军强, 赵春鹏, 胡磊, 等. 远程外科机器人辅助胫骨髓内钉内固定系统的初步应用. 中华骨科杂志, 2006, 26(10): 682-686.
21. Wu XB, Wang JQ, Sun X, et al. Guidance for treatment of pelvic acetabular injuries with precise minimally invasive internal fixation based on the orthopaedic surgery robot positioning system. Orthop Surg, 2019, 11(3): 341-347.
22. Matta JM, Yerasimides JG. Table-skeletal fixation as an adjunct to pelvic ring reduction. J Orthop Trauma, 2007, 21(9): 647-656.
23. Xu L, Xie K, Zhu W, et al. Starr frame-assisted and minimally invasive internal fixation for pelvic fractures: Simultaneous anterior and posterior ring stability. Injury, 2022, 10: S0020-1383(22)00122-X.
24. 杨成亮, 杨晓东, 刘佳, 等. 骨盆解锁复位架辅助微创治疗Tile C2、C3型骨盆骨折. 中华骨科杂志, 2021, 41(19): 1380-1386.
25. Bai L, Yang J, Chen X, et al. Medical robotics in bone fracture reduction surgery: A review. Sensors (Basel), 2019, 19(16): 3593. doi: 10.3390/s19163593.
26. Zhao JX, Li C, Ren H, et al. Evolution and current applications of robot-assisted fracture reduction: A comprehensive review. Ann Biomed Eng, 2020, 48(1): 203-224.
27. 赵春鹏, 王豫, 孙旭, 等. 智能化骨折复位机器人系统辅助骨盆骨折微创复位的解剖学研究. 中华创伤骨科杂志, 2022, 24(5): 372-379.

Chinese Journal of Reparative and Reconstructive Surgery

Orthopedic robot based on 5G technology for remote navigation of percutaneous screw fixation in pelvic and acetabular fractures

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