A clinical study of HoloSight Orthopaedic Trauma Surgery Robot-assisted infra-acetabular screw placement for acetabular fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAO Wenhao ^1,2 , WANG Zhonghe ³ , LI Jiaqi ^1,2 , QI Lin ^1,2 , QI Hongzhe ^1,4 , HE Peiyu ² , HE Jie ^1,2 , LIU Haoyang ⁵ ,  YI Chengla ⁶ ,  CHEN Hua ^2,7

1. Chinese PLA Medical School, Beijing, 100853, P. R. China;
2. Department of Orthopadedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, P. R. China;
3. Graduate School, Ningxia Medical University, Yinchuan Ningxia, 750004, P. R. China;
4. Chinese PLA Strategic Support Force Medical Center, Beijing, 100101, P. R. China;
5. AI Sports Engineering Laboratory, School of Sports Engineering, Beijing Sport University, Beijing, 100084, P. R. China;
6. Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, 430030, P. R. China;
7. National Clinical Research Center for Orthopaedics & Sports Rehabilitation in China, Beijing, 100048, P. R. China;

Corresponding author：

YI Chengla, Email: chenglayi@163.com; CHEN Hua, Email: chenhua0270@126.com

Keywords：

Acetabular fracture; fluoro-navigation; infra-acetabular screw; safety of screw placement

DOI：

10.7507/1002-1892.202404045

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Objective To investigate the effectiveness of HoloSight Orthopaedic Trauma Surgery Robot-assisted infra-acetabular screw placement for treatment of acetabular fractures. Methods The clinical data of 23 patients with acetabular fractures treated with open reduction and internal fixation and infra-acetabular screw placement in two medical centers between June 2022 and October 2023 were retrospectively analyzed. According to the the method of infra-acetabular screw placement, the patients were divided into navigation group (10 cases, using HoloSight Orthopaedic Trauma Surgery Robot-assisted screw placement) and freehand group (13 cases, using traditional X-ray fluoroscopy to guide screw placement). There was no significant difference in gender, age, body mass index, cause of injury, time from injury to operation, and Judet-Letournel classification between the two groups (P>0.05). The time of infra-acetabular screw placement, the fluoroscopy frequency, the guide pin adjustment times, the quality of screw placement, the quality of fracture reduction, and the function of hip joint were compared between the two groups. Results All patients completed the operation successfully. The time of screw placement, the fluoroscopy frequency, and guide pin adjustment times in the navigation group were significantly less than those in the freehand group (P<0.05). The quality of screw placement in the navigation group was significantly better than that in the freehand group (P<0.05). Patients in both groups were followed up 6-11 months, with an average of 7.7 months. There were 9 and 9 cases in the navigation group and the freehand group who achieved excellent and good fracture reduction quality at 1 week after operation, and 12 and 12 cases with excellent and good hip joint function at last follow-up, respectively, and there was no significant difference between the two groups (P>0.05). The fractures in both groups healed well, and there was no significant difference in healing time (P>0.05). During the follow-up, there was no complication related to screw placement, such as failure of internal fixation, vascular and nerve injury, incisional hernia. Conclusion In the treatment of acetabular fractures, compared with the traditional freehand screw placement, the HoloSight Orthopaedic Trauma Surgery Robot-assisted screw placement can reduce the time of screw placement, improve the accuracy of screw placement, and reduce the amount of radiation, which is an efficient, accurate, and safe surgical method.

Citation： CAO Wenhao, WANG Zhonghe, LI Jiaqi, QI Lin, QI Hongzhe, HE Peiyu, HE Jie, LIU Haoyang, YI Chengla, CHEN Hua. A clinical study of HoloSight Orthopaedic Trauma Surgery Robot-assisted infra-acetabular screw placement for acetabular fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(6): 696-702. doi: 10.7507/1002-1892.202404045 Copy

1.	Laird A, Keating JF. Acetabular fractures: a 16-year prospective epidemiological study. J Bone Joint Surg (Br), 2005, 87(7): 969-973.
2.	陈庞涛, 许一凡, 李新宇, 等. 髋臼骨折临床分型研究进展. 中国骨与关节损伤杂志, 2021, 36(4): 443-445.
3.	Judet R, Judet J, Letournel E. Fractures of the acetabulum: Classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg (Am), 1964, 46: 1615-1646.
4.	Letournel E. Acetabulum fractures: Classification and management. J Orthop Trauma, 2019, 33 Suppl 2: S1-S2.
5.	Collinge CA, Lebus GF. Techniques for reduction of the quadrilateral surface and dome impaction when using the anterior intrapelvic (modified Stoppa) approach. J Orthop Trauma, 2015, 29 Suppl 2: S20-S24.
6.	侯志勇. 骨盆、髋臼骨折治疗的创新之路. 中华创伤杂志, 2020, 36(11): 961-965.
7.	洪顾麒, 庆思源, 胡军, 等. 多枚后柱螺钉技术在复合型髋臼骨折中的应用. 中华骨与关节外科杂志, 2023, 16(7): 606-611.
8.	Caviglia H, Mejail A, Landro ME, et al. Percutaneous fixation of acetabular fractures. EFORT Open Rev, 2018, 3(5): 326-334.
9.	Culemann U, Marintschev I, Gras F, et al. Infra-acetabular corridor—technical tip for an additional screw placement to increase the fixation strength of acetabular fractures. J Trauma, 2011, 70(1): 244-246.
10.	Gras F, Marintschev I, Schwarz CE, et al. Screw- versus plate-fixation strength of acetabular anterior column fractures: a biomechanical study. J Trauma Acute Care Surg, 2012, 72(6): 1664-1670.
11.	Marintschev I, Gras F, Schwarz CE, et al. Biomechanical comparison of different acetabular plate systems and constructs—the role of an infra-acetabular screw placement and use of locking plates. Injury, 2012, 43(4): 470-474.
12.	Wang T, Zhao B, Yan J, et al. Finite element analysis of infra-acetabular screw fixation for the treatment of acetabular posterior column fracture. Int Orthop, 2022, 46(3): 623-634.
13.	吕刚, 马雷, 孙辉, 等. 髋臼下螺钉技术治疗髋臼骨折的疗效分析. 中华创伤骨科杂志, 2021, 23(6): 507-512.
14.	Tu P, Wang H, Joskowicz L, et al. A multi-view interactive virtual-physical registration method for mixed reality based surgical navigation in pelvic and acetabular fracture fixation. Int J Comput Assist Radiol Surg, 2023, 18(9): 1715-1724.
15.	Swartman B, Pelzer J, Beisemann N, et al. Fracture reduction and screw position after 3D-navigated and conventional fluoroscopy-assisted percutaneous management of acetabular fractures: a retrospective comparative study. Arch Orthop Trauma Surg, 2021, 141(4): 593-602.
16.	Wong JSY, Lau JCK, Chui KH, et al. Three-dimensional-guided navigation percutaneous screw fixation of fragility fractures of the pelvis. J Orthop Surg (Hong Kong), 2019, 27(1): 2309499019833897. doi: 10.1177/2309499019833897.
17.	Li J, Qi L, Liu N, et al. A new technology using mixed reality surgical navigation with the unlocking closed reduction technique frame to assist pelvic fracture reduction and fixation: Technical note. Orthop Surg, 2023, 15(12): 3317-3325.
18.	曹文豪, 朱正国, 齐红哲, 等. 计算机导航系统辅助骶髂贯穿螺钉植入治疗骨盆后环损伤的早期临床研究. 中国修复重建外科杂志, 2023, 37(9): 1049-1054.
19.	何立, 陈华, 易成腊. 骨盆解锁复位架联合智能可视化系统辅助复位与固定治疗Tile C1型骨盆骨折. 中华骨科杂志, 2023, 43(19): 1308-1315.
20.	李嘉琦, 陈华, 张伟, 等. 非透视下三维可视化技术与二维透视在不稳定型骨盆骨折复位中的应用效果比较. 中国修复重建外科杂志, 2023, 37(2): 129-135.
21.	Lonstein JE, Denis F, Perra JH, et al. Complications associated with pedicle screws. J Bone Joint Surg (Am), 1999, 81(11): 1519-1528.
22.	Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
23.	d’Aubigné RM, Postel M. The classic: functional results of hip arthroplasty with acrylic prosthesis. 1954. Clin Orthop Relat Res, 2009, 467(1): 7-27.
24.	Matta JM, Mehne DK, Roffi R. Fractures of the acetabulum. Early results of a prospective study. Clin Orthop Relat Res, 1986(205): 241-250.
25.	White G, Kanakaris NK, Faour O, et al. Quadrilateral plate fractures of the acetabulum: an update. Injury, 2013, 44(2): 159-167.
26.	Letournel E, Judet R, Elson RA. Introduction: History and development of our methods of classification and treatment of acetabular fractures//Elson RA. Fractures of the acetabulum. Berlin, Heidelberg: Springer, 1993: 1-15.
27.	朱现玮, 严飞, 王黎明, 等. 经单一腹直肌旁入路结合螺钉固定治疗累及髋臼前、后柱的复杂髋臼骨折. 实用骨科杂志, 2020, 26(1): 63-67.
28.	Gras F, Marintschev I, Klos K, et al. Screw placement for acetabular fractures: which navigation modality (2-dimensional vs. 3-dimensional) should be used? An experimental study. J Orthop Trauma, 2012, 26(8): 466-473.
29.	Lehmann W, Rueger JM, Nuechtern J, et al. A novel electromagnetic navigation tool for acetabular surgery. Injury, 2015, 46 Suppl 4: S71-S74.
30.	Zhao B, Zhang W, Li H, et al. The largest secure corridor of the infra-acetabular screw-a 3-D axial perspective analysis. BMC Musculoskelet Disord, 2021, 22(1): 551. doi: 10.1186/s12891-021-04433-z.
31.	Pagano S, Müller K, Alt V, et al. Navigated or conventional acetabular surgery: Comparison of positional accuracy exemplified by the infra-acetabular screw. Unfallchirurgie (Heidelb), 2024, 127(1): 44-53.

1. Laird A, Keating JF. Acetabular fractures: a 16-year prospective epidemiological study. J Bone Joint Surg (Br), 2005, 87(7): 969-973.
2. 陈庞涛, 许一凡, 李新宇, 等. 髋臼骨折临床分型研究进展. 中国骨与关节损伤杂志, 2021, 36(4): 443-445.
3. Judet R, Judet J, Letournel E. Fractures of the acetabulum: Classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg (Am), 1964, 46: 1615-1646.
4. Letournel E. Acetabulum fractures: Classification and management. J Orthop Trauma, 2019, 33 Suppl 2: S1-S2.
5. Collinge CA, Lebus GF. Techniques for reduction of the quadrilateral surface and dome impaction when using the anterior intrapelvic (modified Stoppa) approach. J Orthop Trauma, 2015, 29 Suppl 2: S20-S24.
6. 侯志勇. 骨盆、髋臼骨折治疗的创新之路. 中华创伤杂志, 2020, 36(11): 961-965.
7. 洪顾麒, 庆思源, 胡军, 等. 多枚后柱螺钉技术在复合型髋臼骨折中的应用. 中华骨与关节外科杂志, 2023, 16(7): 606-611.
8. Caviglia H, Mejail A, Landro ME, et al. Percutaneous fixation of acetabular fractures. EFORT Open Rev, 2018, 3(5): 326-334.
9. Culemann U, Marintschev I, Gras F, et al. Infra-acetabular corridor—technical tip for an additional screw placement to increase the fixation strength of acetabular fractures. J Trauma, 2011, 70(1): 244-246.
10. Gras F, Marintschev I, Schwarz CE, et al. Screw- versus plate-fixation strength of acetabular anterior column fractures: a biomechanical study. J Trauma Acute Care Surg, 2012, 72(6): 1664-1670.
11. Marintschev I, Gras F, Schwarz CE, et al. Biomechanical comparison of different acetabular plate systems and constructs—the role of an infra-acetabular screw placement and use of locking plates. Injury, 2012, 43(4): 470-474.
12. Wang T, Zhao B, Yan J, et al. Finite element analysis of infra-acetabular screw fixation for the treatment of acetabular posterior column fracture. Int Orthop, 2022, 46(3): 623-634.
13. 吕刚, 马雷, 孙辉, 等. 髋臼下螺钉技术治疗髋臼骨折的疗效分析. 中华创伤骨科杂志, 2021, 23(6): 507-512.
14. Tu P, Wang H, Joskowicz L, et al. A multi-view interactive virtual-physical registration method for mixed reality based surgical navigation in pelvic and acetabular fracture fixation. Int J Comput Assist Radiol Surg, 2023, 18(9): 1715-1724.
15. Swartman B, Pelzer J, Beisemann N, et al. Fracture reduction and screw position after 3D-navigated and conventional fluoroscopy-assisted percutaneous management of acetabular fractures: a retrospective comparative study. Arch Orthop Trauma Surg, 2021, 141(4): 593-602.
16. Wong JSY, Lau JCK, Chui KH, et al. Three-dimensional-guided navigation percutaneous screw fixation of fragility fractures of the pelvis. J Orthop Surg (Hong Kong), 2019, 27(1): 2309499019833897. doi: 10.1177/2309499019833897.
17. Li J, Qi L, Liu N, et al. A new technology using mixed reality surgical navigation with the unlocking closed reduction technique frame to assist pelvic fracture reduction and fixation: Technical note. Orthop Surg, 2023, 15(12): 3317-3325.
18. 曹文豪, 朱正国, 齐红哲, 等. 计算机导航系统辅助骶髂贯穿螺钉植入治疗骨盆后环损伤的早期临床研究. 中国修复重建外科杂志, 2023, 37(9): 1049-1054.
19. 何立, 陈华, 易成腊. 骨盆解锁复位架联合智能可视化系统辅助复位与固定治疗Tile C1型骨盆骨折. 中华骨科杂志, 2023, 43(19): 1308-1315.
20. 李嘉琦, 陈华, 张伟, 等. 非透视下三维可视化技术与二维透视在不稳定型骨盆骨折复位中的应用效果比较. 中国修复重建外科杂志, 2023, 37(2): 129-135.
21. Lonstein JE, Denis F, Perra JH, et al. Complications associated with pedicle screws. J Bone Joint Surg (Am), 1999, 81(11): 1519-1528.
22. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
23. d’Aubigné RM, Postel M. The classic: functional results of hip arthroplasty with acrylic prosthesis. 1954. Clin Orthop Relat Res, 2009, 467(1): 7-27.
24. Matta JM, Mehne DK, Roffi R. Fractures of the acetabulum. Early results of a prospective study. Clin Orthop Relat Res, 1986(205): 241-250.
25. White G, Kanakaris NK, Faour O, et al. Quadrilateral plate fractures of the acetabulum: an update. Injury, 2013, 44(2): 159-167.
26. Letournel E, Judet R, Elson RA. Introduction: History and development of our methods of classification and treatment of acetabular fractures//Elson RA. Fractures of the acetabulum. Berlin, Heidelberg: Springer, 1993: 1-15.
27. 朱现玮, 严飞, 王黎明, 等. 经单一腹直肌旁入路结合螺钉固定治疗累及髋臼前、后柱的复杂髋臼骨折. 实用骨科杂志, 2020, 26(1): 63-67.
28. Gras F, Marintschev I, Klos K, et al. Screw placement for acetabular fractures: which navigation modality (2-dimensional vs. 3-dimensional) should be used? An experimental study. J Orthop Trauma, 2012, 26(8): 466-473.
29. Lehmann W, Rueger JM, Nuechtern J, et al. A novel electromagnetic navigation tool for acetabular surgery. Injury, 2015, 46 Suppl 4: S71-S74.
30. Zhao B, Zhang W, Li H, et al. The largest secure corridor of the infra-acetabular screw-a 3-D axial perspective analysis. BMC Musculoskelet Disord, 2021, 22(1): 551. doi: 10.1186/s12891-021-04433-z.
31. Pagano S, Müller K, Alt V, et al. Navigated or conventional acetabular surgery: Comparison of positional accuracy exemplified by the infra-acetabular screw. Unfallchirurgie (Heidelb), 2024, 127(1): 44-53.

Chinese Journal of Reparative and Reconstructive Surgery

A clinical study of HoloSight Orthopaedic Trauma Surgery Robot-assisted infra-acetabular screw placement for acetabular fractures

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