ABSTRACT
Objective To analyze the effectiveness and safety of percutaneous screw fixation assisted by an orthopedic robot for treatment of pelvic and acetabular fractures.Methods Fifteen patients with fresh closed pelvic or acetabular fracture were hospitalized from September to December 2017 at Department of Orthopaedics,Foshan Hospital of Traditional Chinese Medicine.They were 10 men and 5 women,from 22 to 69 years of age (average,65.2 years).There were 9 pelvic fractures (5 cases of Tile type B and 4 ones of Tile type C) and 6 acetabular fractures (3 anterior column fractures,2 posterior column fractures and one transverse fracture).All patients underwent percutaneous transpedicular screw fixation with the assistance of an orthopaedic robot.Fluoroscopic frequency,number of guide needle adjustment and deviation between initial planning and the final screw position were recorded intraoperatively.Postoperative CT was performed to evaluate screw positions and incidence of adverse events.Functional recovery in the patients was evaluated in regular follow-ups.Results A total of 26 screws were implanted in the operation.The fluoroscopic frequency ranged from 12 to 49 times,with a mean value of 17.3 times per screw;the number of needle adjustment ranged from 0 to 2 times(mean,0.3 times);the deviation of the actual path from its initial planning ranged from 0.82 to 1.42 mm (mean,1.06 mm).No surgery-related neurovascular injury occurred in any patient.Postoperative CT examination revealed that no screws cut out of cortical bone,yielding a 100％ rate of excellent and good screw positions.Two patients were lost to the follow-up,and the remaining 13 patients were followed up for 12 to 14 months (mean,12.6 months).Their Majeed functional scores at the final follow-up averaged 88.6 points (from 68 to 96 points).No neurological symptoms were observed during follow-up.Conclusion Since percutaneous screw fixation assisted by an orthopaedic robot is accurate and safe and needs less fluoroscopic frequency,it will became a major minimally invasive surgical technique for pelvic and acetabular fractures.