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Objective:Toevaluate the short-term outcomes of mere modified Stoppa approach or in addition to ilia fossa approach for acetabular fractures.Methods:From January 2016 to October 2019, 36 patients with acetabular fracture were treated at Department of Traumatology and Orthopaedics, Beijing Jishuitan Hospital. They were 28 males and 8 females with an average age of 45.2 years (from 27 to 78 years). The left side was affected in 15 cases and the right side in 21. By the Judet-Letournel classification, there were 13 anterior column fractures, 3 anterior column and wall fractures, 12 both-column fractures, 6 anterior and posterior hemitransverse fractures, and 2 T-shaped fractures.The time from injury to surgery averaged 6 days(from 2 to 12 days).All the patients were treated by open reduction and plate-screw fixation through the mere modified Stoppa approach or in addition to the ilia fossa approach.The quality of postoperative fracture reduction was evaluated according to the Matta score.The pain scores of visual analogue scale (VAS) for the patients before operation and 18 months after operation were recorded and compared. The fracture healing time, Harris hip score at the last follow-up and complications in the patients were recorded.Results:The average operation time in this cohort was 213.2 min (from 110 to 340 min). By the Matta scores, anatomical reduction was achieved in 28 cases and satisfactory reduction in 8.The 36 patients were followed up for an average of 20 months (from 18 to 25 months). Their VAS pain scores at 18 months after operation were(0.7 ± 0.6) points, significantly lower than those before operation [(6.7 ± 1.3) points] ( P<0.05). Their fracture healing time averaged 3.2 months (from 1.5 to 6.0 months). Their Harris hip scores at the last follow-up averaged 90.6 points (from 80 to 95 points), yielding 26 excellent and 10 good cases.There were no serious complications like internal fixation failure or neurovascular injury during the follow-up period. Conclusions:In the treatment of acetabular fractures, simple modified Stoppa approach or in addition to ilia fossa approach may lead to fine short-term outcomes, because fractures involving both anterior and posterior columns can be handled safely and effectively at the same time.
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With technological innovations in computer, navigation and robotics, more and more robot-assisted orthopaedic surgeries have been put into clinical practice, such as joint replacement surgery, spine surgery, bone tumor surgery, arthroscopy and fracture fixation surgery, providing a new direction for minimally invasive, precise and personalized treatment of diseases in clinic. TiRobot, an orthopedic robotic system independently developed by China, has been widely used in spine and trauma orthopedic surgery. This article reviews the applications of TiRobot in fracture surgery and in remote surgery, and introduces the progress in application of TiRobot to assist treatments of spinal and cervical fractures, thoracolumbar fractures, pelvic and acetabular fractures, hip fractures, and hand and foot fractures.
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ObjectiveTo unmask the psychological gaps related to suicide ideation in the elderly based on Social Reference Theory， so as to put forward countermeasures for psychological crisis intervention and management. MethodsFrom 2018 to 2019， purposive sampling was adopted to select 19 elderly people with history of suicidal ideation and suicide attempt from 37 geriatric nursing institutions in Ji'nan， Shandong province. Semi-structured interviews were conducted with the elderly， and the collected data were processed by Colaizzi seven-step analysis method. ResultsThe qualitative analysis showed that the elderly with suicidal ideation often experienced strong psychological gaps， including physical condition and function gap， family role gap， socially isolated and lonely gap， filial expectation gap and the gap between the real self and ideal self. ConclusionThe psychological gaps serve as the main psychological motivator for suicidal ideation in the elderly， therefore， reducing the psychological gaps can be a new approach for the suicide intervention among the elderly.
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The cause of hospice care in modern sense has been applied in China for 30 years. Ever since the term "hospice care" was introduced, its interpretation and meaning were different. The development of hospice care in mainland China has experienced ups and downs, but not smoothly. On the one hand, it is influenced by traditional Chinese thought. The practice of sending family members to hospice care institutions often leads to unfilial and unjust accusations. On the other hand, it is due to the imperfection of relevant national policies and the lack of death education in China, which makes it difficult for people to really understand the good death. With the concept of "healthy China" put forward in 2016, the concept of hospice care has attracted people's attention again. However, the cause of hospice care in China is still facing various difficulties. Legislature, administrative departments, hospice care institutions and families must cooperate effectively in order to find countermeasures to meet the needs of hospice care and achieve considerable development.
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Objective To investigate the effects of drainage tube placement after fracture internal fixation.Methods A prospective cohort study was conducted of the 235 patients who were to undergo open reduction and internal fixation for tibia fracture,distal radial fracture or ankle joint fracture at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from March to August,2016.Of them,123 were assigned into an experimental group who were subjected to adequate hemostasis after releasing the tourniquet without drainage following surgery while 112 into a control group who were subjected to conventional hemostasis without relaxing the tourniquet and placement of drainage tubes.The 2 groups were compared in terms of postoperative hospital stay,wound condition,body temperature 3 days postoperatively,counts of hemoglobins,white blood cells and neutrophils,and postoperative visual analogue scale (VAS).Results High fever was not observed in all the patients postoperatively.There were no significant differences between the 2 groups in postoperative hospital stay[(3.3 ± 1.6) d versus (3.7 ± 1.7) d],wound reddening,wound swelling,hemoglobins,white blood cells,neutrophils,or VAS scores postoperatively (P ＞ 0.05).Conclusion Drainage tube placement is not routinely necessary after internal fixation of simple fractures if surgical invasion is limited and hemostasis is adequate after intraoperative release of the tourniquet.
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Objective:To evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures.Methods: In the study,12 patients with pelvic and acetabular fractures who were treated in Beijing Jishuitan Hospital from January to April in 2016 were involved in this research.The research subjects were randomly divided into two groups: the experimental group and the control group.Robotic-assisted percutaneous sacroiliac screw internal fixations were performed under the guidance of fluoroscopy navigation in the experimental group;in the control group,doctors operated manually guided by fluoroscopy.Statistical analysis was performed on the total operation time,the intraoperative fluoroscopy time,the adjustment numbers of intraoperative guide wires,the excellent rate of screw placement and the incidence of adverse events in order to evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures.Results: Eleven screws were placed in 7 patients from the experimental group,while 7 screws were placed in 5 patients from the control group in total.All the screw placement positions were satisfactory according to postoperative CT images.The excellent rates of screw placement position were 100％ in both groups.However,the P value was 0.016 based on the comparison between the screws' distribution in the two groups which meant that the screw distribution of the experimental group was better than that of the control group.The average fluoroscopy time needed for screw insertion was (7.36±2.63) s in the experimental group while (41.80±13.99) s in the control group (P<0.001).This suggested that the difference between the two groups had statistical significances.Intra-operative fluoroscopy time of the experimental group was significantly smaller than that of the control group.The number of the average screw adjustment was (0.36±0.48) times in the experimental group while (9.00±3.06) times in the control group (P=0.003).This suggested that the difference of the number of the guide needle adjustment between the two groups had statistical significances,and the number of the experimental group was smaller than that of the control group.The average operation time was (43.86±49.06) min in the experimental group while only (29.00±12.14) min were needed in the control group (P=0.528).This suggested that the difference between the two groups had no statistical significance.That is,the total operation time of the two groups was equal.All the screws were in satisfactory positions according to validation results of CT scans.No complications such as screw breaking out the bone cortex and entering into the knee joint cavity,wound infection occurred.Conclusion: Surgical robots are suitable for robot-assisted percutaneous screw fixation in pelvic and acetabular fractures.Robot-assisted treatment of pelvic and acetabular fractures has significant advantages over manual operations including high accuracy,small perspective radiation,safety and efficiency.
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Objective To evaluate the safety and efficiency of robot assisted surgery guided by damage control orthopaedics(DCO) in polytraumatised patients with pelvic ring injuries.Methods A retrospective review of the pelvic fracture database was performed.Twenty-six patients who had sustained a pelvic fracture from September 2012 to December 2015 were suitable for robot-assisted minimally invasive internal fixation.They were 17 men and 9 women,aged from 23 to 58 years (average,42.6 years).Their Injury Severity Score(ISS) ranged from 20 to 31 points (average,21.3 years).According to Tile classification,6 cases were type B2,3 type B3,9 type C2 and 8 type C3.Guided by DCO,the vital signs were stabilized by all means and the fractures treated by simple and temporary external fixation before the pelvic and other fractures were managed by the robot-assisted minimally invasive internal fixation.Demographics,times to operating room (TOR),time from acute stabilization to late definitive internal fixation (TAL),time for bone union,type of robot-assisted surgery for major fractures,length of stay (LOS),postoperative complications and mortality were recorded.The outcomes of the pelvis were evaluated at the final follow-up according to the Matta criteria.Results Of the 26 patients,robot-navigated percutaneous screwing was conducted with 23 sacroiliac screws in 19,with 9 ramus pubicus screws in 9,with 6 supraacetabular screws in 4,and with 4 both-column screws in 2 cases.TOR averaged 2.7 times,TAL 5.9 days,LOS at ICU 2.1 days,ICU admission rate 46.2％ (12 of 26),hospital LOS 7.3 days,and time for pelvic bone union 79.0 days.None patients had postoperative complications related to the pelvic fracture and no one died.According to the Matta criteria at the final follow-ups,8 cases were excellent,11 good,5 fair and 2 poor,yielding an excellent and good rate of 73.1％.Conclusion Robot-navigated minimally invasive surgery plus DCO is effective,time saving and safe treatment for polytraumatised patients with pelvic ring injuries.
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Objective To explore the intraoperative fluoroscopy in percutaneous sacroiliac screw fixation based on anatomic measurement and digital reconstructed CT data. Methods The CT data of the pelvis at prostration were collected for 3D reconstruction of the pelvic models from 30 patients with injury to the pelvis or acetabulum.Then the anatomical boundaries of thesafe zone of sacroiliac screw insertion were marked on the 3D models,including the upper,front and back cortex boundaries of S1 vertebra,the front and bottom cortex boundaries of sacral foramen area,and the sacral alar slope. The angles between these anatomical boundaries and the pelvic baseline were measured on the sagittal plane.The digital reconstructed radiology (DRR) was applied to form the inlet,outlet and lateral images of fluoroscopy.The standard protocol to acquire accurate intraoperative images was analyzed by characterization of important anatomic landmarks.Results The angles between the upper,front and back cortex boundaries of S1 vertebra and the baseline (αl,α2,α3) were respectively 37.7°± 8.6°(from 23.2°to 50.8°),22.9° ± 6.7° (from 13.1° to 32.0°),41.9°± 6.8° (from 33.0°to 54.8°).The angles between the front and bottom cortex boundaries of sacral foramen area and the baseline (α4,α5) were 37.0°± 12.0° (from 19.9° to 63.1°) and 38.8°± 8.0° (from 25.7°to 54.6°).The angle between the alar slope and the baseline (α6) was 82.4°± 13.0°(from 70.3°to117.3°).The characteristic manifestations of important anatomic landmarks were observed in the simulated fluoroscopy images. Conclusions It is recommended that the projecting angles in the inlet and outlet views should be decided according to the specific data of each patient.Because the alar slope can not be clearly identified in the outlet view due to its large inclination,the position of screw insertion should be verified in the lateral view to prevent the screw from penetrating the slope to hurt the L5 nerve and iliac vessels.
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A medical robot that is used for closed reduction and the internal fixation of intramedullary locking nailing in treatment of tibial fracture is designed.The system is primarily composed of stereotaxic frame and computer system.Using C-shaped arm-taken X-ray images containing various marked points and keyhole-two-end-center of intramedullary nail,the system calculates the actual position of keyhole in the coordinate system of stereotaxic frame according to space mapping relation and locates the pilot hole on the reference coordinate according to computation.Electric-traction system can realize the precise reduction and remote control operation by network transmission of operation data.In the closed reduction and the internal fixation of intramedullary nail for treatment of tibial fracture in 17 patients,robot reducing fracture and computer-assisted localization of distal keyhole were used.Remote control operation was applied in 4 of them.All operations were performed according to the preset procedure and planning of robot and navigation system.All distal lock nails were successfully implanted at one time.Results demonstrated that both medical robot and computer-assisted localization and navigation system can satisfy fracture reduction and distal Iock nail implantation in the closed reduction and the internal fixation of intramedullary nail for treatment of tibial fracture and shorten intraoperative fluoroscopy time;in addition,remote control operation is reliable and easily mastered due to its simple systemic structure.
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Objective To assess effects and security of the insertion of sacroiliac screws by the bi-planar navigation robot system. Methods In a simulated surgical setup, 12 AO cannulated screws were placed into the S1 vertebral bodies of 4 human pelvic bone under the guidance of the bi-planar navigation robot system which was developed jointly by Beijing Aeronautics and Space University and our hospital. To compare this new technique with the conventional technique, another 12 cannulated screws were placed into 4 Synbone pelvic models under fluoroscopic control. The fluoroscopic times, the radiation exposure time and operation time between image acquisition and guide-wire insertion were recorded. Results With the guidance of the bi-planar navigation robot system, the average fluoroscopic times were 2.5, the average radiation exposure time was 1.5 seconds, and the average operation time was 253 seconds. All the screws were in the safe area. Under the fluoroscopic control, the average fluoroscopic times were 20.3, the average radiation exposure time was 13.7 seconds, and the average operation time was 246 seconds. Two screws (16.7%) were misplaced. The fluoroscopic times and the radiation exposure time were reduced significantly when the bi-planar navigation robot system was used (P0.05). Conclusions The bi-planar navigation robot system can provide precise navigation for insertion of sacroiliac screws within several minutes, and reduce the radiation exposure to the patient and the staff significantly. The results of this prospectively controlled experimental study are encouraging for further clinical trials.