Meta-analysis of efficacy of orthopedic robot-assisted versus freehand percutaneous sacroiliac screw fixation for posterior pelvic ring fractures / 中国组织工程研究

OBJECTIVE:Percutaneous sacroiliac screw internal fixation has become the main surgical procedure for the treatment of posterior pelvic ring fractures;however,the unassisted closure operation requires high operator experience and repeated fluoroscopy increases the radiation hazard for patients and medical personnel.This article compares the clinical efficacy of robot-assisted versus unassisted percutaneous sacroiliac screw placement for posterior pelvic ring fractures by meta-analysis. METHODS:Computer searches of CNKI,WanFang,VIP,CBM,PubMed,Embase,Cochrane Library and ClinicalTrials.gov were conducted from the time of database inception to December 2022.The literature on the clinical efficacy of robot-assisted versus freehand percutaneous sacroiliac screw placement in the treatment of posterior pelvic ring fractures was collected in and outside China.The data were independently screened and extracted by two investigators according to the inclusion and exclusion criteria,respectively.The quality of randomized controlled trials was evaluated using Cochrane risk assessment criteria.The quality of included cohort studies was assessed using the Newcastle-Ottawa Scale.Meta-analysis was performed using RevMan 5.4 software for inclusion metrics.Outcome metrics included operative time,intraoperative bleeding,fluoroscopy time,fluoroscopy frequency,number of holes drilled,Majeed postoperative function score,the excellent and good rates of Matta fracture reduction,the excellent and good rates of Gras screw position,fracture healing time and complications. RESULTS:(1)A total of 13 publications were included,2 were randomized controlled trials both referring to randomized methods,11 non-randomized controlled studies were evaluated for quality of literature according to the Newcastle-Ottawa Scale,1 scored 8,9 scored 7;and 1 scored 6;the quality of literature was good.A total of 748 patients were included,including 430 in the robot-assisted group and 318 in the freehand group.(2)The results of the meta-analysis showed that the operative time(MD=-28.30,95%CI:-40.20 to-16.40),intraoperative bleeding(MD=-6.36,95%CI:-10.06 to-2.66),intraoperative fluoroscopy time(MD=-12.13,95%CI:-19.54 to-4.72),intraoperative fluoroscopy frequency(MD=-17.39,95%CI:-29.00 to-5.78),number of intraoperative needle drillings(SMD=-9.50,95%CI:-14.27 to-4.73)and the excellent and good rates of Gras screw position(OR=8.65,95%Cl:3.26-22.92)in the robot-assisted group were significantly better than those in the freehand group(P<0.05).(3)In the robot-assisted group,the overall postoperative complication rate was significantly reduced(OR=0.10,95%Cl:0.02-0.48,P<0.05).(4)No significant difference was detected in fracture healing time(MD=-0.08,95%CI:-0.21,0.06),the excellent and good rates of Matta fracture repositioning rate(OR=2.06,95%Cl:0.97-4.39),and Majeed functional score(MD=0.91,95%CI:-0.31-2.13)between both groups(P>0.05). CONCLUSION:Compared with freehand sacroiliac joint nailing,robotic assistance shortens the operative time,reduces intraoperative bleeding,decreases radiation damage to patients and medical staff,improves the excellent and good rate of screw position,and reduces the overall incidence of postoperative complications in patients,but there was no significant improvement in fracture reduction quality,fracture healing time,and postoperative function.In the future,more large-sample,multicenter,and high-quality randomized controlled trials are still needed to verify.

Accuracy of sacroiliac screw placement in robot-assisted navigation / 中国组织工程研究

BACKGROUND:Orthopedic robots have been widely used in clinical practice,and relevant reports have shown that they have many advantages such as minimal trauma and short surgical time.However,there is currently no clear report on how accurate they are. OBJECTIVE:To evaluate the accuracy of robot-assisted sacroiliac screw insertion. METHODS:A total of 131 patients with sacroiliac joint fracture and dislocation and sacral fracture admitted to the Department of Trauma Surgery,Gansu Provincial Hospital from January 2020 to April 2023 were retrospectively collected,including 131 S1 screws and 46 S2 screws,totaling 177 screws.They were divided into two groups based on whether robot-assisted navigation was performed.There were 63 cases of sacroiliac screws inserted under robot-assisted navigation(observation group),with 36 males and 27 females,aged 19-72 years,with a mean age of(45.3±17.6)years.Among them,39 cases were fixed with only S1 screws,while 24 cases were fixed with S1S2 screws,resulting in a total of 87 sacroiliac screws.Under C-arm fluoroscopy,68 cases of sacroiliac screws were inserted with bare hands(control group),including 41 males and 27 females,aged 23-67 years,with a mean age of(42.6±21.3)years.Among them,46 cases were fixed with simple S1 screws,while 22 cases were fixed with S1S2 screws,resulting in a total of 90 sacroiliac screws.A postoperative CT scan was performed to evaluate the number of S1 screws,S2 screws,total screw level,and calculate accuracy based on the method introduced by SMITH et al. RESULTS AND CONCLUSION:(1)In the observation group,62 S1 screws were accurately placed(62/63),with an accuracy rate of 98%.24 S2 screws were accurately placed(24/24),with an accuracy rate of 100%.The total number of screws accurately placed was 86(86/87),with an accuracy rate of 99%.(2)In the control group,58 S1 screws were accurately inserted(58/68),with an accuracy rate of 85%.19 S2 screws were accurately inserted(19/22),with an accuracy rate of 86%.The total number of screws accurately inserted was 77(77/90),with an accuracy rate of 86%.(3)There was a statistically significant difference in the accuracy of the S1 screw,S2 screw,and total screw between the two groups(P<0.05).It is suggested that the placement of sacroiliac screws under robot navigation has higher accuracy compared to manual placement under C-arm fluoroscopy,but still has a lower error rate in placement.

Minimally invasive internal fixation of pelvic ring for type C pelvic fracture / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the feasibility of minimally invasive internal fixation of pelvic anterior and posterior ring for the treatment of type C pelvic fracture, and to explore its operative techniques and therapeutic efficacy.</p><p><b>METHODS</b>From December 2010 to December 2015, 18 patients with type C pelvic fracture were treated by reconstructive plates fixation through minimally invasive ilioinguinal approach for pelvic anterior ring injuries, and by invasive percutaneous sacroiliac joint screw fixation for pelvic posterior ring injuries. There were 11 males and 7 females ranging from 29 to 68 years old with an average age of 43.6 years old. According to Tile classification, there were 14 cases of type C1, 3 cases of type C2, 1 case of Type C3. To be specific, 12 cases with hemi-fracture of rami ossa pubis accompanied with fracture of the sacrum, 2 cases with hemi-fracture of rami ossa pubis accompanied with sacro-iliac joint dislocation, 3 cases with bilateral-fracture of rami ossa pubis combined with pubic symphysis separation accompanied with single-fracture of the sacrum, 1 case with bilateral-fracture of rami ossa pubis combined with bilateral-fracture of sacro-iliac joint were included. Operation time, intra-operative blood loss, injuries of lumbosacral nerves and iliac blood vessels, and fracture reduction were observed.</p><p><b>RESULTS</b>All wounds were primary healing. No complications such as infection, deep venous thrombosis, injuries of lumbosacral nerves and iliaca vessels or heterotopic ossification occurred. According to Matta criterion of fracture reduction, 14 cases got excellent results, 3 good and 1 fair. Sixteen patients were followed up in a period varying from 6 to 33 months with 16.7 months on average. And according to functional score of Majeed, 13 cases obtained excellent results, 2 good and 1 fair, with an average score of 92.13±5.44.</p><p><b>CONCLUSIONS</b>Internal fixation with reconstructive plates through the ilioinguinal approach and with percutaneous iliosacral screw for type C pelvic facture on pelvic anterior ring and pelvic posterior ring respectively have advantages of shorter operation time, smaller invasive trauma, less blood loss and etc. Thus, this technique is safe and practicable, yielding satisfying results.</p>

Clinical study on the relationship between the displaced fracture of the inferior ramus of pubis and the posterior pelvic ring injury / 中国骨伤

<p><b>OBJECTIVE</b>To investigate relation between displaced inferior ramus fractures and posterior pelvic ring injury.</p><p><b>METHODS</b>From August 2012 to August 2015, 51 patients of pubic ramus fractures with complete record were retrospective reviewed including 27 males and 24 females with an average age of(49.1±19.0) years old ranging from 9 to 90 years old. The time from injury to treatment ranged from 0.3 to 48 hours with an average of 10.1 hours. According to Tile classification of pelvic fractures, 28 cases were type A, 17 cases were type B, 6 cases were type C. Pelvic radiographs and computed tomography scans were detailed and evaluated for whether there were posterior pelvic ring injury, meanwhile pubic rami fractures were divided into 4 groups as follow: displaced inferior ramus fractures group, undisplaced inferior ramus fractures group, displaced superior ramus fractures group, undisplaced superior ramus fractures group;the incidence rate of association of posterior pelvic ring injury was determined and compared.</p><p><b>RESULTS</b>Twenty-six patients had displaced inferior ramus fractures, all of them (100%) were combined with posterior pelvic ring injury. Twenty patients had undisplaced inferior ramus fractures, 6 of them(30%)were combined with posterior pelvic ring injury. Twenty-eight patients had displaced superior ramus fractures, 22 of them(78.5%) were combined with posterior pelvic ring injury. Twelve patients had displaced superior ramus fractures, 5 of them(41.6%) were combined with posterior pelvic ring injury. Compared with undisplaced inferior ramus fractures group, there was statistic difference(=0.028 8<0.05) on the incidence rate of posterior pelvic ring injury, there were no statistic difference(=0.055 8>0.05;=0.168 3>0.05) while compared with other undisplaced superior ramus fractures group and displaced superior ramus fractures group, but the incidence rate of association with posterior pelvic ring injury much higher than both of two groups (100% vs 41.6%, 78.5%).</p><p><b>CONCLUSIONS</b>Displaced inferior pubic ramus fractures have the highest incidence rate of association with posterior pelvic ring injury, frequently prompted injury to the posterior pelvis. Displaced inferior ramus fractures were an indirect evidence of posterior pelvic injury.</p>

Application of three-dimensional CT for posterior pelvic ring fractures / 中华创伤骨科杂志

Objective To investigate the clinical significance of three-dim en sional CT in diagnosis and treatment of posterior pelvic ring fractures. Methods A retrospective analysis was done for 19 cases of posterior pelvic ring fractur es who were treated from March 2002 to August 2003 and had plain and three-dime nsional CT films. Their radiological characteristics and results were compared b etween the 2 kinds of film. Results 3-D CT corrected the misdiagnosis or uncert ainty of 9 cases who had plain radio-graphs. The 3-D CT showed obvious advanta ges over plain radio-graphs in detecting sacroiliac diastasis, sacroiliac joint fragments, fractures involving iliac and sacral lips abutting the sacroiliac jo int, sacral fracture and complicated comminuted fracture, because it clearly del ineated fractures of posterior pelvic ring and manifested the severity of commin ution and separation. Conclusion The 3-D CT scan provides valuable information for precise diagnosis and treatment plan for the complex posterior pelvic ring f ractures.

Iliosacral Screw Fixation of the Posterior Pelvic Ring Using Local Anesthesia and Computerized Tomography / 대한정형외과학회잡지

PURPOSE: To analyze the functional and radiological results after a CT-guided iliosacral screw fixation of the posterior pelvic ring using local anesthesia. MATERIALS AND METHODS: Nine patients with unstable pelvic ring injuries treated by CT-guided percutaneous iliosacral screw fixation under local anesthesia were enrolled in this study. Anterior lesion including 4 cases of symphysis pubis separation and 3 cases of displaced pubic ramus fracture was stabilized using a plate and screw before the posterior iliosacral screw fixation. The Iowa pelvic score was used for a functional evaluation. A reduction of the sacroiliac joint gap was analyzed using plain radiographs and CT. RESULTS: The mean follow-up period was 25 months (12-48) and the mean Iowa pelvic score was 84. The mean number of screws introduced was 1.55 and the mean time for the procedure was 24 minutes per screw. There were no neurovascular complications related to misplaced screws encroaching the spinal canal or neural foramen. The iliosacral joint separation was 8.2 mm preoperatively and 3.6 mm postoperatively. There was no screw loosening or breakage. CONCLUSION: Iliosacral screw fixation using local anesthesia and computerized tomography is an easyand safe procedure for the patients with unstable pelvic ring injuries.