Robot-assisted pelvic posterior channel screws in the treatment of unstable pelvic fractures in adolescents / 中华骨科杂志

ABSTRACT

Objective:To investigate the clinical outcomes of unstable pelvic fractures in adolescents treated with robot-assisted posterior pelvic channel screw.Methods:From October 2016 to October 2020, 14 adolescent patients with unstable pelvic fractures were retrospectively analyzed. There were 8 males and 6 females, average age of 14.57±1.69 years (range, 12-17 years). Pelvic fracture classification according to Tile classification, 2 cases of B1, 3 cases of B2, 1 case of B3, 2 cases of C1, 5 cases of C2, 1 case of type C3. According to Torode-Zieg classification, 2 cases of type IIIb, 12 cases of type IV. According to Young-Burgess classification, 1 case of APC II, 1 case of APC III, 2 cases of LC I, 2 cases of LC III, 8 cases of VS type. The diameter of the sacroiliac screw channel, operation time, intraoperative blood loss, fracture reduction quality, pelvic asymmetry, pain visual analogue scale (VAS), Majeed score, screw placement accuracy, postoperative complications were analyzed. The pelvic asymmetry and VAS at presurgery, one week after surgery and the last follow-up were statistically analyzed.Results:There were 8 cases of robot-assisted sacroiliac screw placement and 6 cases of robot-assisted triangular fixation. All patients were followed up for 24.85±10.26 months (range, 12-51 months). The average height of S 1 sacroiliac screw channel was 14.85±3.59 mm (range, 8-22 mm). The average width was 13.78±2.64 mm (range, 9-19 mm). The average height of S 2 sacroiliac screw channel was 14.07±3.08 mm (range, 8-21 mm), and the average width was 12.64±2.84 mm (range, 7-19 mm). The operation time was 63.57±21.61 min (range, 20-120 min), and the intraoperative blood loss was 65.71±41.83 ml (range, 20-200 ml). According to Mears and Velyvis imaging evaluation criteria, 7 cases were anatomically reduced, 6 cases were satisfactory, and 1 case was unsatisfactory, and the satisfactory reduction rate was 93% (13/14). The pelvic asymmetry was 18.14±6.07 mm (range, 9-33 mm) before surgery, while one week after surgery, it was 5.43±2.44 mm (range, 3-13 mm), and it was 4.64±2.27 mm (range, 3-12 mm) in the last follow-up. One week after surgery, the last follow-up, and preoperative pelvic asymmetry was statistically different ( F=50.21, P<0.001); As for VAS for pelvic pain, the score was 6.93±1.21 points (range, 5-9 points) preoperative, 3.93±0.99 points (range, 3-6 points) one week after surgery, and 1.21±0.97 points (range, 0-3 points) at the last follow-up. There was statistical difference between 1 week after operation, the last follow-up and preoperative VAS ( F=100.89, P<0.001). The Majeed score was 86.14±7.35 points (range, 70-95 points), and the excellent and good rate was 93%(13/14). All the robot-assisted screws were located in the bone, the screw placement accuracy was 100%. No postoperative complications such as wound infection occurred, and only 1 patient complained of discomfort because of the nail tail. Conclusion:For unstable pelvic fractures in adolescents, robot-assisted pelvic posterior channel screws shows satisfactory postoperative clinical effects, which is minimally invasive, with fewer postoperative complications.