Efficacy of robot-assisted percutaneous retrograde screw fixation for acetabular fractures involving the posterior column / 中华创伤杂志

ABSTRACT

Objective:To investigate the effect of robot-assisted percutaneous retrograde screw fixation in the treatment of acetabular fractures involving the posterior column.Methods:A retrospective case series study was conducted to analyze the clinical data of 13 patients with acetabular fractures involving the posterior column admitted to Wuhan Fourth Hospital from January 2019 to December 2020. There were 8 males and 5 females，aged 62-78 years［（69.7±1.5）years］. According to Judet-Letournel classification，fractures involved the posterior column in 4 patients，anterior column plus posterior semi-transverse column in 3 and double column in 6. According to AO classification，type 62-A2.1 was found in 2 patients，62-A2.2 in 2，62-B3 in 3 and 62-C in 6. All patients were treated with retrograde percutaneous screws assisted by orthopaedic surgery robot. The operation time，intraoperative blood loss，length of hospital stay and time of bone healing were recorded. The incision healing and complications were detected. Matta reduction standard was used to evaluate the fracture reduction quality at 2 days after operation，and Majeed function score was used to evaluate the functional recovery preoperatively，at 3 months after operation and at 6 months after operation.Results:All patients were followed up for 6-12 months［（9.3±1.7）months］. The operation time was 1.1-1.5 hours［（1.3±0.2）hours］. The intraoperative blood loss was 110-200 ml［（161.3±21.1）ml］. The length of hospital stay was 8-13 days［（10.7±1.3）days］. The time of bone healing was 14-18 weeks［（15.4±1.1）weeks］. All incisions were healed by first intention. One patient with sciatic nerve injury was treated with mecobalamin and recovered 3 months later. One patient with advanced heterotopic ossification had no obvious clinical symptoms. All patients had no complications such as incision infection，deep venous thrombosis of lower limbs，fat embolism，screw penetration into hip joint，fracture displacement after failure of internal fixation，traumatic arthritis，or necrosis of femoral head，etc. According to Matta reduction standard，there were 10 patients with anatomical reduction and 3 with satisfactory reduction. Majeed function score was（15.0±1.3）points before operation，（76.5±2.0）points at 3 months after operation and（85.1±1.9）points at 6 months after operation（ P<0.01），and there were 9 patients with excellent results，2 with good results and 2 with fair results，showing the excellent and good rate of 85%. Conclusion:For acetabular fractures involving the posterior column，robot-assisted percutaneous retrograde screw fixation has advantages of less surgical trauma，higher fracture healing rate，fewer complications，satisfactory anatomical reduction and good functional recovery.