Analysis of the therapeutic efficacy of robot-assisted percutaneous screw fixation in the minimally invasive treatment of pelvic fractures.

Objective: To compare the therapeutic efficacy of robot-assisted and manual screw placement techniques for the treatment of pelvic fractures. Methods: This study included patients with pelvic fractures admitted to our orthopedic department between January 2020 and January 2022. They were randomly assigned to either the robot-assisted group or the control group. Various parameters, including surgical duration, intraoperative bleeding, fluoroscopy frequency, postoperative pain, length of hospitalization, postoperative hematological indices, postoperative functional scores, and postoperative complications, were compared between the two groups. Results: There were no significant differences in age, sex, body mass index, and preoperative hematological parameters between the two groups. The robot-assisted group exhibited significantly shorter surgical duration, lower fluoroscopy frequencies, lower postoperative pain scores, and shorter length of hospitalization compared to the control group. At 3 and 6 months postoperatively, patients in the robot-assisted group demonstrated significantly higher Majeed functional scores in comparison to the control group. However, there were no significant differences in Majeed scores at 12 months postoperatively. Moreover, there were no significant differences in postoperative complications between the two groups. Conclusion: Robot-assisted minimally invasive treatment of pelvic fractures using hollow screws effectively reduced surgical duration, mitigated intraoperative bleeding and postoperative pain, shortened hospital stays, and promoted faster functional recovery.

Treatment of lumbar disc herniation with robot combined with unilateral biportal endoscopic technology: A case report.

BACKGROUND: This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion (UBE-LIF), utilizing the UBE's wide viewing field and operating space to perform minimally invasive decompressive fusion of the lesioned segment, and the orthopedic surgical robot's intelligence and precision to perform percutaneous pedicle screw placement. The advancement of this procedure lies in the superposition of advantages and offsetting disadvantages of the two new technologies, and the maximum effect of treatment is achieved with maximum minimization of invasiveness and precision under the monitoring of imaging instruments to maximize the benefit of patients, and this review reports a case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE for reference. CASE SUMMARY: A 44-year-old patient presented to our hospital. Combining various clinical data, we diagnosed the patient with lumbar disc herniation with radiculopathy, lumbar spondylolisthesis, and lumbar spinal stenosis. We developed a surgical plan of "UBE decompression + UBE-LIF + orthopedic surgery robot-assisted percutaneous pedicle screw implantation for internal fixation". The results were satisfactory. CONCLUSION: We present an extremely rare case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE and achieved good results. Therefore, the technique is worthy of clinical promotion.

[Treatment of Tile type C pelvic ring fracture using orthopedic robot combined with Starr pelvis reduction frame].

OBJECTIVE: To investigate the clinical effect of orthopedic robot combined with Starr pelvic reduction frame in the treatment of Tile type C pelvic ring fracture. METHODS: From October 2019 to May 2021, 14 patients with type C pelvic ring fracture were treated with robotic combined with Starr pelvic reduction frame, including 9 males and 5 females. The age ranged from 33 to 69 years. All the 14 patients had fresh closed fractures without femur, tibia and fibula fracture. Surgery was completed from 4 to 7 d after hospital admission. During the operation, the X-ray carbon bed was used, the pelvic ring was reduced by Starr pelvis reduction frame, and pelvic ring fracture was treated by orthopedic robot. Operation time, bleeding volume, fluoroscopy times of single screw placement, fracture reduction quality, affected limb function and complications were observed. Radiological reduction was evaluated using Matta scoring standard, and clinical efficacy was evaluated by Majeed pelvic function scoring system at the final follow-up. RESULTS: All of 14 patients successfully completed the operation, the operation time was 84 to 141 min, the bleeding volume was 20 to 50 ml, and the fluoroscopy times of single screw insertion was 4 to 9 times. All of 14 patients were followed up for 12 to 24 months. The healing time was 3 to 7 months. No complications such as fracture of internal fixation, screw loosening, infection and nerve injury were found. According to the evaluation criteria of Matta imaging reduction, 9 cases were excellent, 4 cases were good, and 1 case was fair. At the final follow-up, Majeed pelvic function scoring system was used:10 cases were excellent, 4 cases were good. CONCLUSION: The treatment of type C pelvic ring fracture with robotic combined Starr pelvis reduction frame is simple, time-saving, less trauma, less complications and effective.

[Short-term effectiveness of orthopedic robot-assisted resection for osteoid osteoma].

Objective: To investigate short-term effectiveness and clinical application advantages of orthopedic robot-assisted resection for osteoid osteoma compared with traditional open surgery. Methods: A retrospective analysis was conducted on clinical data of 48 osteoid osteoma patients who met the selection criteria between July 2022 and April 2023. Among them, 23 patients underwent orthopedic robot-assisted resection (robot-assisted surgery group), and 25 patients received traditional open surgery (traditional surgery group). There was no significant difference ( P>0.05) in gender, age, disease duration, lesion location and size, and preoperative visual analogue scale (VAS) score, and musculoskeletal tumor society (MSTS) score between the two groups. The surgical time, intraoperative blood loss, intraoperative lesion localization time, initial localization success rate, infection, and recurrence were recorded and compared. VAS scores before surgery and at 24 hours, 1, 3, 6, and 9 months after surgery and MSTS score before surgery and at 3 months after surgery were assessed. Results: All patients completed the surgery successfully, with no significant difference in surgical time between the two groups ( P>0.05). Compared to the traditional surgery group, the robot-assisted surgery group had less intraoperative blood loss, shorter lesion localization time, and shorter hospitalization time, with significant differences ( P<0.05). The initial localization success rate was higher in the robot-assisted surgery group than in the traditional surgery group, but the difference between the two groups was not significant ( P>0.05). All patients in both groups were followed up, with the follow-up time of 3-12 months in the robot-assisted surgery group (median, 6 months) and 3-14 months in the traditional surgery group (median, 6 months). The postoperative MSTS scores of both groups improved significantly when compared to those before surgery ( P<0.05), but there was no significant difference in the changes in MSTS scores between the two groups ( P>0.05). The postoperative VAS scores of both groups showed a gradually decreasing trend over time ( P<0.05), but there was no significant difference between the two groups after surgery ( P>0.05). During follow-up, except for 1 case of postoperative infection in the traditional surgery group, there was no infections or recurrences in other cases. There was no significant difference in the incidence of postoperative infection between the two groups ( P>0.05). Conclusion: Orthopedic robot-assisted osteoid osteoma resection achieves similar short-term effectiveness when compared to traditional open surgery, with shorter lesion localization time.

[Effectiveness of robot-guided percutaneous fixation and decompression via small incision for advanced thoracolumbar metastases].

Objective: To evaluate the effectiveness of robot-guided percutaneous fixation and decompression via small incision in treatment of advanced thoracolumbar metastases. Methods: A clinical data of 57 patients with advanced thoracolumbar metastases admitted between June 2017 and January 2021 and met the selection criteria was retrospectively analyzed. Among them, 26 cases were treated with robot-guided percutaneous fixation and decompression via small incision (robot-guided group) and 31 cases with traditional open surgery (traditional group). There was no significant difference in gender, age, body mass index, lesion segment, primary tumor site, and preoperative Tokuhashi score, Tomita score, Spinal Instability Neoplastic Score (SINS), visual analogue scale (VAS) score, Oswestry disability index (ODI), Karnofsky score, and Frankel grading between groups ( P>0.05). The operation time, hospital stays, hospital expenses, intraoperative blood loss, postoperative drainage volume, duration of intensive care unit (ICU) stay, blood transfusion, complications, and survival time were compared. The pedicle screw placement accuracy was evaluated according to the Gertzbein-Robbins grading by CT within 4 days after operation. The pain, function, and quality of life were evaluated by VAS score, ODI, Karnofsky score, and Frankel grading. Results: During operation, 257 and 316 screws were implanted in the robot-guided group and the traditional group, respectively; and there was no significant difference in pedicle screw placement accuracy between groups ( P>0.05). Compared with the traditional group, the operation time, hospital stays, duration of ICU stay were significantly shorter, and intraoperative blood loss and postoperative drainage volume were significantly lesser in the robot-guided group ( P<0.05). There was no significant difference in hospital expenses, blood transfusion rate, and complications between groups ( P>0.05). All patients were followed up 8-32 months (mean, 14 months). There was no significant difference in VAS scores between groups at 7 days after operation ( P>0.05), but the robot-guided group was superior to the traditional group at 1 and 3 months after operation ( P<0.05). The postoperative ODI change was significantly better in the robot-guided group than in the traditional group ( P<0.05), and there was no significant difference in the postoperative Karnofsky score change and Frankel grading change when compared to the traditional group ( P>0.05). Median overall survival time was 13 months [95% CI (10.858, 15.142) months] in the robot-guided group and 15 months [95% CI (13.349, 16.651) months] in the traditional group, with no significant difference between groups ( χ 2=0.561, P=0.454) . Conclusion: Compared with traditional open surgery, the robot-guided percutaneous fixation and decompression via small incision can reduce operation time, hospital stays, intraoperative blood loss, blood transfusion, and complications in treatment of advanced thoracolumbar metastases.

Robotic-assisted systems for the safe and reliable treatment of femoral neck fractures: retrospective cohort study.

BACKGROUND: Robots are being used in a wide range of surgical procedures. However, in clinical practice, the efficacy of orthopedic robotic-assisted treatment of femoral neck fractures is still poorly reported, particularly in terms of screw placement accuracy, femoral neck fracture healing rates and postoperative functional recovery. Moreover, there is a lack of comparative analysis between robot-assisted surgery and traditional surgical approaches. PURPOSE: The purpose of this study was to compare the clinical outcomes of patients with femoral neck fractures treated with TiRobot-assisted hollow screw fixation with those of patients with femoral neck fractures treated with traditional surgical approaches. METHODS: This study included 112 patients with femoral neck fracture who were treated from March 2017 to October 2021 with percutaneous hollow screw internal fixation. These included 56 cases in the TiRobot-assisted surgery group and 56 cases in the standard surgery group. After at least 1 year of follow-up, the treatment outcomes of the two groups were compared, including the amount of intraoperative bleeding, the duration of intraoperative fluoroscopy, the number of guide pin positioning adjustments, the length of hospital stay, the accuracy rate of screw placement, the final Harris Hip Score, the fracture healing rate, and the rate of femoral head necrosis. Statistical analysis software was used to process and analyze the result. RESULTS: The TiRobot-assisted group had a statistically significant improvement over the control group in terms of intraoperative bleeding, the duration of intraoperative fluoroscopy, the number of guide pin positioning adjustments, length of hospital stay, accuracy of screw placement and incidence of femoral head necrosis (P < 0.05). There was no statistically significant difference in time to surgery, final Harris hip score and fracture healing rate (P > 0.05). CONCLUSION: This study shows that TiRobot-assisted surgery has the advantages of short hospital stay, high safety, minimally invasive, high success rate of nail placement, and can reduce the amount of intraoperative radiation and the incidence of femoral head necrosis, thus achieving satisfactory clinical outcomes, and is worthy of clinical promotion.

A comparative study of robot-assisted and traditional surgeries in the treatment of thoracolumbar fractures based on 1-year follow-up observation.

BACKGROUND: There are conflicting results for robot-assisted (RA) pedicle screw fixation compared with freehand (FH) pedicle screw fixation. OBJECTIVE: This study was designed to retrospectively compare the accuracy and efficacy of RA percutaneous pedicle screw fixation and traditional freehand FH pedicle screw fixation in the treatment of thoracolumbar fractures. METHODS: A total of 26 cases were assigned to the RA group, and 24 cases were assigned to the FH group. The operation time, bleeding volume, and visual analog scale (VAS) score 1 day after the operation, and the anterior/posterior (A/P) vertebral height ratio of the injured vertebrae at 3 days and at internal fixation removal 1 year after the operation were compared between the two groups. Pedicle screw position accuracy was assessed according to Gertzbein criteria. RESULTS: The operation times of the RA group and FH group were 138.69 ± 32.67 minutes and 103.67 ± 14.53 minutes, respectively, and the difference was statistically significant. The intraoperative blood loss was 49.23 ± 22.56 ml in the RA group and 78.33 ± 23.90 ml in the FH group, and the difference was statistically significant. There was a significant difference in the A/P vertebral height ratio of the injured vertebrae 3 days after the operation compared with before the operation in both groups (P < 0.05). There was a significant difference in the A/P vertebral height ratio of the injured vertebrae 3 days after the operation compared with that at fixation removal in both groups (P < 0.05). CONCLUSION: The application of RA orthopedic treatment for thoracolumbar fractures can achieve good fracture reduction.

[Comparison of curative effect between Tianji robot assisted screw placement and traditional cannulated screw internal fixation for femoral neck fracture].

OBJECTIVE: To investigate the clinical efficacy and advantages of Tianji orthopedic robot assisted cannulated screw internal fixation for femoral neck fracture. METHODS: The clinical data of 41 patients with femoral neck fracture who underwent internal fixation with cannulated screws from January 2019 to January 2022 were retrospectively analyzed. According to different surgical methods, they were divided into Tianji robot group and traditional cannulated screw fixation group (traditional operation group). Among them, there were 18 patients in Tianji robot group including 8 males and 10 females with age of (56.00±4.22) years old, Garden typeⅠ (4 cases), type Ⅱ (11 cases), type Ⅲ (2 cases), and type Ⅳ (1 case). There were 23 patients in the traditional operation group, including 10 males and 13 females, aged (54.87±4.81) years old;there were 5 cases of Garden typeⅠ, 14 cases of type Ⅱ, 3 cases of type Ⅲ and 1 case of type Ⅳ. The operation time, intraoperative blood loss, fluoroscopy times, guide needle placement times, operation costs and other indicators were observed and compared between two groups. Harris score was used to evaluate hip joint function 12 months after operation. RESULTS: The wounds of all patients healed in Grade A without complications. There were significant differences between two groups in terms of operation time, times of intraoperative fluoroscopy, times of guide needle placement, amount of intraoperative bleeding, and operation cost (P<0.05). All 41 patients were followed up for at least 12 months. The fractures of both groups were healed. There was no infection, screw loosening, fracture displacement and femoral head necrosis in Tianji robot group during follow-up;Screw loosening occurred in 2 patients in the traditional operation group during follow-up. At 12 months after operation, Harris hip joint function score of Tianji robot group was higher than that of traditional operation group in daily activity, lameness, joint activity score and total score (P<0.05). CONCLUSION: Tianji robot assisted nail placement is a better method for the treatment of femoral neck fracture, which improves the surgical efficiency, is more accurate, has higher success rate of one-time nail placement, shorter operation time, less radiation, and has better hip joint function recovery after surgery.

Comparison of curative effect between Tianji robot assisted screw placement and traditional cannulated screw internal fixation for femoral neck fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy and advantages of Tianji orthopedic robot assisted cannulated screw internal fixation for femoral neck fracture.@*METHODS@#The clinical data of 41 patients with femoral neck fracture who underwent internal fixation with cannulated screws from January 2019 to January 2022 were retrospectively analyzed. According to different surgical methods, they were divided into Tianji robot group and traditional cannulated screw fixation group (traditional operation group). Among them, there were 18 patients in Tianji robot group including 8 males and 10 females with age of (56.00±4.22) years old, Garden typeⅠ (4 cases), type Ⅱ (11 cases), type Ⅲ (2 cases), and type Ⅳ (1 case). There were 23 patients in the traditional operation group, including 10 males and 13 females, aged (54.87±4.81) years old;there were 5 cases of Garden typeⅠ, 14 cases of type Ⅱ, 3 cases of type Ⅲ and 1 case of type Ⅳ. The operation time, intraoperative blood loss, fluoroscopy times, guide needle placement times, operation costs and other indicators were observed and compared between two groups. Harris score was used to evaluate hip joint function 12 months after operation.@*RESULTS@#The wounds of all patients healed in Grade A without complications. There were significant differences between two groups in terms of operation time, times of intraoperative fluoroscopy, times of guide needle placement, amount of intraoperative bleeding, and operation cost (P<0.05). All 41 patients were followed up for at least 12 months. The fractures of both groups were healed. There was no infection, screw loosening, fracture displacement and femoral head necrosis in Tianji robot group during follow-up;Screw loosening occurred in 2 patients in the traditional operation group during follow-up. At 12 months after operation, Harris hip joint function score of Tianji robot group was higher than that of traditional operation group in daily activity, lameness, joint activity score and total score (P<0.05).@*CONCLUSION@#Tianji robot assisted nail placement is a better method for the treatment of femoral neck fracture, which improves the surgical efficiency, is more accurate, has higher success rate of one-time nail placement, shorter operation time, less radiation, and has better hip joint function recovery after surgery.

Short-term effectiveness of orthopedic robot-assisted resection for osteoid osteoma / 中国修复重建外科杂志

OBJECTIVE@#To investigate short-term effectiveness and clinical application advantages of orthopedic robot-assisted resection for osteoid osteoma compared with traditional open surgery.@*METHODS@#A retrospective analysis was conducted on clinical data of 48 osteoid osteoma patients who met the selection criteria between July 2022 and April 2023. Among them, 23 patients underwent orthopedic robot-assisted resection (robot-assisted surgery group), and 25 patients received traditional open surgery (traditional surgery group). There was no significant difference ( P>0.05) in gender, age, disease duration, lesion location and size, and preoperative visual analogue scale (VAS) score, and musculoskeletal tumor society (MSTS) score between the two groups. The surgical time, intraoperative blood loss, intraoperative lesion localization time, initial localization success rate, infection, and recurrence were recorded and compared. VAS scores before surgery and at 24 hours, 1, 3, 6, and 9 months after surgery and MSTS score before surgery and at 3 months after surgery were assessed.@*RESULTS@#All patients completed the surgery successfully, with no significant difference in surgical time between the two groups ( P>0.05). Compared to the traditional surgery group, the robot-assisted surgery group had less intraoperative blood loss, shorter lesion localization time, and shorter hospitalization time, with significant differences ( P<0.05). The initial localization success rate was higher in the robot-assisted surgery group than in the traditional surgery group, but the difference between the two groups was not significant ( P>0.05). All patients in both groups were followed up, with the follow-up time of 3-12 months in the robot-assisted surgery group (median, 6 months) and 3-14 months in the traditional surgery group (median, 6 months). The postoperative MSTS scores of both groups improved significantly when compared to those before surgery ( P<0.05), but there was no significant difference in the changes in MSTS scores between the two groups ( P>0.05). The postoperative VAS scores of both groups showed a gradually decreasing trend over time ( P<0.05), but there was no significant difference between the two groups after surgery ( P>0.05). During follow-up, except for 1 case of postoperative infection in the traditional surgery group, there was no infections or recurrences in other cases. There was no significant difference in the incidence of postoperative infection between the two groups ( P>0.05).@*CONCLUSION@#Orthopedic robot-assisted osteoid osteoma resection achieves similar short-term effectiveness when compared to traditional open surgery, with shorter lesion localization time.

Effectiveness of robot-guided percutaneous fixation and decompression via small incision for advanced thoracolumbar metastases / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the effectiveness of robot-guided percutaneous fixation and decompression via small incision in treatment of advanced thoracolumbar metastases.@*METHODS@#A clinical data of 57 patients with advanced thoracolumbar metastases admitted between June 2017 and January 2021 and met the selection criteria was retrospectively analyzed. Among them, 26 cases were treated with robot-guided percutaneous fixation and decompression via small incision (robot-guided group) and 31 cases with traditional open surgery (traditional group). There was no significant difference in gender, age, body mass index, lesion segment, primary tumor site, and preoperative Tokuhashi score, Tomita score, Spinal Instability Neoplastic Score (SINS), visual analogue scale (VAS) score, Oswestry disability index (ODI), Karnofsky score, and Frankel grading between groups ( P>0.05). The operation time, hospital stays, hospital expenses, intraoperative blood loss, postoperative drainage volume, duration of intensive care unit (ICU) stay, blood transfusion, complications, and survival time were compared. The pedicle screw placement accuracy was evaluated according to the Gertzbein-Robbins grading by CT within 4 days after operation. The pain, function, and quality of life were evaluated by VAS score, ODI, Karnofsky score, and Frankel grading.@*RESULTS@#During operation, 257 and 316 screws were implanted in the robot-guided group and the traditional group, respectively; and there was no significant difference in pedicle screw placement accuracy between groups ( P>0.05). Compared with the traditional group, the operation time, hospital stays, duration of ICU stay were significantly shorter, and intraoperative blood loss and postoperative drainage volume were significantly lesser in the robot-guided group ( P<0.05). There was no significant difference in hospital expenses, blood transfusion rate, and complications between groups ( P>0.05). All patients were followed up 8-32 months (mean, 14 months). There was no significant difference in VAS scores between groups at 7 days after operation ( P>0.05), but the robot-guided group was superior to the traditional group at 1 and 3 months after operation ( P<0.05). The postoperative ODI change was significantly better in the robot-guided group than in the traditional group ( P<0.05), and there was no significant difference in the postoperative Karnofsky score change and Frankel grading change when compared to the traditional group ( P>0.05). Median overall survival time was 13 months [95% CI (10.858, 15.142) months] in the robot-guided group and 15 months [95% CI (13.349, 16.651) months] in the traditional group, with no significant difference between groups ( χ 2=0.561, P=0.454) .@*CONCLUSION@#Compared with traditional open surgery, the robot-guided percutaneous fixation and decompression via small incision can reduce operation time, hospital stays, intraoperative blood loss, blood transfusion, and complications in treatment of advanced thoracolumbar metastases.

[Orthopedic robot based on 5G technology for remote navigation of percutaneous screw fixation in pelvic and acetabular fractures].

Objective: To investigate the accuracy and safety of percutaneous screw fixation for pelvic and acetabular fractures with remote navigation of orthopedic robot based on 5G technology. Methods: Between January 2021 and December 2021, 15 patients with pelvic and/or acetabular fractures were treated with percutaneous screws fixation which were placed by remote navigation of orthopedic robot based on 5G technology. There were 8 males and 7 females. The age ranged from 20 to 98 years, with an average of 52.1 years. The causes of trauma included traffic accident injury in 6 cases, falling from height injury in 6 cases, fall injury in 2 cases, and heavy object smashing injury in 1 case. The time from injury to operation ranged from 3 to 32 days, with an average of 10.9 days. There were 8 cases of simple pelvic fractures, 2 simple acetabular fractures, and 5 both pelvic and acetabular fractures. There were 7 cases of pelvic fractures of Tile type B2, 2 type B3, 1 type C1, and 3 type C2; 4 cases of unilateral anterior column fracture of the acetabulum, 2 bilateral anterior column fractures, and 1 anterior wall fracture. CT images within 5 days after operation were collected for screw position assessment. The screw planning time and guidewire placement time were recorded, as well as the presence of intraoperative adverse events and complications within 5 days after operation. Results: All patients achieved satisfactory surgical results. A total of 36 percutaneous screws were inserted (20 sacroiliac screws, 6 LC Ⅱ screws, 9 anterior column screws, and 1 acetabular apical screw). In terms of screw position evaluation, 32 screws (88.89%) were excellent and 4 screws (11.11%) were good; there was no screw penetrating cortical bone. The screw planning time ranged from 4 to 15 minutes, with an average of 8.7 minutes. The guidewire placement time ranged from 3 to 10 minutes, with an average of 6.8 minutes. The communication delayed in 2 cases, but the operation progress was not affected, and no serious intraoperative adverse events occurred. No delayed vascular or nerve injury, infection, or other complications occurred within 5 days after operation. No cases need surgical revision. Conclusion: The fixation of pelvic and acetabular fractures by percutaneous screw with remote navigation of orthopedic robot based on 5G technology is accurate, safe, and reliable.

[Short-term effectiveness of orthopedic robot-assisted femoral neck system fixation for fresh femoral neck fractures].

Objective: To investigate the short-term effectiveness and advantages of the orthopedic robot-assisted femoral neck system (FNS) fixation in the treatment of fresh femoral neck fractures compared with the traditional manual operation. Methods: A clinical data of 74 patients with fresh femoral neck fractures, who had undergone internal fixation with FNS between April 2020 and September 2021, was retrospectively analyzed. Among them, there were 31 cases of TiRobot-assisted operation (trial group) and 43 cases of traditional manual operation (control group). There was no significant difference between groups ( P>0.05) in terms of gender, age, cause of injury, time from injury to operation, fracture side and type. The fracture fixation time (intraoperative fracture reduction to the end of suture), invasive fixation time (incision of internal fixation to the end of suture), the number of placing key-guide needle, incision length, intraoperative blood loss, fracture healing, and Harris score of hip function were recorded and compared. Results: All operations were performed with no neurovascular injury or incision complications. The invasive fixation time, intraoperative blood loss, the number of placing key-guide needle, and the incision length in the trial group were superior to the control group ( P<0.05), and there was no significant difference in fracture fixation time between groups ( P>0.05). All patients were followed up 4-16 months (mean, 7 months). The fracture did not heal in 1 patient of trial group, and the other fractures healed in 2 groups; the fracture healing time was (17.6±1.9) weeks in trial group and (18.2±1.9) weeks in control group, and there was no significant difference between groups ( t=0.957, P=0.345). At last follow-up, the Harris score of the trial group was 82.4±5.8, which was higher than that of the control group (79.0±7.7), but the difference was not significant ( t=-1.483, P=0.147). Conclusion: Orthopedic robot-assisted FNS fixation in the treatment of fresh femoral neck fractures has the similar short-term effectiveness as the traditional method, but the former has advantages in terms of operation time, intraoperative blood loss, and the number of placing key-guide needle, making the operation more minimally invasive and quicker, and more suitable for older patients.

A randomized trial on the application of a nurse-led early rehabilitation program after minimally invasive lumbar internal fixation.

BACKGROUND: Lumbar degenerative disease (LDD) is a narrowing of the spinal canal and intervertebral foramina caused by aging and degeneration of lumbar spine tissue. Minimally invasive internal lumbar spine fixation is emerging in the treatment of LDD. However, no standard early rehabilitation protocol for orthopedic robot-assisted minimally invasive internal lumbar spine fixation exits. To investigate the effect of a nurse-led early rehabilitation program in the postoperative recovery of patients with lumbar degenerative lesions undergoing orthopedic robot-assisted minimally invasive lumbar internal fixation. METHODS: Eighty patients with minimally invasive orthopedic robot-assisted lumbar degenerative lesions admitted to our hospital between January 2019 and January 2021 were recruited to this study. The patients were randomly allocated to a control group (n=40), involving conventional care, and an observation group (n=38; 40 initially and 2 later excluded) including a nurse-led early rehabilitation program added on the basis of the control group. The primary outcomes were the general postoperative conditions, scores of daily living ability, the degree of low back pain and functional recovery. Participants were also compared in terms of their compliance with the care regimen and the incidence of complications. RESULTS: Participants in the observation group had a significantly shorter first time on the floor after surgery (P<0.001) and shorter hospital stay (P=0.003). Meanwhile, participants in the observation group had higher Barthel index (BI) scores (P=0.039), lower visual analogue scale (VAS) scores (P=0.028), and Oswestry disability index (ODI) scores (P=0.002) at 3 days postoperatively, and there was no difference in the three scores between the two groups at 1 month postoperatively (all P>0.05). The compliance of participants in the observation group was significantly higher than that of the control group (P<0.001). Participants in the observation group were less likely to experience constipation (P=0.043) and bloating (P=0.012) within 1 month after surgery. CONCLUSIONS: Implementation of a nurse-led early rehabilitation program in patients undergoing orthopedic robotic-assisted minimally invasive treatment of lumbar degenerative lesions can significantly improve patient compliance, significantly shorten postoperative flooring and hospitalization time, reduce the incidence of gastrointestinal adverse events, and accelerate postoperative recovery. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100048698.

A hybrid feature-based patient-to-image registration method for robot-assisted long bone osteotomy.

PURPOSE: The purpose of this study is to provide a simple, feasible and effective patient-to-image registration method for robot-assisted long bone osteotomy, which has rarely been systematically reported. The practical requirement is to meet the accuracy of 1 mm or even higher without bone-implanted markers. METHODS: A hybrid feature-based registration method termed CR-RAMSICP is proposed. Point-based coarse registration (CR) is accomplished relying on the optical retro-reflective markers attached to the tracked rigid body fixed out of the bone. In surface-based fine registration, an improved iterative closest point (ICP) algorithm based on the range-adaptive matching strategy (termed RAMSICP) is presented to cope with the robust precise matching between the asymmetric patient and image point clouds, which avoids converging to a local minimum. RESULTS: A series of registration experiments based on the isolated porcine iliums are carried out. The results illustrate that CR-RAMSICP not only significantly outperforms CR and CR-ICP in the accuracy and reproducibility, but also exhibits better robustness to the CR errors and less sensitiveness to the distribution and number of fiducial points located in the patient point cloud than CR-ICP. CONCLUSION: The proposed registration method CR-RAMSICP can stably satisfy the desired registration accuracy without the use of bone-implanted markers like fiducial screws. Besides, the RAMSICP algorithm used in fine registration is convenient for programming because any complex metrics or models are not involved.

[A comparative study of robot-assisted and freehand pedicle screw placement in upper thoracic surgery].

OBJECTIVE: To compare the safety and accuracy of pedicle screw placement assisted by robot system with freehand pedicle screw placement in upper thoracic surgery. METHODS: Between December 2017 and December 2019, 39 cases with upper thoracic pedicle screw internal fixation were included in the study, including 19 cases in robot group (group A, robot assisted pedicle screw placement) and 20 cases in freehand group (group B, freehand pedicle screw placement). There were 104 screws implanted in group A and 108 screws in group B. There was no significant difference in age, gender composition, body mass index, disease type, number of screws implanted, and segmental distribution between the two groups ( P>0.05). The operation time, intraoperative blood loss, and postoperative drainage were recorded and compared between the two groups. CT scan was performed in all patients at 2 days after operation to evaluate the screw accuracy based on the Gertzbein-Robbins grading standard. RESULTS: The operation time of group A was significantly longer than that in group B ( t=2.759, P=0.009). There was no significant difference in intraoperative blood loss and postoperative drainage between the two groups ( t=-0.796, P=0.431; t=-0.814, P=0.421). At 2 days after operation, according to Gertzbein-Robbins grading standard, the accuracy of pedicle screw implantation in group A were grade A in 94 screws, grade B in 9 screws, and grade C in 1 screw; and in group B were grade A in 72 screws, grade B in 26 screws, grade C in 9 screws, and grade D in 1 screw; the difference between the two groups was significant ( Z=4.257, P=0.000). The accuracy rate of group A was 99.04%, and that of group B was 90.74%, showing significant difference ( χ 2=7.415, P=0.006). CONCLUSION: Compared with traditional freehand pedicle screw placement, robot-assisted pedicle screw placement significantly improves the accuracy and safety of screw placement without increasing the bleeding and postoperative drainage.