TiRobot-assisted percutaneous sacroiliac cannulated screw fixation for posterior pelvic ring injury with sacral variations_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Chengzhi , LIU Gang , TANG Jingli , LI Gaorong , QIN Xi ,  HU Juzheng

Trauma Center, Fourth Affiliated Hospital of Guangxi Medical University/Liuzhou Workers’ Hospital, Liuzhou Guangxi, 545005, P. R. China;

Corresponding author：

HU Juzheng, Email: 516072259@qq.com

Keywords：

TiRobot; posterior pelvic ring injury; sacral variation; sacroiliac cannulated screw; internal fixation

DOI：

10.7507/1002-1892.202204043

Video：

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Objective To investigate the effectiveness of TiRobot-assisted percutaneous sacroiliac cannulated screw fixation in the treatment of posterior pelvic ring injuries with sacral variations, and to evaluate its feasibility and safety. Methods The clinical data of 7 patients with Tile type C pelvic fractures and sacral variations treated with TiRobot-assisted percutaneous sacroiliac cannulated screw fixation between January 2020 and June 2021 were retrospectively analyzed. There were 5 males and 2 females with an average age of 36 years (range, 17-56 years). The causes of injury were traffic accident in 4 cases and falling from height in 3 cases. According to Tile classification of pelvic fractures, there were 1 case of type C1.1, 1 case of type C1.2, and 5 cases of type C1.3; according to Denis classification of sacral fractures, there were 3 cases of zone Ⅰ and 4 cases of zone Ⅱ; sacral deformities included 3 cases of lumbar sacralization, 2 cases of sacral lumbarization, and 2 cases of accessory auricular surface of the sacrum. The time from injury to operation ranged from 2 to 7 days, with an average of 4.6 days. The implantation time of each screw, the fluoroscopy times of each guide pin, the quality of fracture reduction (according to Matta score), the excellent and good rate of screw position, the healing time of fracture, and the incidence of complications were recorded, and the effectiveness was evaluated by Majeed score. Results A total of 13 screws were implanted during the operation, the implantation time of each screw was 10-23 minutes, with an average of 18.2 minutes; the position of the guide pin was good, and no guide pin was adjusted, the fluoroscopy times of each guide pin were 3-7 times, with a median of 4 times. Postoperative imaging data at 3 days showed that the position of sacroiliac screw implantation was evaluated as excellent. No complication such as incision infection or vascular nerve injury occurred, and no adverse events related to robotic devices occurred. At 3 days after operation, according to Matta score, the quality of fracture reduction was excellent in 6 cases and good in 1 case, and the excellent and good rate was 100%. All the 7 patients were followed up 6-15 months, with an average of 12.4 months. Bone union was achieved in all patients, and the healing time ranged from 18 to 24 weeks, with an average of 21.2 weeks. Majeed score at last follow-up was 81-95, with an average of 91.5; 5 cases were excellent, 2 cases were good, and the excellent and good rate was 100%. Conclusion TiRobot-assisted percutaneous sacroiliac cannulated screw fixation for posterior pelvic ring injury with sacral variation is accurate, safe, minimally invasive, and intelligent, and the effectiveness is satisfactory.

Citation： YANG Chengzhi, LIU Gang, TANG Jingli, LI Gaorong, QIN Xi, HU Juzheng. TiRobot-assisted percutaneous sacroiliac cannulated screw fixation for posterior pelvic ring injury with sacral variations. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(8): 940-945. doi: 10.7507/1002-1892.202204043 Copy

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2.	Gardner MJ, Morshed S, Nork SE, et al. Quantification of the upper and second sacral segment safe zones in normal and dysmorphic sacra. J Orthop Trauma, 2010, 24(10): 622-629.
3.	Ziran BH, Wasan AD, Marks DM, et al. Fluoroscopic imaging guides of the posterior pelvis pertaining to iliosacral screw placement. J Trauma, 2007, 62(2): 347-356.
4.	Moed BR, Fissel BA, Jasey G. Percutaneous transiliac pelvic fracture fixation: Cadaver feasibility study and preliminary clinical results. J Trauma, 2007, 62(2): 357-364.
5.	Conflitti JM, Graves ML, Chip Routt ML. Radiographic quantification and analysis of dysmorphic upper sacral osseous anatomy and associated iliosacral screw insertions. J Orthop Trauma, 2010, 24(10): 630-636.
6.	Wu LP, Li YK, Li YM, et al. Variable morphology of the sacrum in a Chinese population. Clin Anat, 2009, 22(5): 619-626.
7.	Van der List JP, Chawla H, Pearle AD. Robotic-assisted knee arthroplasty: an overview. Am J Orthop, 2016, 45(4): 202-211.
8.	Chen AF, Kazarian GS, Jessop GW, et al. Robotic technology in orthopaedic surgery. J Bone Joint Surg (Am), 2018, 100(22): 1984-1992.
9.	林书, 胡豇, 万仑, 等. 机器人辅助下经皮微创椎弓根螺钉内固定与传统开放内固定治疗胸腰椎骨折的短期疗效比较. 中国修复重建外科杂志, 2020, 34(1): 76-82.
10.	赵春鹏, 王军强, 苏永刚, 等. 机器人辅助经皮螺钉内固定治疗骨盆和髋臼骨折. 北京大学学报 (医学版), 2017, 49(2): 274-280.
11.	Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
12.	Matta JM. Indications for anterior fixation of pelvic fractures. Clin Orthop Relat Res, 1996, (329): 88-96.
13.	Lee SK, Chaudhry S. Open reduction and internal fixation through fracture fragment specific fixation methods. Oper Techn Orthop, 2009, 19(2): 70-76.
14.	Routt ML, Meier M, Kregor P. Percutaneous iliosacral screws with the patient supine-technique. Operative Techniques in Orthopaedics, 1993, 3: 35-45.
15.	Matta JM. Regarding safe and effective placement of ileosacral screws. J Orthop Trauma, 1996, 10(7): 514. doi: 10.1097/00005131-199610000-00014.
16.	杨成志, 黄站珠, 唐经励, 等. 骨科手术机器人与 “O” 型臂X线导航辅助骨盆骨折经皮内固定术的比较. 中华骨科杂志, 2021, 41(19): 1387-1395.
17.	Flander LB, Corruccini RS. Shape differences in the sacral alae. American Journal of Physical Anthropology, 1980, 52: 399-403.
18.	Cheng JS, Song JK. Anatomy of the sacrum. Neurosurg Focus, 2003, 15(2): E3. doi: 10.3171/foc.2003.15.2.3.
19.	Crowl AC, Kahler DM. Closed reduction and percutaneous fixation of anterior column acetabular fractures. Comput Aided Surg, 2002, 7(3): 169-178.
20.	梁国穗, 邓宁. 骨盆-髋臼骨折X线透视导航下闭合复位与经皮固定. 中华创伤骨科杂志, 2005, 7(7): 637-639.
21.	Zwingmann J, Konrad G, Mehlhorn AT, et al. Percutaneous iliosacral screw insertion: malpositioning and revision rate of screws with regards to application technique (navigated vs. Conventional). J Trauma, 2010, 69(6): 1501-1506.
22.	Routt ML, Kregor PJ, Simonian PT, et al. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma, 1995, 9(3): 207-214.
23.	Routt ML, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma, 1997, 11(8): 584-589.
24.	刘华水, 段升军, 贾逢爽, 等. TiRobot机器人辅助经皮空心螺钉内固定治疗不稳定型骨盆骨折. 山东大学学报 (医学版), 2017, 55(7): 103-109.
25.	Liu HS, Duan SJ, Liu SD, et al. Robot-assisted percutaneous screw placement combined with pelvic internal fixator for minimally invasive treatment of unstable pelvic ring fractures. Int J Med Robot, 2018, 14(5): e1927. doi: 10.1002/rcs.1927.

1. 陈华, 唐佩福. 骨盆髋臼骨折微创治疗. 郑州: 河南科学技术出版社, 2016: 13-16.
2. Gardner MJ, Morshed S, Nork SE, et al. Quantification of the upper and second sacral segment safe zones in normal and dysmorphic sacra. J Orthop Trauma, 2010, 24(10): 622-629.
3. Ziran BH, Wasan AD, Marks DM, et al. Fluoroscopic imaging guides of the posterior pelvis pertaining to iliosacral screw placement. J Trauma, 2007, 62(2): 347-356.
4. Moed BR, Fissel BA, Jasey G. Percutaneous transiliac pelvic fracture fixation: Cadaver feasibility study and preliminary clinical results. J Trauma, 2007, 62(2): 357-364.
5. Conflitti JM, Graves ML, Chip Routt ML. Radiographic quantification and analysis of dysmorphic upper sacral osseous anatomy and associated iliosacral screw insertions. J Orthop Trauma, 2010, 24(10): 630-636.
6. Wu LP, Li YK, Li YM, et al. Variable morphology of the sacrum in a Chinese population. Clin Anat, 2009, 22(5): 619-626.
7. Van der List JP, Chawla H, Pearle AD. Robotic-assisted knee arthroplasty: an overview. Am J Orthop, 2016, 45(4): 202-211.
8. Chen AF, Kazarian GS, Jessop GW, et al. Robotic technology in orthopaedic surgery. J Bone Joint Surg (Am), 2018, 100(22): 1984-1992.
9. 林书, 胡豇, 万仑, 等. 机器人辅助下经皮微创椎弓根螺钉内固定与传统开放内固定治疗胸腰椎骨折的短期疗效比较. 中国修复重建外科杂志, 2020, 34(1): 76-82.
10. 赵春鹏, 王军强, 苏永刚, 等. 机器人辅助经皮螺钉内固定治疗骨盆和髋臼骨折. 北京大学学报 (医学版), 2017, 49(2): 274-280.
11. Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
12. Matta JM. Indications for anterior fixation of pelvic fractures. Clin Orthop Relat Res, 1996, (329): 88-96.
13. Lee SK, Chaudhry S. Open reduction and internal fixation through fracture fragment specific fixation methods. Oper Techn Orthop, 2009, 19(2): 70-76.
14. Routt ML, Meier M, Kregor P. Percutaneous iliosacral screws with the patient supine-technique. Operative Techniques in Orthopaedics, 1993, 3: 35-45.
15. Matta JM. Regarding safe and effective placement of ileosacral screws. J Orthop Trauma, 1996, 10(7): 514. doi: 10.1097/00005131-199610000-00014.
16. 杨成志, 黄站珠, 唐经励, 等. 骨科手术机器人与 “O” 型臂X线导航辅助骨盆骨折经皮内固定术的比较. 中华骨科杂志, 2021, 41(19): 1387-1395.
17. Flander LB, Corruccini RS. Shape differences in the sacral alae. American Journal of Physical Anthropology, 1980, 52: 399-403.
18. Cheng JS, Song JK. Anatomy of the sacrum. Neurosurg Focus, 2003, 15(2): E3. doi: 10.3171/foc.2003.15.2.3.
19. Crowl AC, Kahler DM. Closed reduction and percutaneous fixation of anterior column acetabular fractures. Comput Aided Surg, 2002, 7(3): 169-178.
20. 梁国穗, 邓宁. 骨盆-髋臼骨折X线透视导航下闭合复位与经皮固定. 中华创伤骨科杂志, 2005, 7(7): 637-639.
21. Zwingmann J, Konrad G, Mehlhorn AT, et al. Percutaneous iliosacral screw insertion: malpositioning and revision rate of screws with regards to application technique (navigated vs. Conventional). J Trauma, 2010, 69(6): 1501-1506.
22. Routt ML, Kregor PJ, Simonian PT, et al. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma, 1995, 9(3): 207-214.
23. Routt ML, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma, 1997, 11(8): 584-589.
24. 刘华水, 段升军, 贾逢爽, 等. TiRobot机器人辅助经皮空心螺钉内固定治疗不稳定型骨盆骨折. 山东大学学报 (医学版), 2017, 55(7): 103-109.
25. Liu HS, Duan SJ, Liu SD, et al. Robot-assisted percutaneous screw placement combined with pelvic internal fixator for minimally invasive treatment of unstable pelvic ring fractures. Int J Med Robot, 2018, 14(5): e1927. doi: 10.1002/rcs.1927.

Chinese Journal of Reparative and Reconstructive Surgery

TiRobot-assisted percutaneous sacroiliac cannulated screw fixation for posterior pelvic ring injury with sacral variations

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