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Qi H, Ai X, Ren T, Li Z, Zhang C, Wu B, Cui Y, Li M. A clinical study on robot navigationassisted intramedullary nail treatment for humeral shaft fractures. BMC Musculoskelet Disord 2024; 25:766. [PMID: 39354426 PMCID: PMC11446091 DOI: 10.1186/s12891-024-07848-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 09/04/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the advantages of robot navigation system-assisted intramedullary nail treatment for humeral shaft fractures and compare it's efficacy with that of traditional surgical intramedullary nail treatment. MATERIALS AND METHODS This was a retrospective analysis of patients with humeral shaft fractures who received intramedullary nail treatment at our centre from March 2020 to September 2022. The analysis was divided into a robot group and a traditional surgical group on the basis of whether the surgery involved a robot navigation system. We compared the baseline data (age, sex, cause of injury, fracture AO classification, and time of injury-induced surgery), intraoperative conditions (surgery time, length of main nail insertion incision, postoperative fluoroscopy frequency, intraoperative bleeding), fracture healing time, and shoulder joint function at 1 year postsurgery (ASES score and Constant-Murley score) between the two groups of patients. RESULTS There was no statistically significant difference in the baseline data or average fracture healing time between the two groups of patients. However, the robotic group had significantly shorter surgical times, longer main nail incisions, fewer intraoperative fluoroscopies, and less intraoperative blood loss than did the traditional surgery group (P < 0.001). CONCLUSION Robot navigation system-assisted intramedullary nail fixation for humeral shaft fractures is a reasonable and effective surgical plan. It can help surgeons determine the insertion point and proximal opening direction faster and more easily, shorten the surgical time, reduce bleeding, avoid more intraoperative fluoroscopy, and enable patients to achieve better shoulder functional outcomes.
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Affiliation(s)
- Hongfei Qi
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Xianjie Ai
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Taotao Ren
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Zhong Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Chengcheng Zhang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Bo Wu
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Yu Cui
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Ming Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China.
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Wu X, Lin Y, Xu Y, Yan L, Tu S. Application of the "3-2-1" body surface localization method in intertrochanteric femoral fractures: a technical note. Front Surg 2024; 11:1394575. [PMID: 39268495 PMCID: PMC11390651 DOI: 10.3389/fsurg.2024.1394575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 08/09/2024] [Indexed: 09/15/2024] Open
Abstract
In femoral intertrochanteric fractures, poor incision positioning may result in inaccurate intramedullary nail placement direction, which increases the difficulty of reduction and thus the size and number of incisions. Repeated intraoperative fluoroscopy not only increases the radiation exposure of the surgeon but also affects the operative outcomes. This technical note proposes a method of identifying incision positioning preoperatively using the "3-2-1" body surface localization method. This auxiliary positioning technique uses a body surface locator and the lower limb force axis. It can predict the incisions for the needle insertion point, spiral blade, and locking nails, create minimally invasive incisions, avoid incorrect incision position, facilitate accurate intraoperative intramedullary nail placement, reduce the incision size, intraoperative bleeding, and radiation exposure, and improve surgical efficiency and reduction quality.
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Affiliation(s)
- Xiaowei Wu
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou, China
| | - Yanbin Lin
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou, China
| | - Yangkai Xu
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou, China
| | - Linglan Yan
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou, China
| | - Shaochen Tu
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou, China
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Shi J, Shen J, Zhang C, Guo W, Wang F. Robot-assisted versus traditional surgery in the treatment of intertrochanteric fractures: a meta-analysis. J Robot Surg 2024; 18:221. [PMID: 38780662 PMCID: PMC11116270 DOI: 10.1007/s11701-024-01979-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
Intramedullary nail fixation of intertrochanteric fractures assisted by orthopedic surgical robot navigation is a new surgical method, but there are few studies comparing its efficacy with traditional intramedullary nail fixation. We aimed to assess whether robot-assisted internal fixation confers certain surgical advantages through a literature review. PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wan fang Data Knowledge service Platform were searched to collect randomized and non-randomized studies on patients with calcaneal fractures. Five studies were identified to compare the clinical indexes. For the clinical indexes, the technology of robot-assisted is generally feasible, in time to operation, intraoperative fluoroscopy times, blood loss, pine insertion, tip apex distance (TAD), and Harris score (P < 0.05). However, on the complication and excellent and good rate after operation did not show good efficacy compared with the traditional group (P > 0.05). Based on the current evidence, For the short-term clinical index, the advantages of robot-assisted are clear. The long-term clinical effects of the two methods are also good, but the robot-assisted shows better. However, the quality of some studies is low, and more high-quality randomized controlled trials (RCTs) are needed for further verification.
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Affiliation(s)
- Jiaxiao Shi
- Department of Orthopaedics, Hebei Province Cangzhou Hospital of Integrated Traditional Chinese Medicine-Western Medicine, Cangzhou, China.
- Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing), Cangzhou, China.
| | - Jiaxin Shen
- Department of Intensive Care Unit, Cangzhou Central Hospital, Cangzhou, 061001, China
| | - Chaochao Zhang
- Department of Orthopaedics, Hebei Province Cangzhou Hospital of Integrated Traditional Chinese Medicine-Western Medicine, Cangzhou, China
- Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing), Cangzhou, China
| | - Wei Guo
- Department of Orthopaedics, Hebei Province Cangzhou Hospital of Integrated Traditional Chinese Medicine-Western Medicine, Cangzhou, China
- Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing), Cangzhou, China
| | - Fangfang Wang
- Department of Orthopaedics, Hebei Province Cangzhou Hospital of Integrated Traditional Chinese Medicine-Western Medicine, Cangzhou, China
- Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing), Cangzhou, China
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Khoriati AA, Shahid Z, Fok M, Frank RM, Voss A, D'Hooghe P, Imam MA. Artificial intelligence and the orthopaedic surgeon: A review of the literature and potential applications for future practice: Current concepts. J ISAKOS 2024; 9:227-233. [PMID: 37949113 DOI: 10.1016/j.jisako.2023.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Al-Achraf Khoriati
- Rowley Bristow Orthopaedic Centre, Ashford and St Peter's NHS Foundation Trust, Chertsey, KT106PZ, UK.
| | - Zuhaib Shahid
- Rowley Bristow Orthopaedic Centre, Ashford and St Peter's NHS Foundation Trust, Chertsey, KT106PZ, UK.
| | - Margaret Fok
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam Rd, High West, Hong Kong, China; Asia Pacific Orthopaedic Association, 57000, Malaysia.
| | - Rachel M Frank
- Department of Orthopaedic Surgery, Joint Preservation Program, University of Colorado School of Medicine, 12631 E 17th Ave, Mail Stop B202, Aurora, CO 80045, USA.
| | - Andreas Voss
- Sporthopaedicum Regensburg, Street, Hildegard-von-Bingen-Straße 1, 93053, Regensburg, Germany.
| | - Pieter D'Hooghe
- Aspetar Orthopedic and Sports Medicine Hospital, Aspire Zone, Sportscity Street 1, P.O. Box 29222, Doha, Qatar
| | - Mohamed A Imam
- Rowley Bristow Orthopaedic Centre, Ashford and St Peter's NHS Foundation Trust, Chertsey, KT106PZ, UK; Smart Health Centre, University of East London, University Way, London, E16 2RD, United Kingdom.
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Xu Z, Zhang X, Wang Y, Hao X, Liu M, Sun J, Zhao Z. Comparison of Bone-setting Robots and Conventional Reduction in the Treatment of Intertrochanteric Fracture: A Retrospective Study. Orthop Surg 2024; 16:312-319. [PMID: 38086603 PMCID: PMC10834210 DOI: 10.1111/os.13954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE Intertrochanteric fracture of the femur is a common fracture in older people. Due to the poor systemic condition and prognosis of elderly patients, it is prone to more complications. We introduce the bone-setting concept in the design of the robots, which are used for intertrochanteric fracture of the femur reduction. The purpose of this study is to compare the effect of bone-setting robots and conventional reduction in the treatment of intertrochanteric fracture of the femur (IFF). METHODS From June 2021 to January 2023, 60 patients with IFF who were treated surgically were assigned to bone-setting robots group and conventional reduction methods group in this retrospective study. The reduction time, operation time, total time, intraoperative blood loss, incision length, fluoroscopy time, and the follow-up time were reviewed. The visual analogue scale (VAS) and Harris scores were used for functional assessment. For continuous variables, independent t-tests were applied; for categorical data, the chi-square test was applied. The significance level as p < 0.05. RESULTS Among the 60 patients with IFF, 31 were assigned to the bone-setting robots group, and 29 were assigned to the conventional reduction methods group. Both groups with a similar baseline in the number, gender, age, and classification (p > 0.05). The reduction time, operation time, total time, intraoperative blood loss, and fluoroscopy time were less than those in the bone-setting robots reduction group compared to the conventional reduction group. In the bone-setting robots reduction group, the preoperative VAS score was 6.2 ± 1.3, the Harris score was 35.3 ± 3.1, 1 week after surgery VAS score was 3.3 ± 1.2, the Harris score was 57.3 ± 3.7, and at the last follow-up VAS score was 2.4 ± 0.8, and the Harris score was 88.7 ± 3.4. While in the conventional reduction group, the preoperative VAS score was 6.3 ± 1.3, the Harris score was 35.9 ± 2.9, 1 week after surgery VAS score was 4.8 ± 1.4, the Harris score was 46.8 ± 2.8, and at the last follow-up VAS score was 2.6 ± 0.8, and the Harris score was 87.3 ± 3.3. There were no significant differences between the two groups at the preoperative and 6-month postoperative follow-ups in VAS score and Harris score (p > 0.05, p > 0.05, respectively). But the difference was statistically significant at the one-week postoperative follow-up in VAS and Harris scores (p < 0.001). CONCLUSION The bone-setting robots can better protect the "fracture environment" and have the advantages of being precise, minimally invasive, simple, short time, low radiation, and rapid fracture recovery. The clinical effect of closed repair of IFF is ideal.
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Affiliation(s)
- Zhanmin Xu
- Tianjin Fourth Centre HospitalTianjinChina
| | - Xinan Zhang
- Tianjin University of Traditional Chinese MedicineTianjinChina
| | | | | | - Meiyue Liu
- Tianjin Fourth Centre HospitalTianjinChina
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Qi H, Li Z, Ma T, Jiang Y, Ren C, Xu Y, Huang Q, Zhang K, Lu Y, Li M. Robot Navigation System Assisted PFNA Fixation of Femoral Intertrochanteric Fractures in the Elderly: A Retrospective Clinical Study. Clin Interv Aging 2024; 19:11-19. [PMID: 38204959 PMCID: PMC10777025 DOI: 10.2147/cia.s412397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
Objective The incidence of hip fracture in the elderly is increasing. Robot navigation technology has the advantages of minimally invasive and accurate. To explore the difference between the clinical effects of proximal femoral anti-rotation intramedullary nail (PFNA) assisted by robot navigation in the treatment of femoral intertrochanteric fracture and traditional PFNA in the treatment of femoral intertrochanteric fracture in the elderly; analyze the advantages and feasibility of PFNA assisted by robot navigation in the treatment of femoral intertrochanteric fracture in the elderly. Patients and Methods From February 2021 to October 2022, the elderly (>65 years old) with femoral intertrochanteric fracture underwent surgery in our center. Divided the patients included in the study into 2 groups based on the surgical method. The surgical method of robot group was PFNA fixation assisted by robot navigation, while the surgical method of traditional group was classic PFNA fixation, Baseline data (general condition, Evans classification, time from injury to operation, preoperative hemoglobin) and observation indicators (intraoperative bleeding, operation time, the length of incision for mail nail insertion, postoperative hemoglobin drop, blood transfusion rate and the Harris score of hip joint 1 year after operation) of the two groups were collected to compare whether there were differences between the two groups. Results There was no statistical difference in baseline data between the two groups (P>0.05). The intraoperative bleeding in the robot group was 68.17±10.66 mL, the intraoperative bleeding in the traditional group was 174±8.11mL (P<0.001). The operation time in the robot group was 68.81 ± 6.89 min, in the traditional group, the operation time was 76.94 ± 8.18 min (P<0.001). The length of incision for mail nail insertion in the robot group was 3.53 ± 0.63 cm, the length of the incision for mail nail insertion in the traditional group was 4.23 ± 0.71 cm (P<0.001). 5 patients (13.9%) in the robot group received blood transfusion treatment, and 13 patients (36.1%) in the traditional group received blood transfusion treatment (P=0.029). The hemoglobin in the robot group decreased by 14.81 ± 3.27 g/l after operation compared with that before operation, while that in the traditional group decreased by 16.69 ± 3.32 g/l (P=0.018). The Harris score of the hip joint of the affected limb in the robot group was excellent in 25 cases, good in 8 cases and poor in 3 cases one year after the operation; In the traditional group, Harris scores were excellent in 18 cases, good in 11 cases and poor in 7 cases (P=0.021). Conclusion PFNA fixation of femoral intertrochanteric fracture with robot navigation assistance has the advantages of minimally invasive and accurate, shorter operation time, less bleeding and lower blood transfusion rate than traditional surgical methods, and has certain advantages in reducing postoperative complications of elderly patients.
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Affiliation(s)
- Hongfei Qi
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Zhong Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Teng Ma
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Yangyang Jiang
- Xi’an Medical College, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Cheng Ren
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Yibo Xu
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Qiang Huang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Kun Zhang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Yao Lu
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
| | - Ming Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, 710000, People’s Republic of China
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Bai H, Wang R, Dai Y, Xue Y. Optimizing milling parameters based on full factorial experiment and backpropagation artificial neural network of lamina milling temperature prediction model. Technol Health Care 2024; 32:201-214. [PMID: 37302049 DOI: 10.3233/thc-220812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Milling operations of laminae in spinal surgery generate high temperatures, which can lead to thermal injury and osteonecrosis and affect the biomechanical effects of implants, ultimately leading to surgical failure. OBJECTIVE In this paper, a backpropagation artificial neural network (Bp-ANN) temperature prediction model was developed based on full factorial experimental data of laminae milling to optimize the milling motion parameters and to improve the safety of robot-assisted spine surgery. METHODS A full factorial experiment design were used to analyze the parameters affecting the milling temperature of laminae. The experimental matrixes were established by collecting the corresponding cutter temperature Tc and bone surface temperature Tb for the milling depth, feed speed and different bone densities. The Bp-ANN lamina milling temperature prediction model was constructed from experiment data. RESULTS Increasing milling depth increases bone surface and cutter temperature. Increasing feed speed had little effect on cutter temperature, but decreased bone surface temperature. Increasing bone density of laminae increased cutter temperature. The Bp-ANN temperature prediction model had best training results in the 10th epoch, and there is no overfitting (training set R= 0.99661, validation set R= 0.85003, testing set R= 0.90421, all temperature data set R= 0.93807). The goodness of fit R of Bp-ANN was close to 1, indicating that the predicted temperature was in good agreement with the experiment measurements. CONCLUSION This study can help spinal surgery-assisted robot to select appropriate motion parameters at different density bones to improve lamina milling safety.
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Affiliation(s)
- He Bai
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Wang
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Dai
- Institute of Robotics and Automatic Information System, Tianjin Key Laboratory of Intelligent Robotics, College of Artificial Intelligence, Nankai University, Tianjin, China
| | - Yuan Xue
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
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Lazzarini F, Paoli T, Cozzi Lepri A, Secci G, Zanna L, Innocenti M, Matassi F, Carulli C, Civinini R. Accuracy of radiographic projections to guide cephalic screw position in pertrochanteric fracture: a cadaveric study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:479-487. [PMID: 37624410 PMCID: PMC10771593 DOI: 10.1007/s00590-023-03690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE The aim of this study was to evaluate the relationship between the Löwenstein Lateral view and the True Lateral view for the positioning of the cephalic hip screw, through a cadaveric study. MATERIALS AND METHODS We placed two Kirschner wires in eight femur specimens using an Antero-Posterior view, Löwenstein Lateral view and True Lateral view. The distances between the Kirschner wires and the anterior, posterior, superior and inferior cortex were measured in all projections. The head of the femur was then sectioned, and the same macroscopic distances were measured. Finally, we could calculate the accuracy of the two radiographic lateral projections. RESULTS When the Kirschner wire was placed in the center of the head using the Antero-Posterior and the True Lateral view, the accuracy of Antero-Posterior view was 0.9705 while the accuracy of True Lateral view and Löwenstein Lateral view was 1.1479 and 1.1584, respectively. When the Kirschner wire was placed superior on the Antero-Posterior and centrally on the True Lateral view, the accuracy of Antero-Posterior view was 0.9930 while the accuracy of True Lateral view and Löwenstein Lateral view was 1.1159 and 0.7224, respectively. CONCLUSION When the Kirschner wire was positioned proximal in Antero-Posterior view and central in True Lateral view, only the True Lateral view showed high accuracy.
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Affiliation(s)
- Francesco Lazzarini
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital,, Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Tommaso Paoli
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital,, Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Andrea Cozzi Lepri
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
| | - Gregorio Secci
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy.
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital,, Via Antella 58, 50012, Bagno a Ripoli, Italy.
| | - Luigi Zanna
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital,, Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Matteo Innocenti
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
| | - Fabrizio Matassi
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
| | - Christian Carulli
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
| | - Roberto Civinini
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
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Guo X, Wang D, Li J, Zhang H. Global research status and trends in orthopaedic surgical robotics: a bibliometric and visualisation analysis study. J Robot Surg 2023:10.1007/s11701-023-01579-x. [PMID: 37017859 DOI: 10.1007/s11701-023-01579-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/18/2023] [Indexed: 04/06/2023]
Abstract
This study aimed to investigate and summarise the current state of research and trends in orthopaedic surgical robots. Data on publicly available publications related to orthopaedic surgical robots were extracted by abstract searches of the Web of Science Core Collection database. A bibliometric analysis and detailed reading of the publications were then carried out and the information was visualised using co-authorship analysis, coupling analysis, co-citation analysis and co-occurrence analysis in VOSviewer. With 436 publications included in the study from 1993 to 2022, the overall contribution of publications to the world showed an increasing trend year by year, with a particularly pronounced after 2017, and a geographical trend of predominantly East Asia, North America, and Western Europe. Of these, China was the largest contributor (n = 128). Overall, the UK affiliates and their scholars were leaders in the field, with a high number of publications, total citations, average citations per article and H-index. The most published institutions and authors were Imperial College London (n = 21) and Professor Fares Sahi Haddad of University College London (n = 12), respectively. Journals with a high overall impact on robotic orthopaedic surgery were the Journal of Arthroplasty, Bone Joint Journal, International Journal of Medical Robotics and Computer Assisted Surgery. Keyword co-occurrence network analysis revealed four main clusters: robot-assisted knee, hip arthroplasty, spine surgery, and robotic technology research and development. The top three most common sites for robot-assisted surgery use were the knee, hip and spine. The most used robot types were the knee and spine, with Mako and Arobot being the most used robots for the knee and TiRobot for the spine. This study comprehensively reveals the current status and trends of global research on orthopaedic surgical robots, covering countries, institutions, authors, journals, research hotspots, robot types and surgical sites, providing directional guidance and research ideas for further research on the technological development and clinical evaluation of orthopaedic surgical robots.
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Affiliation(s)
- Xinmeng Guo
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Jiantao Li
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Hao Zhang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
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Robot-assisted percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a retrospective matched-cohort study. INTERNATIONAL ORTHOPAEDICS 2023; 47:595-604. [PMID: 36520167 DOI: 10.1007/s00264-022-05654-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE This study aims to introduce the principle, clinical efficacy, and learning curve of robot-assisted percutaneous vertebroplasty (PVP). METHODS Forty-two patients who underwent robot-assisted single-level PVP were analyzed retrospectively and 42 age-matched patients using freehand technique were selected as the control group. The visual analog scale, operation time, radiation exposure, accuracy, and learning curve were analyzed. RESULTS The puncture time and total operation time were significantly shorter, and the puncture and total fluoroscopy number were fewer in the robot group. The deviation between pre-operative planned and actual puncture trajectory well met clinical requirement. The puncture time, total operation time, and puncture fluoroscopy number were significantly more in early cases than in later cases in the robot group. CONCLUSION The robot-assisted pedicle puncture technique shortens the operation time and reduces radiation exposure, and the accuracy meets the clinical requirement in PVP. The learning curve is short and not steep.
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Tang L, Yi X, Yuan T, Li H, Xu C. Navigated intramedullary nailing for patients with intertrochanteric hip fractures is cost-effective at high-volume hospitals in mainland China: A markov decision analysis. Front Surg 2023; 9:1048885. [PMID: 36726954 PMCID: PMC9885142 DOI: 10.3389/fsurg.2022.1048885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/23/2022] [Indexed: 01/17/2023] Open
Abstract
Objective Previous studies have reported that navigation systems can improve clinical outcomes of intramedullary nailing (IMN) for patients with intertrochanteric fractures. However, information is lacking regarding the relationship between the costs of navigated systems and clinical outcomes. The present research aimed to evaluate the cost-effectiveness of navigated IMN as compared with traditional freehand IMN for patients with intertrochanteric fractures. Methods A Markov decision model with a 5-year time horizon was constructed to investigate the costs, clinical outcomes and incremental cost-effectiveness ratio (ICER) of navigated IMN for a 70-year-old patient with an intertrochanteric fracture in mainland China. The costs [Chinese Yuan (¥)], health utilities (quality-adjusted life-years, QALYs) and transition probabilities were obtained from published studies. The willingness-to-pay threshold for ICER was set at ¥1,40,000/QALY following the Chinese gross domestic product in 2020. Three institutional surgical volumes were used to determine the average navigation-related costs per patient: low volume (100 cases), medium volume (200 cases) and high volume (300 cases). Results Institutes at which 300, 200 and 100 cases of navigated IMN were performed per year showed an ICER of ¥43,149/QALY, ¥76,132.5/QALY and ¥1,75,083/QALY, respectively. Navigated IMN would achieve cost-effectiveness at institutes with an annual volume of more than 125 cases. Conclusions Our analysis demonstrated that the navigated IMN could be cost-effective for patients with inter-trochanteric fracture as compared to traditional freehand IMN. However, the cost-effectiveness was more likely to be achieved at institutes with a higher surgical volume.
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Affiliation(s)
- Liang Tang
- Department of Orthopaedics, Hengyang Central Hospital, The Affiliated Hengyang Hospital of Southern Medical University, Hengyang, China
| | - Xiaoke Yi
- Department of Orthopaedics, Hengyang Central Hospital, The Affiliated Hengyang Hospital of Southern Medical University, Hengyang, China
| | - Ting Yuan
- Department of Orthopaedics, Hengyang Central Hospital, The Affiliated Hengyang Hospital of Southern Medical University, Hengyang, China
| | - Hua Li
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Cheng Xu
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
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12
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Fan X, Zhu Q, Tu P, Joskowicz L, Chen X. A review of advances in image-guided orthopedic surgery. Phys Med Biol 2023; 68. [PMID: 36595258 DOI: 10.1088/1361-6560/acaae9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
Orthopedic surgery remains technically demanding due to the complex anatomical structures and cumbersome surgical procedures. The introduction of image-guided orthopedic surgery (IGOS) has significantly decreased the surgical risk and improved the operation results. This review focuses on the application of recent advances in artificial intelligence (AI), deep learning (DL), augmented reality (AR) and robotics in image-guided spine surgery, joint arthroplasty, fracture reduction and bone tumor resection. For the pre-operative stage, key technologies of AI and DL based medical image segmentation, 3D visualization and surgical planning procedures are systematically reviewed. For the intra-operative stage, the development of novel image registration, surgical tool calibration and real-time navigation are reviewed. Furthermore, the combination of the surgical navigation system with AR and robotic technology is also discussed. Finally, the current issues and prospects of the IGOS system are discussed, with the goal of establishing a reference and providing guidance for surgeons, engineers, and researchers involved in the research and development of this area.
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Affiliation(s)
- Xingqi Fan
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Qiyang Zhu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Puxun Tu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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13
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Li C, Zhang T, Wang H, Hou Z, Zhang Y, Chen W. Advanced surgical tool: Progress in clinical application of intelligent surgical robot. SMART MEDICINE 2022; 1:e20220021. [PMID: 39188736 PMCID: PMC11235784 DOI: 10.1002/smmd.20220021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/07/2022] [Indexed: 08/28/2024]
Abstract
Surgical robot is a revolutionary tool conceived in the progress of clinical medicine, computer science, microelectronics and biomechanics. It provides the surgeon with clearer views and more comfortable surgical postures. With the assistance of computer navigation during delicate operations, it can further shorten the patient recovery time via reducing intraoperative bleeding, the risk of infection and the amount of anesthesia needed. As a comprehensive surgical revolution, surgical robot technique has a wide range of applications in related fields. This paper reviews the development status and operation principles of these surgical robots. At the same time, we also describe their up-to-date applications in different specialties and discusses the prospects and challenges of surgical robots in the medical area.
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Affiliation(s)
- Chao Li
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Tongtong Zhang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Haoran Wang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Zhiyong Hou
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Yingze Zhang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Wei Chen
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
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14
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Xu D, Lou W, Li M, Xiao J, Wu H, Chen J. Current status of robot-assisted surgery in the clinical application of trauma orthopedics in China: A systematic review. Health Sci Rep 2022; 5:e930. [PMID: 36381405 PMCID: PMC9642816 DOI: 10.1002/hsr2.930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Abstract
Background and Aims To elaborate on the development and characteristics of trauma orthopedic robots and their real curative effect in a clinical application through the collection and analysis of relevant literature and reported clinical results. Method We conducted the Embase, ScienceDirect, Pubmed, Medline, Wanfang, CNKI, and VIP search of the literature on robotic-assisted surgery in trauma orthopedics in China. We combined search terms with "robotic surgery/artificial intelligence surgery/navigation surgery," "trauma/trauma orthopedics," and "China/Chinese." The exclusion criteria were: (1) articles in languages other than English or Chinese, (2) articles focused on other topics other than robotic-assisted surgery in trauma orthopedics of China, (3) article types were not clinical studies (reviews, basic research, etc.), and (4) articles were not included in the Chinese core journals or science citation index. Authors, type of surgery, robot type, and clinical research results were recorded and analyzed. Results There were three categories of surgical robots in the clinical application of trauma orthopedics (TiRobot, electromagnetic navigation surgical robots, and small medical robots developed by Beijing Jishuitan Hospital). In terms of blood loss, the fluoroscopy time, and fluoroscopy frequency, most studies found that the robot group was significantly better than the traditional group. Conclusions Robot-assisted surgery has obvious advantages in accuracy, stability, and reducing intraoperative radiation exposure, but there is no final conclusion about functional recovery.
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Affiliation(s)
- Ding Xu
- Department of Orthopedic Trauma SurgeryNingbo No. 6 HospitalNingboChina
- Department of SurgeryNingbo University Medical CollegeNingboChina
| | - Weigang Lou
- Department of Orthopedic Trauma SurgeryNingbo No. 6 HospitalNingboChina
| | - Ming Li
- Department of Orthopedic Trauma SurgeryNingbo No. 6 HospitalNingboChina
| | - Jingwei Xiao
- Department of SurgeryNingbo University Medical CollegeNingboChina
| | - Hongbao Wu
- Department of Orthopedic Trauma SurgeryNingbo No. 6 HospitalNingboChina
| | - Jianming Chen
- Department of Orthopedic Trauma SurgeryNingbo No. 6 HospitalNingboChina
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15
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Accuracy and Safety of Robot-Assisted versus Fluoroscopy-Guided Posterior C1 Lateral Mass and C2 Pedicle Screw Internal Fixation for Atlantoaxial Dislocation: A Preliminary Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8508113. [PMID: 36132077 PMCID: PMC9484877 DOI: 10.1155/2022/8508113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/24/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
Objective To compare the accuracy, efficiency, and safety of robotic assistance (RA) and conventional fluoroscopy guidance for the placement of C1 lateral mass and C2 pedicle screws in posterior atlantoaxial fusion. Methods The data of patients who underwent posterior C1–C2 screw fixation (Goel-Harm's technique) in our hospital from August 2014 to March 2021 were retrospectively evaluated, including 14 cases under fluoroscopic guidance and 11 cases under RA. The hospital records, radiographic results, surgical data, and follow-up records were reviewed. Accuracy of screw placement was assessed using the Gertzbein and Robbins scale, and clinical outcomes were evaluated by Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS), modified MacNab criteria, and postoperative complications. Results Baseline characteristics of both groups were similar. The mean estimated blood loss in the fluoroscopic guidance and RA groups was 205.7 ± 80.3 mL and 120.9 ± 31.9 mL, respectively (p = 0.03). The mean surgical duration was 34 min longer with RA compared to that performed with free-hand (FH) method (p = 0.15). In addition, lower intraoperative radiation exposure was detected in the RA group (12.4 ± 1.4 mGy/screw) versus the FH (19.9 ± 2.1 mGy/screw) group (p = 0.01). The proportion of “clinically acceptable” screws (graded 0 and I) was higher in the RA group (93.2%) than that in the FH group (87.5%, p = 0.04). There was no significant difference in the increase of JOA score and decrease of VAS score between the two surgical procedures. Furthermore, there were no significant differences in overall clinical outcome between the two groups and no neurovascular complications associated with screw insertion. Conclusions RA is a safe and potentially more accurate alternative to the conventional fluoroscopic-guided FH technique for posterior atlantoaxial internal fixation.
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[Development and clinical application of robot-assisted technology in traumatic orthopedics]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:915-922. [PMID: 35979779 PMCID: PMC9379455 DOI: 10.7507/1002-1892.202206097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To review and evaluate the basic principles and advantages of orthopedic robot-assisted technology, research progress, clinical applications, and limitations in the field of traumatic orthopedics, especially in fracture reduction robots. METHODS An extensive review of research literature on the principles of robot-assisted technology and fracture reduction robots was conducted to analyze the technical advantages and clinical efficacy and shortcomings, and to discuss the future development trends in this field. RESULTS Orthopedic surgical robots can assist orthopedists in intuitive preoperative planning, precise intraoperative control, and minimally invasive operations. It greatly expands the ability of doctors to evaluate and treat orthopedic trauma. Trauma orthopedic surgery robot has achieved a breakthrough from basic research to clinical application, and the preliminary results show that the technology can significantly improve surgical precision and reduce surgical trauma. However, there are still problems such as insufficient evaluation of effectiveness, limited means of technology realization, and narrow clinical indications that need to be solved. CONCLUSION Robot-assisted technology has a broad application prospect in traumatic orthopedics, but the current development is still in the initial stage. It is necessary to strengthen the cooperative medical-industrial research, the construction of doctors' communication platform, standardized training and data sharing in order to continuously promote the development of robot-assisted technology in traumatic orthopedics and better play its clinical application value.
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17
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Cheng QH, Li PB, Lu TT, Guo SF, Di WF, Yang KH, Qian YW. Computer-assisted cannulated screw internal fixation versus conventional cannulated screw internal fixation for femoral neck fractures: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:687. [PMID: 34809649 PMCID: PMC8607593 DOI: 10.1186/s13018-021-02806-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/20/2021] [Indexed: 02/08/2023] Open
Abstract
Objective To compare the effects between computer-assisted and traditional cannulated screw internal fixation on treating femoral neck fracture. Methods The search was conducted in Embase, Pubmed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang Database from the beginning to August 2020. RevMan5.4 software, which was provided by the International Cochrane Group, was used for the meta-analysis comparing the differences in operation time, intraoperative bleeding volume, fluoroscopy frequency, fracture healing time, total drilling times, Harris score, fracture healing rate, and femoral head necrosis rate between computer-assisted and traditional methods groups. Results A total of 1028 patients were included in 16 studies. Primary outcome indicators: Compared with the traditional method group, the computer-assisted group had less operative time (2RCTs, P < 0.00001; 8 non-RCTs, P = 0.009; Overall, P < 0.00001), intraoperative bleeding (1 RCTs, P < 0.00001; 9non-RCTs, P < 0.00001; Overall, P < 0.00001), femoral head necrosis rate (1 RCT, P = 0.11;7 non-RCTs, P = 0.09; Overall, P = 0.02) and higher Harris scores (1 RCT, P < 0.0001; 9 non-RCTs, P = 0.0002; Overall, P < 0.0001), and there were no significant differences in fracture healing rate between the two groups (5 non-RCTs, P = 0.17). Secondary outcomes indicators: The computer-assisted group had a lower frequency of intraoperative fluoroscopy and total number of drills compared with the traditional method group, while there was no significant difference in fracture healing time. Conclusion Compared with the traditional hollow screw internal fixation on the treatment of femoral neck fracture, computer-assisted percutaneous cannulated screw fixation can shorten the operation time and improve the operation efficiency and reduce the X-ray injury of medical staff and help patients obtain a better prognosis. Therefore, computer-assisted percutaneous cannulated screw fixation is a better choice for the treatment of femoral neck fracture. Study registration PROSPERO registration number CRD42020214493. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02806-7.
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Affiliation(s)
- Qing-Hao Cheng
- Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China.,Institution of Clinical Research and Evidence-Based Medicine, The Gansu Provincial Hospital, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 222, Tianshui South Road, Chengguan District, Lanzhou, 730000, China.,School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, China
| | - Peng-Biao Li
- Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - Ting-Ting Lu
- Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China.,Institution of Clinical Research and Evidence-Based Medicine, The Gansu Provincial Hospital, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 222, Tianshui South Road, Chengguan District, Lanzhou, 730000, China
| | - Shi-Fang Guo
- Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - Wen-Fei Di
- Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - Ke-Hu Yang
- Institution of Clinical Research and Evidence-Based Medicine, The Gansu Provincial Hospital, Lanzhou, China. .,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 222, Tianshui South Road, Chengguan District, Lanzhou, 730000, China. .,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| | - Yao-Wen Qian
- Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China.
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Robot-assisted fracture fixation in orthopaedic trauma surgery: a systematic review. OTA Int 2021; 4:e153. [PMID: 34765903 PMCID: PMC8575426 DOI: 10.1097/oi9.0000000000000153] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
Objective: To investigate the applications of robot-assisted surgery and its effect on surgical outcomes in orthopaedic trauma patients. Data Sources: A search was performed in PubMed and Embase for articles in English, Dutch, German, or French, without restrictions on follow-up times, study size, or year of publication. Study Selection: Studies were included if they investigated patients undergoing robot-assisted fracture fixation surgery for orthopaedic trauma. Data Extraction: Outcomes studied were operating time, fluoroscopy time/frequency, complications, functional outcomes, intraoperative blood loss, fracture healing, and screw placement accuracy. Critical appraisal was done by using the Methodological Index for Non-Randomized Studies. Data Synthesis: Narrative review. Conclusions: A total of 3832 hits were identified with the search and 8 studies were included with a combined total of 437 included patients, 3 retrospective cohort studies, 2 prospective cohort studies, 1 cohort study not otherwise specified, 1 case series, and 1 randomized controlled trial. Four studies investigated pelvic ring fractures, 3 studies investigated femur fractures, and 1 study investigated scaphoid fractures. Seven investigated percutaneous screw fixation and 1 studied intramedullary nail fixation. One robotic system was used across all studies, the TiRobot, and all procedures were performed in China. The limited evidence suggests that that robot-assisted orthopaedic trauma surgery may reduce operating time, use of fluoroscopy, intraoperative blood loss, and improve screw placement accuracy, but the overall quality of evidence was low with a high risk of bias. Robot-assisted fracture fixation does not appear to lead to better functional outcomes for the patient. Level of evidence: III
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Gao Y, Wang H, Tu P, Hu J, Wang Q, Chen X. A novel dynamic electromagnetic tracking navigation system for distal locking of intramedullary nails. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 209:106326. [PMID: 34433127 DOI: 10.1016/j.cmpb.2021.106326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The accurate distal locking of intramedullary (IM) nails is a clinical challenge for surgeons. Although many navigation systems have been developed, a real-time guide method with free radiation exposure, better user convenience, and high cost performance has not been proposed. METHODS This paper aims to develop an electromagnetic navigation system named TianXuan-MDTS that provides surgeons with a proven surgical solution. And the registration method with external landmarks for IM nails and calibration algorithm for guiders were proposed. A puncture experiment, model experiments measured by 3D Slicer and cadaver experiments (2 cadaveric leg specimens and 6 drilling operations) are conducted to evaluate its performance and stability. RESULTS The registration deviations (TRE) is 1.05± 0.13 mm. In the puncture experiment, a success rate of 96% can be achieved in 45.94 s. TianXuan-MDTS were evaluated on 3 tibia model. The results demonstrated that all 9 screw holes were successfully prepared at a rate of 100% in 91.67 s. And the entry point, end point, and angular deviations were 1.60±0.20 mm, 1.47±0.18 mm, and 3.10±0.84°, respectively. Postoperative fluoroscopy in cadaver experiments showed that all drills were in the distal locking holes, with a success rate of 100% and the average time 143.17± 18.27 s. CONCLUSIONS The experimental results indicate that our system with novel registration and calibration methods could serve as a feasible and promising tool to assist surgeons during distal locking.
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Affiliation(s)
- Yao Gao
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Huixiang Wang
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Puxun Tu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Junlei Hu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qiugen Wang
- Trauma Center, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaojun Chen
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China; Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China.
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Pang Y, He QF, Zhu LL, Bian ZY, Li MQ. Loss of Reduction after Cephalomedullary Nail Fixation of Intertrochanteric Femoral Fracture: A Brief Report. Orthop Surg 2020; 12:1998-2003. [PMID: 33084250 PMCID: PMC7767684 DOI: 10.1111/os.12828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 09/12/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022] Open
Abstract
Objective At present, cephalomedullary nail is the most frequently used implant in the management of intertrochanteric fractures around the world. The implant design and fixation techniques of the cephalomedullary nail have been continuously improved to ensure uncomplicated bone union during the past decade. However, a degree of reduction loss during bone healing is still not rare in clinical work. Many attributed this complication to misoperation during the surgery and hold that a series of techniques and tips could help to avoid the loss of reduction. However, until now there has been no research to explore whether the reduction loss after the operation can be fully prevented in the best cases. The purposes of the study are as follows: (i) to evaluate the efficiency of the current established CMN techniques; (ii) to quantify the loss of reduction under an appropriately implanted CMN to anatomically realigned intertrochanteric fractures; and (iii) to explore the possible underlying causes for the inevitable loss of reduction. Methods In the retrospective study, 163 consecutive cases with the intertrochanteric fractures fixed with standard cephalomedullary nail technique were reviewed. The anatomical reduction and optimal positioning of the nail were confirmed by postoperative imaging. The fracture types ranged from 31‐A1.1–2.3 according to the OTA/AO fracture classification. One hundred and fifteen cases with stable fracture types (31A1.1–2.1) were allocated to Group A, and 48 cases with unstable 31A2.2–2.3 fracture types were allocated to Group B. The radiological measurements included femoral neck shortening, loss of the neck‐shaft angle, cutout, and cut‐through of the blade. The outcomes between postoperative and 1 year after the operation were evaluated and compared. Results The patients consisted of 66 males and 97 females with an average age of 69.4 (range: 46–78, SD: 14.6) years. At the 1‐year follow‐up, no fixation failure or nonunion was observed in each group. The mean femoral neck shortening and loss of the neck‐shaft angle were 4.47 mm (range: 0.43–17.68, SD: 3.71) and 5.4° (range: 0.51–19.10, SD: 3.58) separately. The mean cutout and cut‐through were 1.84 mm (range: 0.24–11.30, SD: 2.33) and 1.25 mm (range: 0.51–10.29, SD: 1.74). The average femoral neck shortening and loss of the neck‐shaft angle were higher in Group B than Group A. Among the 23 cases with the femoral neck shortening more than 10 mm, 19 cases (16.5%) were from Group A and four cases (8.3%) were from Group B. There were nine (7.8%) cases with the loss of the neck‐shaft angle more than 10° in Group A and six (12.5%) cases in Group B. Conclusions Current established CMN techniques are efficient in treating intertrochanteric femoral fracture. However, even with currently consensual techniques of cephalomedullary nail, the process of fracture healing still risks the loss of reduction, although the migration of the blade could be minimized. This situation may associate with the intrinsic design of the CMN and further improvement is still needed.
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Affiliation(s)
- Yao Pang
- Department of Orthopaedic Surgery, Hangzhou Hospital Affiliated to Nanjing Medical University (Hangzhou First People's Hospital), Nanjing, China
| | - Qi-Fang He
- Department of Orthopaedic Surgery, Hangzhou Hospital Affiliated to Nanjing Medical University (Hangzhou First People's Hospital), Nanjing, China
| | - Liu-Long Zhu
- Department of Orthopaedic Surgery, Hangzhou First People's Hospital, Hangzhou, China
| | - Zhen-Yu Bian
- Department of Orthopaedic Surgery, Hangzhou First People's Hospital, Hangzhou, China
| | - Mao-Qiang Li
- Department of Orthopaedic Surgery, Hangzhou First People's Hospital, Hangzhou, China
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Luo J, Yan YJ, Wang XD, Long XD, Lan H, Li KN. Accuracy and Safety of Robot-Assisted Drilling Decompression for Osteonecrosis of the Femoral Head. Orthop Surg 2020; 12:784-791. [PMID: 32394643 PMCID: PMC7307221 DOI: 10.1111/os.12678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/14/2020] [Accepted: 03/18/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To investigate the safety and superiority of robot-assisted femoral head drilling decompression in the treatment of femoral head necrosis. METHODS A total of 63 patients who underwent borehole decompression of the femoral head in our hospital from January 2016 to March 2019 were recruited. Patients were divided into two groups for comparison according to surgical methods. In the robot-assisted surgery group, there were 30 cases with 41 femoral heads. The conventional group had 33 cases and 46 femoral heads. All patients signed the consent form before the operation. The follow-up time was 6 months. The incision lengths, operation times, intraoperative blood loss, intraoperative fluoroscopies, guide needle punctures, postoperative Harris scores, and postoperative complications of the two groups were compared. RESULTS The incision length of the robot surgery group was 5.16 ± 0.41 cm, while that of the traditional surgery group was 7.42 ± 0.50 cm. The operation time of the robot surgery group was 46.99 ± 4.94 min, while that of the traditional surgery group was 55.01 ± 6.19 min. The fluoroscopy frequency of the robot surgery group was 10.50 ± 1.78 times, while that of the traditional surgery group was 17.91 ± 2.20 times. The intraoperative blood loss in the robotic surgery group was 20.62 ± 2.52 mL, while that in the conventional surgery group was 52.72 ± 3.39 mL. In the robot operation group, each femoral head guide needle was punctured three times, and the puncture was successful one time. The number of guided needle punctures in the traditional group was 8.02 ± 1.73. The difference between the two groups was statistically significant (P < 0.05). The Harris score was 69.53 ± 7.51 in the robot surgery group and 68.38 ± 7.26 in the traditional surgery group one month after surgery, 78.52 ± 6.49 in the robot surgery group and 76.41 ± 7.95 in the traditional surgery group three months after surgery, and 83.32 ± 8.62 in the robot surgery group and 81.74 ± 6.20 in the traditional surgery group six months after surgery. There was no significant difference between the two groups (P > 0.05). In the traditional group, there was one case of incision infection and one case of femoral head collapse during follow-up. In the robot group, there were no complications, such as incision infection and deep vein thrombosis. No collapse of the femoral head was found in the robot group during follow-up. CONCLUSION The positioning system of the orthopaedic robot is an ideal method for the treatment of femoral head necrosis. This method has the advantages of simple operation, accurate drilling, a short operation time, less surgical trauma, less radioactivity, and good recovery of hip joint function.
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Affiliation(s)
- Jin Luo
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Ya-Jing Yan
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Xiao-Dong Wang
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Xu-Dong Long
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Hai Lan
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Kai-Nan Li
- Department of Orthopaedics, Affiliated Hospital of Chengdu University, Chengdu, China
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Cheng Md Q, Lin Bm L, Zhu Md XD, Li Md GZ, Gao Bm XM, Qian Bm Y, Zhao Md GY, Di Md DH. Procedure for Femoral Intertrochanteric Fractures using the "Three-Finger Method" Assisted by Proximal Femoral Nail Antirotation. Orthop Surg 2020; 12:543-551. [PMID: 32347007 PMCID: PMC7189038 DOI: 10.1111/os.12656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/05/2020] [Accepted: 02/13/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To assess long‐term follow‐up evaluations for the treatment of femoral intertrochanteric fractures with the “three‐finger method” assisted by proximal femoral nail antirotation (PFNA). Methods From January 2010 to January 2017, 123 patients were selected and followed for the treatment of femoral intertrochanteric fractures with PFNA assisted by the “three‐finger method” (application of the index finger, middle finger, and ring finger in the process of surgery to assist PFNA). There were 56 male patients and 67 female patients aged 52–93 years with an average age of 75.6 years, and 88 cases were due to a fall and 35 due to a traffic accident injury. The femoral necks were fixed with PFNA assisted by the “three‐finger method” applying the following procedure: traction reduction, determining the incision, inserting the needle, and placing screw. The Harris hip score, postoperative complications, hip pain and function status were statistically analyzed to evaluate the surgical efficacy and to discuss the surgical technique of the “three‐finger method” assisted by PFNA. Results According to the Harris scoring criteria, patients were followed for 1, 2, 4, 6, and 8 years, and the good outcomes of patients were recorded. The excellent and good rate of 87% was the highest in the second year of follow‐up. Then, the rate decreased following the eighth year of follow‐up. The excellent and good rate of 82.7% was the lowest. The patients with incisions healed well, there were no instances of fat liquefaction or infection. There were three cases of effusion, the rate was 2.4%. The secretions were cultured, and no bacterial growth was found. After treatment of the wound, it healed, and the spiral blade used for the femoral head did not wear out. There was one case of femoral head necrosis. There was no significant correlation between hip pain and sex and age (P > 0.05), and the function of the hip joint was significantly correlated with the age of the patients (P < 0.05). Conclusion The “three‐finger method” in the process of surgery to assist PFNA for the treatment of patients with intertrochanteric fractures of the femur simplified the operation steps, reduced the operation difficulty, shortened the operation time, improved the operation efficiency, and reduced the incidence of postoperative complications.
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Affiliation(s)
- Qian Cheng Md
- Department of Orthopaedic, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopaedic, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Li Lin Bm
- Medical College, Jiangsu University, Zhenjiang, China
| | - Xiao-Dong Zhu Md
- Department of Orthopaedic, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gui-Zhu Li Md
- Department of Orthopaedic, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | | | - Yao Qian Bm
- Medical College, Jiangsu University, Zhenjiang, China
| | - Guo-Yang Zhao Md
- Department of Orthopaedic, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Dong-Hua Di Md
- Department of Orthopaedic, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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