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Hirschfeld M, Pascual-Lopez FJ, Guerado E. [Translated article] Spinopelvic dissociation: Current concepts. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T398-T408. [PMID: 38336155 DOI: 10.1016/j.recot.2024.01.025] [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: 02/15/2023] [Revised: 08/21/2023] [Accepted: 09/02/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Spinopelvic dissociation is an uncommon injury, but, at the same time, very serious, since it can associate important complications with high morbidity and mortality. Its low frequency means that the experience of the specialists who have to deal with it is often very limited. OBJECTIVE To analyze the treatment indications based in classifications and surgery techniques. METHOD A search for scientific articles from high-impact journals was performed through international databases, such as Pubmed, Cochrane Library, Scopus, Science Direct and OVID. CONCLUSIONS The management of the injury we are analyzing represents a challenge. The diagnosis is carried out through a meticulous anamnesis and physical examination, supported by imaging tests, where tomography acquires special relevance. The treatment is fundamentally surgical, reserved the conservative option for a few cases. Triangular fixation is nowadays considered the treatment of choice.
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Affiliation(s)
- M Hirschfeld
- Hospital Universitario Costa del Sol, Facultad de Medicina, Universidad de Málaga, Spain.
| | - F J Pascual-Lopez
- Hospital Universitario Costa del Sol, Facultad de Medicina, Universidad de Málaga, Spain
| | - E Guerado
- Hospital Universitario Costa del Sol, Facultad de Medicina, Universidad de Málaga, Spain
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Hirschfeld M, Pascual-López FJ, Guerado E. Spinopelvic dissociation: Current concepts. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:398-408. [PMID: 37689352 DOI: 10.1016/j.recot.2023.09.001] [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: 02/15/2023] [Revised: 08/21/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION Spinopelvic dissociation is an uncommon injury, but, at the same time, very serious, since it can associate important complications with high morbidity and mortality. Its low frequency means that the experience of the specialists who have to deal with it is often very limited. OBJECTIVE To analyze the treatment indications based in classifications and surgery techniques. METHOD A search for scientific articles from high-impact journals was performed through international databases, such as Pubmed, Cochrane Library, Scopus, Science Direct and OVID. CONCLUSIONS The management of the injury we are analyzing represents a challenge. The diagnosis is carried out through a meticulous anamnesis and physical examination, supported by imaging tests, where tomography acquires special relevance. The treatment is fundamentally surgical, reserved the conservative option for a few cases. Triangular fixation is nowadays considered the treatment of choice.
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Affiliation(s)
- M Hirschfeld
- Hospital Universitario Costa del Sol, Facultad de Medicina, Universidad de Málaga, España.
| | - F J Pascual-López
- Hospital Universitario Costa del Sol, Facultad de Medicina, Universidad de Málaga, España
| | - E Guerado
- Hospital Universitario Costa del Sol, Facultad de Medicina, Universidad de Málaga, España
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Atiç R, Alemdar C, Ulus SA, Yazar C, Durgut F, Sayar Ş, Aydın A. Outcomes of Lumbosacral Fixation in Patients with Suicidal Jumper's Fractures: A Retrospective Study from a Single Center in Turkey. Med Sci Monit 2024; 30:e942831. [PMID: 38225811 PMCID: PMC10802078 DOI: 10.12659/msm.942831] [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] [Received: 10/11/2023] [Accepted: 11/13/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Suicide attempts that involve jumping from a great height may not be fatal but can result in lumbosacral facture-dislocations. This retrospective study aimed to present the experience from a single center in Turkey of 21 patients with lumbosacral facture-dislocations, or suicidal jumper fractures, treated with lumbosacral fixation between 2015 and 2022. MATERIAL AND METHODS The study included 21 patients. The diagnosis was established through X-ray and computed tomography (CT) examinations. Neurological damage was assessed using the Gibbons score. Among the patients, 2 were classified as Roy-Camille type 1, 12 as Roy-Camille type 2, and 7 as Roy-Camille type 3. Morphologically, 8 patients had H-type fractures, 7 had T-type fractures, and 6 had U-type fractures. Bilateral spinopelvic fixation was performed. Functional outcomes were evaluated using the Majeed score. RESULTS The average Injury Severity Score (ISS) was 31.6±12.2. The mean duration of surgery was 123.6±44.9 minutes. According to the Majeed score, excellent results were observed in 8 individuals (40%), good results in 5 individuals (25%), fair results in 5 individuals (25%), and poor results in 2 individuals (10%). Out of 18 patients with neurological deficits, 14 showed improvement after surgery, while 4 continued to experience deficits. CONCLUSIONS The findings from this study highlight the importance of obtaining a clear history of the cause of lumbosacral facture-dislocation, as attempted suicide by jumping from a height can cause specific types of injury to the lumbar spine and sacrum that require rapid diagnosis and management to reduce the incidence of permanent paraplegia.
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Affiliation(s)
- Ramazan Atiç
- Department of Orthopedics and Traumatology, Dicle University Medical School, Diyarbakır, Turkey
| | - Celil Alemdar
- Department of Orthopedics and Traumatology, Medicana International Hospital, Istanbul, Turkey
| | - Sait Anıl Ulus
- Department of Orthopedics and Traumatology, Mardin Training and Research Hospital, Mardin, Turkey
| | - Cihan Yazar
- Department of Orthopedics and Traumatology, Dicle University Medical School, Diyarbakır, Turkey
| | - Fatih Durgut
- Department of Orthopedics and Traumatology, Selçuk University Medical School, Konya, Turkey
| | - Şafak Sayar
- Department of Orthopedics and Traumatology, Biruni University Hospital, Istanbul, Turkey
| | - Abdulkadir Aydın
- Ataturk Vocational School of Health Services, Dicle University, Diyarbakir, Turkey
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Lu Y, Xu Y, Ren C, Li Z, Zhang K, Huang Q, Ma T. A feasibility study of robot-assisted percutaneous reduction and fixation technique for treating posterolateral depression tibial plateau fractures. Sci Rep 2023; 13:22026. [PMID: 38087037 PMCID: PMC10716110 DOI: 10.1038/s41598-023-49624-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/10/2023] [Indexed: 12/18/2023] Open
Abstract
Posterolateral (PL)-depression fractures of the tibial plateau are difficult to manage. The aim of this study was: (1) to present our experience with a novel technique of robot-assisted percutaneous reduction and fixation and (2) to compare it with the traditional percutaneous screw osteosynthesis (PSO) technique for the treatment of PL-depression tibial plateau fractures. The clinical data of patients with PL-depression tibial plateau fractures treated by robot-assisted percutaneous reduction and fixation technique and traditional PSO technique from January 2017 to January 2021 were retrospectively analyzed. Among them, there were 18 cases in the robot-assisted group (RA group) and 23 cases in the PSO group. All fractures were unilateral, closed and fresh PL-depression fractures of the tibial plateau. Patients in the RA group were treated by robot assisted reduction and minimally invasive absorbable screw fixation. The PSO group was treated by closed reduction and percutaneous absorbable screw osteosynthesis. The incision length, operation time, intraoperative blood loss, fluoroscopic times, inpatient time, weight training time and postoperative complications of the two groups were statistically analyzed. The Rasmussen radiological score was used to assess the reduction quality after operation while the Rasmussen functional score was used to evaluate knee joint functions at one year postoperatively. All patients were followed for at least one year. There was no significant difference in demographic information between the two groups (p > 0.05). Compared with the PSO group, the RA group showed less fluoroscopic times and better Rasmussen radiological and functional scores (p < 0.05). Besides, there was no significant difference in the incidence of postoperative complications between the two groups (p > 0.05). The novel robot-assisted percutaneous reduction and fixation technique had the characteristics of less radiation, accurate reduction and fixation. It could accelerate the rehabilitation of patients with PL-depression fractures of the tibial plateau and enable patients to obtain good joint functions.
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Affiliation(s)
- Yao Lu
- Department of Orthopedics, Hong Hui Hospitalospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - YiBo Xu
- Department of Orthopedics, Hong Hui Hospitalospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Cheng Ren
- Department of Orthopedics, Hong Hui Hospitalospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Zhong Li
- Department of Orthopedics, Hong Hui Hospitalospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Kun Zhang
- Department of Orthopedics, Hong Hui Hospitalospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Qiang Huang
- Department of Orthopedics, Hong Hui Hospitalospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
| | - Teng Ma
- Department of Orthopedics, Hong Hui Hospitalospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
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Tian W, Jia FS, Zheng JM, Jia J. Treatment of Unstable Sacral Fractures with Robotically-aided Minimally Invasive Triangular Fixation. Orthop Surg 2023; 15:3182-3192. [PMID: 37873590 PMCID: PMC10694018 DOI: 10.1111/os.13907] [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: 04/19/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE The treatment of unstable sacral fractures is huge challenge to surgeons. Robotically-aided minimally invasive triangular fixation (RoboTFX) is the most advanced technique up to now. This study is to evaluate the clinical outcomes of unstable sacral fractures treated with RoboTFX. METHODS From March 2017 to October 2021, 48 consecutive patients with unstable sacral fractures were included in the study. All patients received surgical treatment with triangular fixation (TFX). Patients were divided into four groups according to the number of fractures (uni- or bilateral) and surgical method employed (RoboTFX or traditional open TFX). Between these four groups, clinical data on operation time, intraoperative bleeding, intraoperative fluoroscopy time, infection rate, fracture healing rates, insertion accuracy, Majeed pelvic outcome score, Mears' criterion, and Gibbons score were compared. Quantitative data were expressed as mean ± standard deviation and compared using Student's t-test. Categorical variable were compared using the Pearson's χ2 test. RESULTS Comparing unilateral RoboTFX versus open TFX, neither fracture healing rate, infection rate, Majeed pelvic outcome score, Mears' radiological evaluation criterion, nor Gibbons score of the two groups were statistically significantly different (p > 0.05). However, operation time, intraoperative bleeding, intraoperative fluoroscopy time, and insertion accuracy in the RoboTFX group were all significantly better than those of the traditional open group (p < 0.05). Likewise, operation time, intraoperative bleeding, intraoperative fluoroscopy time, and accuracy of fixation insertion of the bilateral RoboTFX group were significantly better than those of the bilateral open group (p < 0.05). Meanwhile infection rate, fracture healing rate, Majeed score, Mears' criterion, and Gibbons score of two groups were not significantly different (p > 0.05). CONCLUSION RoboTFX has the advantages of less operation time, less intraoperative bleeding and fluoroscopy, more accurate fixation insertion, and a higher healing rate compared to traditional open methods in the treatment of unstable sacral fractures. However, RoboTFX requires a few critical considerations, and the indications of its operation should be strictly evaluated.
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Affiliation(s)
- Wei Tian
- Department of Orthopaedic Trauma, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Feng-Shuang Jia
- Department of Orthopaedic Trauma 2nd, Third People's Hospital of Jinan City, Jinan, China
| | - Jia-Ming Zheng
- Academy of Clinical Medicine, West China Medical School, Sichuan University, Chengdu, China
| | - Jian Jia
- Department of Orthopaedic Trauma, Tianjin Hospital, Tianjin University, Tianjin, China
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Liu ZJ, Gu Y, Jia J. Robotic guidance for percutaneous placement of triangular osteosynthesis in vertically unstable sacrum fractures: a single-center retrospective study. J Orthop Surg Res 2023; 18:8. [PMID: 36597117 PMCID: PMC9811800 DOI: 10.1186/s13018-022-03489-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To evaluate the effectiveness and safety of robot-aided percutaneous triangular osteosynthesis combined with close reduction for vertically unstable sacrum fractures (VUSFs). METHODS The data on 21 patients of the VUSF were retrospectively analyzed from November 2016 to January 2021. According to Denis classification, there were 3 cases in zone I, 11 cases in zone II, and 7 case in zone III. The main perioperative indicators were recorded. The maximal angulation and displacement deviations of the screws were analyzed by comparing the planned trajectory with the actual position. Postoperative X-ray radiographs and CT scans were obtained for evaluating the reduction quality. Functional outcome was scored with Majeed criterion. RESULTS Fourteen patients of the unilateral VUSF and 7 patients of the bilateral VUSF underwent unilateral and bilateral triangular osteosynthesis with robotic assistance, respectively. No intraoperative neurovascular injuries and postoperative infection occurred. All patients were followed up for at least 12 months. The average operation time of posterior pelvic ring was 111.4 min, with the mean intraoperative bleeding of 110.5 ml. A total of 58 pedicle and iliosacral screws were implanted with robotic assistance. Of those, 52 screws were in the cancellous bone except 4 pedicle and 2 iliosacral screws cutting the cortical bone. The angulation and displacement deviations of the screws were 4.2° ± 2.5° and 1.7 ± 0.9 mm, respectively. The average displacement of the sacral fracture was reduced from 19.7 mm preoperatively to 3.1 mm postoperatively. According to Matta's criterion, the reduction quality was graded as "excellent" in 13 patients and "good" in 8. All sacral fractures healed within 6 months except one fracture with nonunion. The mean Majeed score at the last follow-up was 89.6. CONCLUSIONS Robot-aided triangular osteosynthesis combined with close reduction provide a safe and reliable option for percutaneous treatment of the fresh VUSF, with a high accuracy of iliosacral and pedicle screw implantation except insertion of iliac screws. Meanwhile, the technique may help to reduce incision-related complications.
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Affiliation(s)
- Zhao-Jie Liu
- grid.417028.80000 0004 1799 2608Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211 China
| | - Ya Gu
- grid.417028.80000 0004 1799 2608Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211 China
| | - Jian Jia
- grid.417028.80000 0004 1799 2608Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211 China
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Sun N, Liu Y, Yan H, Zhang Z, Li Y, Zeng C. Recent Progress in the Classification and Operation of Sacral Fractures. Emerg Med Int 2023; 2023:2795722. [PMID: 36950069 PMCID: PMC10024997 DOI: 10.1155/2023/2795722] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/31/2023] [Accepted: 02/17/2023] [Indexed: 03/14/2023] Open
Abstract
Most sacral fractures are caused by high-energy, violent injuries, often accompanied by lumbosacral plexus injuries, which can cause instability of the posterior pelvic ring or lumbosacral junction in severe cases. Currently, the most commonly used clinical classification methods are Denis classification, Tile classification, Isler classification, and Denis II classification. In recent years, lumbosacral vertebral injury classification and injury degree scoring systems have often been applied clinically as the choice of treatment methods. At present, the internal fixation and implantation methods of sacral fracture are developing in the direction of positive, efficient, safe, and minimally invasive. But different fixation methods have their own indications, which should be strictly followed. This article reviews the classification of sacral fractures and the latest progress in surgical treatment.
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Affiliation(s)
- Nian Sun
- 1Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- 2Orthopaedic Hospital of Guangdong Province, Guangzhou, China
| | - Yijun Liu
- 1Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- 2Orthopaedic Hospital of Guangdong Province, Guangzhou, China
| | - Haohan Yan
- 1Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- 2Orthopaedic Hospital of Guangdong Province, Guangzhou, China
| | - Zhiqiang Zhang
- 1Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- 2Orthopaedic Hospital of Guangdong Province, Guangzhou, China
| | - Yanbing Li
- 3National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510000, China
| | - Canjun Zeng
- 1Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- 2Orthopaedic Hospital of Guangdong Province, Guangzhou, China
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Liu ZJ, Gu Y, Jia J. Comparative retrospective study of triangular osteosynthesis with and without robotic assistance for unilateral unstable sacral fractures combined with lumbosacral junction injuries. BMC Surg 2022; 22:430. [PMID: 36527080 PMCID: PMC9756517 DOI: 10.1186/s12893-022-01857-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To compare the clinical efficacy of unilateral unstable sacral fractures (USFs) involving the lumbosacral region treated with and without robot-aided triangular osteosynthesis (TOS). METHODS Patients of the unilateral USF combined with the ipsilateral lumbosacral junction injury (LSJI) treated with TOS were retrospectively analyzed and divided into two groups: the robot group (TOS with robotic assistance) and the conventional group (TOS with open procedure). Screw placement was assessed using the modified Gras criterion. Patients were followed up with routine visits for clinical and radiographic examinations. At the final follow-up, clinical outcomes were recorded and scored using the Majeed scoring system. RESULTS Eleven patients in the robot group and seventeen patients in the conventional group were recruited into this study. Significant differences in surgical bleeding (P < 0.001) and fluoroscopy time (P = 0.002) were noted between the two groups. Operation time (P = 0.027) and fracture healing time (P = 0.041) was shorter in the robot group. There was no difference in postoperative residual displacement between the two groups (P = 0.971). According to the modified Gras criterion, the percentages of grade I for sacroiliac screws in the two groups were 90.9% (10/11) and 70.6% (12/17), and for pedicle screws were 100% (11/11) and 100% (17/17), respectively. The rate of incision-related complications was 0% (0/11) in the robot group and 11.8% (2/17) in the conventional group. Statistical differences were shown on the Majeed criterion (P = 0.039), with higher scores in the robot group. CONCLUSION TOS with robotic assistance for the treatment of unilateral USFs combined with ipsilateral LSJIs is safe and feasible, with the advantages of less radiation exposure and fewer incision-related complications.
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Affiliation(s)
- Zhao-Jie Liu
- grid.417028.80000 0004 1799 2608Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211 China
| | - Ya Gu
- grid.417028.80000 0004 1799 2608Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211 China
| | - Jian Jia
- grid.417028.80000 0004 1799 2608Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211 China
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Wu C, Zeng B, Deng J, Qin B, Shen D, Wang X, Hu H, Huang L, Liu X, Qiu G. Finite Element Analysis and Transiliac-Transsacral Screw Fixation for Posterior Pelvic Ring with Sacrum Dysplasia. Orthop Surg 2022; 15:337-346. [PMID: 36424734 PMCID: PMC9837241 DOI: 10.1111/os.13585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 09/23/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Posterior pelvic ring sacroiliac screws are preferred by clinicians for their good biomechanical performance. However, there are few studies on mechanical analysis and intraoperative screw insertion of the dysplastic sacrum and sacroiliac screw. This study investigated the biomechanical performance of oblique sacroiliac screws (OSS) in S1 combined with transiliac-transsacral screws (TTSs) in S2 for pelvic fracture or sacroiliac dislocation with dysplastic sacrum and evaluated the safety of screw placement assisted by the navigation template. METHODS Six models were established, including one OSS fixation in the S2 segment, one transverse sacroiliac screw (TSS) fixation in the S2 segment, one TTS fixation in the S2 segment, one OSS fixation in the S1 and S2 segments, one OSS fixation in the S1 segment and one TSS fixation in the S2 segment, one OSS fixation in the S1 segment and one TTS fixation in the S2 segment. Then, finite element analysis (FEA) was performed. Twelve dysplastic sacrum patients with pelvis fracture or sacroiliac dislocation underwent OSS insertion in the S1 combined with TTS insertion in the S2 under the assistance of the patient-specific locked navigation template. Grading and Matta scores were evaluated after surgery. RESULTS In the one-screw fixation group, the vertical displacements of the sacrum surface of S2 OSS, S2 TSS and S2 TTS were 1.23, 1.42, and 1.22 mm, respectively, and the maximum stress of screw were 139.45 MPa, 144.81 MPa, 126.14 MPa, respectively. In the two-screw fixation group, the vertical displacements of the sacrum surface of the S1 OSS + S2 OSS, S1 OSS + S2 TSS and S1 OSS + S2 TTS were 0.91, 1.06, and 0.75 mm, respectively, and the maximum stress of screw were 149.26 MPa, 167.13 Pa, 136.76 MPa, respectively. Clinically, a total of 12 TTS and OSS were inserted under the assistance of navigation templates, with a surgical time of 55 ± 7.69 min, bleeding of 57.5 ± 18.15 ml and radiation times of 14.5 ± 4.95. One of the TTS and one of the OSS were grade 1, and the other screws were grade 0. The Matta scores of nine patients were excellent, and three patents were good. CONCLUSION OSS in the S1 combined with TTS in the S2 had the best mechanical stability in six models, and it is safe for screw insertion assisted by the patient-specific locked navigation template.
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Affiliation(s)
- Chao Wu
- Department of OrthopaedicsZigong Fourth People's HospitalZigongChina,Institute of Digital MedicineZigong Academy of Big Data for Medical Science and Artificial IntelligenceZigongChina
| | - Baifang Zeng
- Department of OrthopaedicsZigong Fourth People's HospitalZigongChina,Department of OrthopaedicsAffiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Jiayan Deng
- Institute of Digital MedicineZigong Academy of Big Data for Medical Science and Artificial IntelligenceZigongChina
| | - Binwei Qin
- Department of OrthopaedicsZigong Fourth People's HospitalZigongChina,Department of OrthopaedicsAffiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Danwei Shen
- Institute of Digital MedicineZigong Academy of Big Data for Medical Science and Artificial IntelligenceZigongChina
| | - Xiangyu Wang
- Department of OrthopaedicsZigong Fourth People's HospitalZigongChina
| | - Haigang Hu
- Department of OrthopaedicsZigong Fourth People's HospitalZigongChina
| | - Li Huang
- Operation CenterZigong Fourth People's HospitalZigongChina
| | - Xin Liu
- Health Management CenterZigong Fourth People's HospitalZigongChina
| | - Guigang Qiu
- Department of OrthopaedicsZigong Fourth People's HospitalZigongChina
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Lang Z, Han X, Fan M, Liu Y, He D, Tian W. Posterior atlantoaxial internal fixation using Harms technique assisted by 3D-based navigation robot for treatment of atlantoaxial instability. BMC Surg 2022; 22:378. [PMCID: PMC9636711 DOI: 10.1186/s12893-022-01826-2] [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: 09/05/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background To evaluate the accuracy of screw placement using the TiRobot surgical robot in the Harms procedure and to assess the clinical outcomes of this technique. Methods This retrospective study included 21 patients with atlantoaxial instability treated by posterior atlantoaxial internal fixation (Harms procedure) using the TiRobot surgical robot between March 2016 and June 2021. The precision of screw placement, perioperative parameters and clinical outcomes were recorded. Screw placement was assessed based on intraoperative guiding pin accuracy measurements on intraoperative C-arm cone-beam computed tomography (CT) images using overlay technology and the incidence of screw encroachment identified on CT images. Results Among the 21 patients, the mean age was 44.8 years, and the causes of atlantoaxial instability were os odontoideum (n = 11), rheumatoid arthritis (n = 2), unknown pathogenesis (n = 3), and type II odontoid fracture (n = 5). A total of 82 screws were inserted with robotic assistance. From intraoperative guiding pin accuracy measurements, the average translational and angular deviations were 1.52 ± 0.35 mm (range 1.14–2.25 mm) and 2.25° ± 0.45° (range 1.73°–3.20º), respectively. Screw placement was graded as A for 80.5% of screws, B for 15.9%, and C for 3.7%. No complications related to screw misplacement were observed. After the 1-year follow-up, all patients with a neurological deficit experienced neurological improvement based on Nurick Myelopathy Scale scores, and all patients with preoperative neck pain reported improvement based on Visual Analog Scale scores. Conclusions Posterior atlantoaxial internal fixation using the Harms technique assisted by a 3D-based navigation robot is safe, accurate, and effective for treating atlantoaxial instability.
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Affiliation(s)
- Zhao Lang
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
| | - Xiaoguang Han
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
| | - Mingxing Fan
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
| | - Yajun Liu
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
| | - Da He
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
| | - Wei Tian
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
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Liu ZJ, Gu Y, Jia J. The Kocher-Langenbeck approach combined with robot-aided percutaneous anterior column screw fixation for transverse-oriented acetabular fractures: a retrospective study. BMC Musculoskelet Disord 2022; 23:345. [PMID: 35410204 PMCID: PMC8996653 DOI: 10.1186/s12891-022-05313-w] [Citation(s) in RCA: 1] [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: 09/18/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Transverse-oriented acetabular fractures (TOAFs), including transverse, transverse with posterior wall and T-shaped fractures, are always challenging for double-column reduction and fixation with minimally invasive method. The purpose of this study is to compare the therapeutic effects of robot-aided percutaneous anterior column screw fixation versus minimally invasive anterior plate fixation for TOAFs based on the Kocher-Langenbeck (K-L) approach. Methods Patients suffering TOAFs that were fixed by robot-aided percutaneous anterior column screw fixation or minimally invasive anterior plate fixation associated with posterior fixation via the K-L approach were divided into two groups: group A (screw fixation) and group B (plate fixation). Surgical time, blood loss, incision length for anterior fixation and complications were recorded. Fracture reduction quality was evaluated using criteria described by Matta. Fracture healing was assessed on the series of pelvic radiographs at each follow-up. Functional outcomes were investigated using the modified Postel Merle D’Aubigne score at the final follow-up. Results Twenty-nine patients with TOAFs, including 12 patients in group A and 17 patients in group B, were evaluated for study eligibility. The mean surgical time of anterior fracture fixation was 18.7 ± 4.6 min in group A and 33.4 ± 5.0 min in group B (P < 0.001). The amount of intraoperative blood loss was 615.6 ± 178.7 ml in group A and 719.3 ± 199.0 ml in group B (P < 0.001). Incision length for anterior fixation was 9.0 ± 1.8 mm in group A and 81.2 ± 7.3 mm in group B (P < 0.001). The complications related to the surgery of anterior column only occurred in group B (lateral femoral cutaneous nerve palsy in 1 patient and groin discomfort in 1 patient). No significant differences in reduction quality, hospital stay, fracture healing time and functional results were noted between the two groups. Conclusion The K-L approach combined with robot-aided anterior column screw fixation is a safe and effective option for TOAFs. Compared with minimally invasive anterior plate fixation, robot-aided screw fixation has obvious advantages on surgical time, blood loss, and invasiveness. The K-L approach combined with minimally invasive anterior plate fixation can also be a reliable alternative for TOAFs, with the similar reduction quality and functional results.
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Affiliation(s)
- Zhao-Jie Liu
- Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211, China
| | - Ya Gu
- Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211, China
| | - Jian Jia
- Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211, China.
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Patel S, Ghosh A, Jindal K, Kumar V, Aggarwal S, Kumar P. Spinopelvic fixation for vertically unstable AO type C pelvic fractures and sacral fractures with spinopelvic dissociation- A systematic review and pooled analysis involving 479 patients. J Orthop 2022; 29:75-85. [PMID: 35241881 PMCID: PMC8858730 DOI: 10.1016/j.jor.2022.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Posterior pelvic ring injuries can be fixed using iliosacral screws, plates or bars. Another promising modality is spinopelvic fixation or triangular osteosynthesis, indicated in vertical instability and sacral fractures associated with spinopelvic dissociation. QUESTION/PURPOSE This systematic review and pooled analysis was conducted to analyze the outcomes (functional and radiological) of the use of spinopelvic fixation, as well as assess the associated complications and neurological recovery. METHODS A systematic review of literature was performed from the PubMed/Medline, EMBASE and the SCOPUS databases. All studies reporting on spinopelvic fixations, with a minimum follow up of 1 year were included in the review. Pooled analysis was done for the outcome and complication rates. The MINORS Tool was used for assessing the risk of bias. RESULTS A total of 22 studies were included with average follow-up between 12 and 86.4 months. There were 7 prospective and 15 retrospective case series. The functional outcomes were excellent/good in 90% cases, across 8 studies (95% CI 84-95%); radiological outcomes were excellent/good in 97% cases (95% CI 94-100%) across 5 studies. The most commonly reported complications were hardware prominence in 21.3% (95% CI 11.6,30.9%) and infections in 7.2% cases (95% CI 4.8,9.5%). 73% of the patients reported partial or complete improvement in their neurological condition. CONCLUSION Spinopelvic fixation is an effective method in vertical instability of the pelvis and sacral fractures with spinopelvic dissociations, with good to excellent radiological and functional outcomes. However, adequate precautions are needed to avoid infections and wound complications.
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