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Liang M, Zhang X, Liu H, Gao R, Guo D, Yao Z. Robot-assisted Temporary Hemiepiphysiodesis With Eight-plates for Lower Extremity Deformities in Children. J Pediatr Orthop 2024; 44:260-266. [PMID: 38312109 DOI: 10.1097/bpo.0000000000002631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
PURPOSE This study was performed to compare the radiographic results of robot-assisted and traditional methods of treating lower extremity deformities (LEDs). METHODS From January 2019 to February 2022, 55 patients with LEDs were treated by temporary hemiepiphysiodesis with eight-plates. They were divided into a robot group and a freehand group. The fluoroscopy time and operation time were recorded. The accuracy of screw placement was measured after the operation using the following parameters: coronal entering point (CEP), sagittal entering point (SEP), and angle between the screw and epiphyseal plate (ASEP). The limb length discrepancy (LLD) and femorotibial angle (FTA) were measured before the operation, after the operation, and at the last follow-up. Patients were followed up for 12 to 24 months, and the radiographic results of the 2 groups were compared. RESULTS Among the 55 patients with LEDs, 36 had LLD and 19 had angular deformities. Seventy-six screws were placed in the robot group and 85 in the freehand group. There was no difference in the CEP between the 2 groups ( P >0.05). The robot group had a better SEP (2.96±1.60 vs. 6.47±2.80 mm) and ASEP (3.46°±1.58° vs. 6.92°±3.92°) than the freehand group ( P <0.001). At the last follow-up, there was no difference in the LLD or FTA improvement between the two groups ( P >0.05). The incidence of complications was significantly lower in the robot group than in the freehand group (0/27 vs. 5/28, P <0.05). CONCLUSION Robot-assisted temporary hemiepiphysiodesis with eight-plates is a safe and effective method for treating LEDs in children. Robotic placement of screws is superior to freehand placement with respect to the entering position and direction. Although the correction effect for LLD and angular deformity is similar, screw dislocation is less common when using robot assistance. LEVELS OF EVIDENCE Level-III. Retrospective comparative study.
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Affiliation(s)
- Mingqian Liang
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Li Y, Wang Y, Dong B, Yang P, Sun Y, Zhou L, Shen J, Ma X, Ma J. Comparison of rehabilitation outcomes between robot-assisted and freehand screw placement in treatment of femoral neck fractures: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:208. [PMID: 38459524 PMCID: PMC10921808 DOI: 10.1186/s12891-024-07325-0] [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: 10/24/2023] [Accepted: 02/29/2024] [Indexed: 03/10/2024] Open
Abstract
PURPOSE To compare the postoperative rehabilitation of femoral neck fractures treated with robot-assisted nailing and freehand nailing. METHODS We systematically searched the PubMed, EMBASE, Cochrane, China National Knowledge Infrastructure(CNKI), WanFang database, China Science and Technology Journal Database (VIP) and Web of Science databases to identify potentially eligible articles. Indispensable data such as the year of publication, country, study type, robot type, age, number of patients, sex distribution, study design, and outcome indicators were extracted. The outcome indicators of interest included healing rate, length of healing time, Harris score, operation time, frequency of X-ray fluoroscopy, frequency of guide pin insertion, and intraoperative blood loss. RevMan 5.4.1 was used for the meta-analysis. RESULTS Fourteen studies with 908 participants were included in this meta-analysis. The results showed that in terms of healing rate (SMD = 2.75, 95% CI, 1.03 to 7.32, P = 0.04) and Harris score (SMD = 2.27, 95% CI, 0.79 to 3.75, P = 0.003), robot-assisted screw placement technique scores were higher than the traditional freehand technique. Additionally, operative time (SMD = -12.72, 95% CI, -19.74 to -5.70, P = 0.0004), healing time (SMD = -13.63, 95% CI, -20.18 to -7.08, P < 0.0001), frequency of X-ray fluoroscopy (SMD = - 13.64, 95% CI, - 18.32 to - 8.95, P < 0.00001), frequency of guide pin insertion (SMD = - 7.95, 95% CI, - 10.13 to - 5.76, P < 0.00001), and intraoperative blood loss (SMD = - 17.33, 95% CI, - 23.66 to - 11.00, P < 0.00001) were lower for patients who underwent robotic-assisted screw placement than those for patients who underwent the conventional freehand technique. CONCLUSION Compared to the freehand nailing technique, robot-assisted nailing helps improve postoperative healing rates in patients with femoral neck fractures; shortens healing times; better restores hip function; reduces the number of intraoperative fluoroscopies, guides pin placements; reduces intraoperative bleeding; and increases perioperative safety.
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Affiliation(s)
- Yiyang Li
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Yan Wang
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Benchao Dong
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Peichuan Yang
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Yadi Sun
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Liyun Zhou
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Jiahui Shen
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China
| | - Xinlong Ma
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China.
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China.
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China.
| | - Jianxiong Ma
- Tianjin Hospital of Tianjin University, Tianjin, 300211, People's Republic of China.
- Tianjin Orthopedic Institute, Tianjin, 300211, People's Republic of China.
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300211, People's Republic of China.
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Accuracy and digital screw path design of TiRobot-assisted pedicle screw placement for lumbar spondylolisthesis. INTERNATIONAL ORTHOPAEDICS 2023; 47:309-317. [PMID: 36331595 DOI: 10.1007/s00264-022-05615-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To investigate lumbar spondylolisthesis screw placement assisted by TiRobot in terms of digital screw path design, accurate implementation, and accuracy evaluation method. METHODS In this study, we enrolled 40 patients with lumbar spondylolisthesis between December 2020 and August 2021 who underwent spine surgery at the Affiliated Hospital of PuTian University. Pre-operative computed tomography position and screw path designation, intra-operative pedicle screw placement according to pre-operative planning, and post-operative evaluation of the accuracy of screw placement were performed. 3D coordinates of the entry and exit points before and after the operation were collected. The qualified points at different levels of accuracy were counted. The screw placement accuracy was based on the absolute difference using the Chi-squared test. RESULTS In total, 194 screws were successfully implanted with no screws penetrating the cortex. The absolute difference of entry points X, Y, and Z coordinates before and after the operation was 0.425 ± 0.294 mm, 0.417 ± 0.310 mm, and 0.466 ± 0.327 mm, respectively. The corresponding values in terms of exit points were 0.702 ± 0.470 mm, 0.963 ± 0.595mm, and 0.983 ± 0.566 mm, respectively. No obvious differences in coordinates before and after the operation were observed with an entry point degree of accuracy of ≥ 1.2 mm and exit point degree of accuracy of ≥ 2.1 mm. Therefore, the real surgery was consistent with the design. CONCLUSIONS TiRobot-assisted lumbar spondylolisthesis surgery achieved optimal path designation and precise surgery.
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Yang Z, Sheng B, Liu D, Wang Y, Liu C, Xiao R. Sacroiliac screws fixation navigated with three-dimensional printing personalized guide template for the treatment of posterior pelvic ring injury: A case report. Front Surg 2023; 9:1025650. [PMID: 36684191 PMCID: PMC9852618 DOI: 10.3389/fsurg.2022.1025650] [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: 08/23/2022] [Accepted: 11/25/2022] [Indexed: 01/09/2023] Open
Abstract
Objective Pelvic injuries refer to the disruption of the inherent structural and mechanical integrity of the pelvic ring. Sacroiliac screw fixation technique is often used for the treatment of posterior pelvic ring injury, which is prone to the iatrogenic injury. Various attempts were proposed to avoid iatrogenic injuries, while the executing processes are usually too cumbersome. The patient-personalized guide template based on 3D printing technology has been considered as a promising method, which can achieve lower deviation and higher accuracy in a simple and convenient way. We reported the first case of posterior pelvic ring injury using 3D printing personalized guide template with the verification of intraoperative CT. Methods The subject was a 74-year-old female with posterior pelvic ring injury. Two patient-specific guide templates were customized based on 3D printing technology, one for S1 and the other for S2. We used the guide templates for navigation to place the sacroiliac screws. The placement of screws was verified by intraoperative CT. Intraoperative and postoperative variables were collected. Results The technique helped us successfully insert the sacroiliac screws into the safe zone. The intraoperative blood loss was 23.03 ml, and the duration of operation was 62 min. The exposure dose during CT scanning was 7.025 mSv. The assessment of screws position was excellent. Furthermore, there was no sign of any functional impairment postoperatively. Conclusion Sacroiliac screws fixation with the assistance of 3D printing personalized guide template under the verification of intraoperative CT may be a promising method to treat posterior pelvic ring injuries.
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Affiliation(s)
- Zhanyu Yang
- Department of Orthopedics, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, China,Department of Orthopedics, Hunan Emergency Center, Changsha, China
| | - Bin Sheng
- Department of Orthopedics, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, China,Department of Orthopedics, Hunan Emergency Center, Changsha, China,Correspondence: Bin Sheng
| | - Delong Liu
- Department of Orthopedics, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, China,Department of Orthopedics, Hunan Emergency Center, Changsha, China
| | - Yiwei Wang
- Department of Orthopedics, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Chao Liu
- Department of Orthopedics, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Rui Xiao
- Department of Orthopedics, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, China
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Al-Naseem A, Sallam A, Gonnah A, Masoud O, Abd-El-Barr MM, Aleem IS. Robot-assisted versus conventional percutaneous sacroiliac screw fixation for posterior pelvic ring injuries: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:9-20. [PMID: 34842991 DOI: 10.1007/s00590-021-03167-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/15/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Robot-assisted pelvic screw fixation is a new technology with promising benefits on intraoperative outcomes for patients with posterior pelvic ring injuries. We aim to compare robot-assisted pelvic screw fixation to the traditional fluoroscopy-assisted technique with regards to intraoperative and postoperative outcomes. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used along with a search of electronic information to identify all studies comparing the outcomes of robot-assisted versus conventional screw fixation in patients with posterior pelvic ring injuries. Primary outcomes included operative duration (minutes), intraoperative bleeding (mL), fluoroscopy exposure and intraoperative drilling frequency. Secondary outcome measures included Majeed score, healing time (minutes) and rate (%), postoperative complications, screw positioning, incision length (cm) and guide wire insertion times (minutes). The random effects model was used for analysis. RESULTS Four observational studies including a total of 294 patients were identified. There was a significant difference between robot-assisted and conventional groups in terms of operative duration (MD = - 24.66, p < 0.05), intraoperative bleeding (MD = - 10.37, P < 0.05), fluoroscopy exposure (MD = - 2.15, P < 0.05) and intraoperative drilling frequency (MD = - 2.42, P = < 0.05). For secondary outcomes, no significant difference was seen in Majeed score, healing time and rate and postoperative complications. The robot-assisted group had better screw positioning, smaller incision length, and shorter anaesthesia and guide wire insertion times. CONCLUSIONS Robot-assisted fixation has superior intraoperative outcomes compared to conventional fixation. Further studies are needed to look at postoperative outcomes as there is no significant difference in postoperative prognosis between the techniques.
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Affiliation(s)
| | - Abdelrahman Sallam
- School of Medicine, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Ahmed Gonnah
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Omar Masoud
- School of Medicine, King's College London, London, UK
| | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Division of Spine, Duke University Medical Centre, Durham, USA
| | - Ilyas S Aleem
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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Zhu Z, Liao F. Optimal position and apex-subchondral bone distance of cannulated screws for internal fixation of femoral neck fracture: A radiological study. J Orthop Res 2022. [PMID: 36495052 DOI: 10.1002/jor.25503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
To determine the optimal position of three cannulated screws in an inverted triangle pattern for internal fixation of femoral neck fractures, including the apex-subchondral bone distance, computed tomography (CT) images of the hip were processed using the MIMICS (Materialize Interactive Medical Image Control System) Research software. Points adjacent to the inferior, anterosuperior, and posterior cortex of the femoral neck were selected on the axial view. Subsequently, the positions of these points were adjusted to maximize the area between them, and splines were drawn in the coronal and sagittal planes to represent the cannulated screws. Finally, the virtual anteroposterior and lateral fluoroscopy images of the proximal femur and splines were created and the parameters calculated. Finite element analysis showed this fixation scheme provides stronger fracture support and stability. Twenty patients with femoral neck fractures (Modified group), with the area and perimeter of the triangle formed on axial postoperative CT images, including the shortest distance from the tip of the screw to the subchondral bone was compared with 23 matched patients for whom the conventional inverted isosceles triangle configuration of screws for internal fixation was used (Conventional group). The area and perimeter of the stabilization screws were larger, with a shorter apex-subchondral bone distance for the Modified group. There was no incidence of screw penetration in the femoral neck or head in either group, and all fractures healed within a follow-up period of 10 months. The modified screw placement method is simple and safe and provides greater fracture stability than the conventional empirical method of fixation.
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Affiliation(s)
- Zongdong Zhu
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Feng Liao
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Li H, Zhuang T, Wu W, Gan W, Wu C, Peng S, Huan S, Liu N. A systematic review on the cost-effectiveness of the computer-assisted orthopedic system. HEALTH CARE SCIENCE 2022; 1:173-185. [PMID: 38938554 PMCID: PMC11080830 DOI: 10.1002/hcs2.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/30/2022] [Accepted: 09/14/2022] [Indexed: 06/29/2024]
Abstract
Computer-assisted orthopedic system (CAOS) is rapidly gaining popularity in the field of precision medicine. However, the cost-effectiveness of CAOS has not been well clarified. We performed this review to summarize and assess the cost-effectiveness analyses (CEAs) with regard to CAOS. Publications on CEA in CAOS have been searched in PubMed and CEA Registry up to May 31, 2022. The Quality of Health Economic Studies (QHES) instrument was used to estimate the quality of studies. Relationships between qualities and potential factors were also examined. There were 15 eligible studies in the present review. Twelve studies evaluated CAOS joint arthroplasties and found that CAOS joint arthroplasties were cost-effective compared to manual methods. Three studies focused on spinal surgery, two of which analyzed the cost-effectiveness of CAOS for patients after spinal fusion, with conflicting results. One study demonstrated that CAOS was cost-effective in spinal pedicle screw insertion. The mean QHES score of CEAs included was 86.1. The potential factors had no significant relationship with the quality of studies. Based on available studies, our review reflected that CAOS was cost-effective in the field of joint arthroplasty. While in spinal surgery, the answer was unclear. Current CEAs represent high qualities, and more CEAs are required in the different disciplines of orthopedics where CAOS is employed.
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Affiliation(s)
- Hua Li
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Tengfeng Zhuang
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Wenrui Wu
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Wenyi Gan
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Chongjie Wu
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Sijun Peng
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Songwei Huan
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Ning Liu
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
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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. [DOI: 10.1002/hsr2.930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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
Affiliation(s)
- Ding Xu
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
- Department of Surgery Ningbo University Medical College Ningbo China
| | - Weigang Lou
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
| | - Ming Li
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
| | - Jingwei Xiao
- Department of Surgery Ningbo University Medical College Ningbo China
| | - Hongbao Wu
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
| | - Jianming Chen
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
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Xia G, Liu W, Bai H, Xue Y, Dai Y, Lei P, Zhang J. Surgical Tool Handle Vibration-Based Drilling State Recognition During Hip Fracture Fixation. Orthop Surg 2022; 14:2964-2978. [PMID: 36177881 PMCID: PMC9627077 DOI: 10.1111/os.13507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/10/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Traditional manual drilling during hip fracture fixation can easily lead to unstable fixation and vascular damage. This study aimed to investigate a safe and easy‐to‐use robot‐assisted method to automatically drill bone and distinguish critical bone drilling states with high accuracy in real‐time for the bone hole‐making process during hip fracture fixation. Methods A bone‐drilling robotic system was designed to automatically create holes in the femoral neck. Four fresh pig femurs were drilled at the posterosuperior femoral neck using three modes: “all‐in” (AI), “in‐out‐in” (IOI), and “percutaneous fixation” (PF). A high‐frequency accelerometer captured the generated vibrations of the drill handle, which were then transferred to a personal computer using a data acquisition card. Five bone drilling states are defined, including: “drill idling,” “initial drilling,” “in the cancellous bone,” “out the femoral neck,” and “in the cortical bone.” The harmonic distribution of the vibration signal was extracted by fast Fourier transform (FFT) and used as a critical feature to identify different drilling states. To prove the difference in the harmonic distribution at different drilling states, an independent sample t‐test was used to compare the percentage of the first harmonic amplitude in the first 10 harmonics at each drilling state. A neural network classifier was trained with the frequency spectrum as the input and the drilled state as the output to distinguish the critical bone drilling states with high accuracy in real‐time. The classifier was trained and tested on four specimens to ensure that the surgical robot could accurately identify the five drilling states. Results In each specimen, the harmonic distributions of the drilling vibration at different drilling modes were significantly different (p < 0.05). The average recognition accuracies of the drilling state for the four specimens were all higher than 84%. The three defined modes were distinguished with extremely high accuracies. The recognition accuracies of “in the cancellous bone” for specimens 1 to 4 were 83.2%, 84.8%, 92.9%, and 84.7%. The recognition accuracies of “in out the femoral neck” from specimens 1 to 4 are 98.2%, 88.4%, 95.8%, and 88.8%. The recognition accuracies of “in the cortical bone” for specimens 1 to 4 were 94.6%, 80.8%, 95.5%, and 85.8%. Conclusions The proposed robot‐assisted method can automatically distinguish five critical bone‐drilling states with high accuracy in real‐time to avoid weak fixation and damage to the lateral epiphyseal artery.
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Affiliation(s)
- Guangming Xia
- Institute of Robotics and Automatic Information System, Tianjin, China
| | - Wei Liu
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Department of Orthopaedic Surgery, Tianjin Baodi Hospital, Tianjin, China
| | - He Bai
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Xue
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Dai
- Institute of Robotics and Automatic Information System, Tianjin, China
| | - Ping Lei
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jianxun Zhang
- Institute of Robotics and Automatic Information System, Tianjin, China
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Lin S, Wang F, Hu J, Tang LY. Comparison of the Accuracy and Safety of TiRobot-Assisted and Fluoroscopy-Assisted Percutaneous Pedicle Screw Placement for the Treatment of Thoracolumbar Fractures. Orthop Surg 2022; 14:2955-2963. [PMID: 36177873 DOI: 10.1111/os.13504] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 08/14/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Studies have compared the safety and accuracy of robot-assisted techniques for inserting conventional open pedicle screws for spinal surgery. However, no relevant studies have confirmed that robot-assisted percutaneous screw placement is better than fluoroscopic percutaneous screw placement for the treatment of thoracolumbar fractures. This study compared the accuracy and safety of TiRobot-assisted percutaneous pedicle screw placement with those of the fluoroscopy-assisted percutaneous technique for the treatment of thoracolumbar fractures. METHODS This retrospective study included 126 patients with thoracolumbar fractures who underwent percutaneous pedicle screw placement. Sixty-five patients were treated with the TiRobot-assisted technique and 61 patients were treated with the fluoroscopy-assisted technique. Patient demographics, accuracy of screw placement (according to the Gertzbein and Robbins scale of grades A to E), screw insertion angle, radiation exposure, surgical time, intraoperative blood loss, length of hospital stay, incision length, hospital expenses, surgical site infection, and neurological injury of the TiRobot-assisted and fluoroscopy-assisted groups were compared using Student's t-test, Pearson χ2 test, or Fisher's exact test. RESULTS A total of 729 screws were placed (TiRobot-assisted group: 374 screws; fluoroscopy-assisted group: 355 screws). In the TiRobot-assisted group, 82.8% of screws were optimally positioned (grade A); however, the placement grades of the remaining screws were categorized as grade B (13.3%), grade C (3.2%), and grade D (0.5%). In the fluoroscopy-assisted group, 66.7% of the screws were optimally positioned (grade A); however, the placement grades of the remaining screws were categorized as grade B (21.4%), grade C (7.6%), grade D (3.6%), and grade E (0.5%). The proportion of clinically acceptable screws (grade A or B) was greater in the TiRobot-assisted group than in the fluoroscopy-assisted group. Additionally, the TiRobot-assisted group had a significantly larger mean screw insertion angle (22.27° ± 5.48° vs 20.55° ± 5.15°), larger incision length (13.86 ± 1.24 cm vs 12.77 ± 1.43 cm), and higher hospital expenses (69061.55 ± 7166.60 yuan vs 59383.85 ± 5019.64 yuan) than the fluoroscopy-assisted group. There were no significant differences in the intraoperative blood loss, length of hospital stay, and rates of surgical site infection and neurological injury in both groups (p > 0.05). However, the TiRobot-assisted group had significantly better surgical times, radiation times, and radiation exposure than the fluoroscopy-assisted group (p < 0.05). CONCLUSIONS Percutaneous TiRobot-assisted pedicle screw placement is a safe, useful, and potentially more accurate alternative to the percutaneous fluoroscopy-assisted technique for treating thoracolumbar fractures.
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Affiliation(s)
- Shu Lin
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Fei Wang
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiang Hu
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Liu-Yi Tang
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Al-Naseem AO, Gonnah AR, Al-Ali H, Al-Naseem AO, Siddique I. Robot-Assisted Versus Conventional Freehand Fluoroscopy-Guided Percutaneous Screw Fixation in Femoral Neck Fractures: A Systematic Review and Meta-analysis. Cureus 2022; 14:e24258. [PMID: 35607578 PMCID: PMC9123337 DOI: 10.7759/cureus.24258] [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] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/05/2022] Open
Abstract
Robotic-assisted navigation for percutaneous femoral neck fracture fixation is a new technology that has shown enhanced intraoperative and postoperative outcomes compared to the conventional freehand fluoroscopy-guided technique. The authors aim to compare robot-assisted femoral neck fracture fixation to conventional freehand fluoroscopy-guided repair. Electronic databases were searched, identifying all observational studies comparing outcomes of both groups. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis were conducted. The primary outcomes included operative duration (minutes), intraoperative bleeding (mL), fluoroscopy exposure, and frequency of intraoperative drilling. The secondary outcomes included Harris scores, healing rate and time, screw accuracy, and postoperative complications. Seven observational studies were identified, enrolling 506 patients. There was a significant difference between the robot-assisted and conventional groups in terms of intraoperative blood loss (mean difference (MD) = -18.83, p ≤ 0.05), fluoroscopy exposure (MD = -1.81, p ≤ 0.05), and intraoperative drilling frequency (MD = -7.35, p < 0.05). There was no significant difference in operative duration between the groups (MD = -0.21, p = 0.66). Most secondary outcomes were improved in the robot-assisted group. Overall, robot-assisted fixation was superior in terms of safety and efficacy.
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Affiliation(s)
| | - Ahmed R Gonnah
- School of Medicine, University of Liverpool, Liverpool, GBR
| | - Hussain Al-Ali
- Orthopaedic Surgery Department, McGill University Health Centre, Quebec, CAN
| | | | - Irfan Siddique
- Department of Complex Spinal Surgery, Salford Royal National Health Services (NHS) Foundation Trust, Manchester, GBR
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高 峰, 吴 晓, 徐 锋, 钱 平, 尹 自, 高 雪. [Clinical application of new three-dimensional honeycomb guide in percutaneous cannulated screw fixation of femoral neck fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:65-70. [PMID: 35038801 PMCID: PMC8844631 DOI: 10.7507/1002-1892.202107106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/16/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To design a new type of three-dimensional honeycomb guide for percutaneous cannulated screw placement in femoral neck fracture and evaluate its effectiveness. METHODS The clinical data of 40 patients with femoral neck fracture who met the selection criteria between June 2019 and December 2020 were retrospectively analyzed. According to different intraoperative positioning methods, they were divided into control group (20 cases, free hand positioning screws) and study group (20 cases, new guide assisted positioning screws). There was no significant difference in gender, age, side, cause of injury, Garden classification, and time from injury to operation between the two groups ( P>0.05). The operation time, fluoroscopy times, guide needle puncture times, and fracture healing time of the two groups were recorded. The hip function was evaluated by Harris score at last follow-up. At immediate after operation, the following imaging indexes were used to evaluate the accuracy of screw implantation distribution: screw spacing, screw coverage area, distance from screw to cervical cortex, parallelism between screws, and screw to cervical axial deviation. RESULTS All operations were successfully completed, and the guide needle did not penetrate the femoral neck cortex. There was no significant difference in operation time and fluoroscopy times between the two groups ( P>0.05); the guide needle puncture times in the study group was significantly less than that in the control group ( t=8.209, P=0.000). Imaging detection at immediate after operation showed that the screw spacing and screw coverage area in the study group were significantly greater than those in the control group ( P<0.05); the distance from screw to cervical cortex, parallelism between screws, and screw to cervical axial deviation were significantly smaller than those in the control group ( P<0.05). All patients were followed up 7-25 months, with an average of 19.3 months. There was no significant difference in follow-up time between the two groups ( t=-0.349, P=0.729). There were 2 cases of fracture nonunion in the control group and 1 case in the study group, and the other fractures completely healed. One case of osteonecrosis of the femoral head occurred in the control group. During the follow-up, there was no complication such as vascular and nerve injury, venous thrombosis, screw penetration, withdrawal, breakage, and refracture, etc. There was no significant difference in fracture healing time and Harris score at last follow-up between the two groups ( P>0.05). CONCLUSION The new three-dimensional honeycomb guide has the advantages of simple structure and convenient use. It can reduce the puncture times of the guide needle and effectively improve the accuracy distribution of cannulated screw implantation.
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Affiliation(s)
- 峰 高
- 南京中医药大学附属昆山市中医医院骨科(江苏昆山 215300)Department of Orthopedics, Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Kunshan Jiangsu, 215300, P. R. China
| | - 晓峰 吴
- 南京中医药大学附属昆山市中医医院骨科(江苏昆山 215300)Department of Orthopedics, Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Kunshan Jiangsu, 215300, P. R. China
| | - 锋 徐
- 南京中医药大学附属昆山市中医医院骨科(江苏昆山 215300)Department of Orthopedics, Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Kunshan Jiangsu, 215300, P. R. China
| | - 平康 钱
- 南京中医药大学附属昆山市中医医院骨科(江苏昆山 215300)Department of Orthopedics, Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Kunshan Jiangsu, 215300, P. R. China
| | - 自飞 尹
- 南京中医药大学附属昆山市中医医院骨科(江苏昆山 215300)Department of Orthopedics, Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Kunshan Jiangsu, 215300, P. R. China
| | - 雪琴 高
- 南京中医药大学附属昆山市中医医院骨科(江苏昆山 215300)Department of Orthopedics, Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Kunshan Jiangsu, 215300, P. R. China
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Feng W, Yao Z, Liu H, Guo D, Zhu D, Song B, Wang Q, Zhang X. Robot-assisted cannulated compression screw internal fixation for treatment of femoral neck fracture in children: A case series of ten patients. Front Pediatr 2022; 10:1105717. [PMID: 36699299 PMCID: PMC9869125 DOI: 10.3389/fped.2022.1105717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To investigate the safety and efficacy of robot-assisted cannulated compression screw internal fixation in the treatment of femoral neck fracture in children. METHODS We retrospectively reviewed the data of ten children with femoral neck fractures treated by robot-assisted internal fixation from January 2020 to June 2021. The clinical and radiological characteristics, operation duration, and fluoroscopy frequency of robot-assisted screws placement together with the complications and function were evaluated. At the 12-month follow-up, the hip joint function was evaluated using the Ratliff classification. RESULTS Ten children, six boys and four girls, aged 4-14 years were included. There were eight type II and three type III femoral neck fractures using the Delbet classification. In the process of robot-assisted internal fixation, the median of fluoroscopy frequency was 22 times and the median of operation duration was 47 min. The median of screw parallelism was 1.33° and 0.66° on the anteroposterior and lateral x-ray films, and the median of screw distribution was 41.86% and 44.93% on the anteroposterior and lateral x-ray films, respectively. At the 12-month follow-up, there were two cases of femoral head necrosis, and fracture healing was achieved in all patients, of which eight fractures were excellent and three were good by the Ratliff function classification. DISCUSSION The application of robot-assisted cannulated compression screw internal fixation could help us achieve more safe and accurate screw placement, as well as a good treatment effect for children's femoral neck fractures. LEVEL OF EVIDENCE Level IV. retrospective case series.
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Affiliation(s)
- Wei Feng
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ziming Yao
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Haonan Liu
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Dong Guo
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Danjiang Zhu
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Baojian Song
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qiang Wang
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuejun Zhang
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Ding G, Yang G, Zhang J, Huang H, Du J, Ren S, Wang Q, Zhou Z, Zhang X, Ao Y. Feasibility and accuracy of orthopaedic surgical robot system for intraoperative navigation to locate bone tunnel in anterior cruciate ligament reconstruction. Int J Med Robot 2021; 18:e2354. [PMID: 34806824 DOI: 10.1002/rcs.2354] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The combination of navigational system and robotics has the potential to accurately identify and drill bone tunnels in anterior cruciate ligament (ACL) reconstruction. This study explores the feasibility and accuracy of bone tunnel positioning using the TiRobot, an orthopaedic surgical robot. METHODS The experiment was divided into two groups. In group A, the bone tunnels were positioned using the TiRobot surgical robot (n = 8). In group B, handheld locators were used for positioning (n = 8). RESULTS TiRobot can be used for positioning the ACL bone tunnel. The accuracy of positioning the femoral tunnel in group A and B was 1.00 ± 0.20 and 3.10 ± 0.59 mm, respectively (t = -9.49, P < 0.001). As for tibial tunnel, the accuracy was 1.02 ± 0.20 and 2.64 ± 0.14 mm, respectively (t = -18.54, P < 0.001). CONCLUSIONS The bone tunnel drilling precision using TiRobot for ACL reconstruction surgery was more accurate than traditional surgical techniques.
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Affiliation(s)
- Guocheng Ding
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Gang Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jiahao Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Hongjie Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jianing Du
- Peking University Health Science Center, Beijing, China
| | - Shuang Ren
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Qining Wang
- Department of Advanced Manufacturing and Robotics, Peking University, Beijing, China.,Institute for Artificial Intelligence, Peking University, Beijing, China
| | - Zhihao Zhou
- Department of Advanced Manufacturing and Robotics, Peking University, Beijing, China.,Institute for Artificial Intelligence, Peking University, Beijing, China
| | - Xin Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yingfang Ao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
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