Laratta Joseph L, Shillingford Jamal N, Lombardi Joseph M, Alrabaa Rami G, Benkli Barlas, Fischer Charla, Lenke Lawrence G, Lehman Ronald A
Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY, USA.
Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY, USA.
Spine Deform. 2018 Mar-Apr;6(2):130-136. doi: 10.1016/j.jspd.2017.08.009. Epub 2017 Oct 16.
Case series.
To determine the safety and feasibility of S2 alar-iliac (S2AI) screw placement under robotic guidance.
Similar to standard iliac fixation, S2AI screws aid in achieving fixation across the sacropelvic junction and decreasing S1 screw strain. Fortunately, the S2AI technique minimizes prominent instrumentation and the need for offset connectors to the fusion construct. Herein, we present an analysis of the largest series of robotic-guided S2AI screws in the literature without any significant author conflicts of interest with the robotics industry.
Twenty-three consecutive patients who underwent spinopelvic fixation with 46 S2AI screws under robotic guidance were analyzed from 2015 to 2016. Screws were placed by two senior spine surgeons, along with various fellow or resident surgical assistants, using a proprietary robotic guidance system (Renaissance; Mazor Robotics Ltd., Caesara, Israel). Screw position and accuracy was assessed on intraoperative CT O-arm scans and analyzed using three-dimensional interactive viewing and manipulation of the images.
The average caudal angle in the sagittal plane was 31.0° ± 10.0°. The average horizontal angle in the axial plane using the posterior superior iliac spine as a reference was 42.8° ± 6.6°. The average S1 screw to S2AI screw angle was 11.3° ± 9.9°. Two violations of the iliac cortex were noted, with an average breach distance of 7.9 ± 4.8 mm. One breach was posterior (2.2%) and one was anterior (2.2%). The overall robotic S2AI screw accuracy rate was 95.7%. There were no intraoperative neurologic, vascular, or visceral complications related to the placement of the S2AI screws.
Spinopelvic fixation achieved using a bone-mounted miniature robotic-guided S2AI screw insertion technique is safe and reliable. Despite two breaches, no complications related to the placement of the S2AI screws occurred in this series.
Level IV, therapeutic.
病例系列。
确定在机器人引导下S2翼髂（S2AI）螺钉置入的安全性和可行性。
与标准髂骨固定类似，S2AI螺钉有助于实现经骶髂关节固定并减轻S1螺钉的应力。幸运的是，S2AI技术最大限度地减少了突出的器械操作以及对融合结构使用偏移连接器的需求。在此，我们对文献中最大系列的机器人引导下S2AI螺钉进行分析，作者与机器人行业无任何重大利益冲突。
对2015年至2016年期间连续23例在机器人引导下使用46枚S2AI螺钉进行脊柱骨盆固定的患者进行分析。螺钉由两名资深脊柱外科医生以及不同的住院医师或实习外科助手，使用专有的机器人引导系统（Renaissance；Mazor Robotics Ltd.，凯撒拉，以色列）置入。在术中CT O型臂扫描上评估螺钉位置和准确性，并使用图像的三维交互式查看和操作进行分析。
矢状面平均尾侧角度为31.0°±10.0°。以髂后上棘为参考，轴平面平均水平角度为42.8°±6.6°。S1螺钉与S2AI螺钉的平均角度为11.3°±9.9°。发现两例髂骨皮质侵犯，平均突破距离为7.9±4.8mm。一例为后方侵犯（2.2%），一例为前方侵犯（2.2%）。机器人辅助S2AI螺钉总体准确率为95.7%。未发生与S2AI螺钉置入相关的术中神经、血管或内脏并发症。
使用骨-mounted微型机器人引导的S2AI螺钉置入技术实现脊柱骨盆固定是安全可靠的。尽管有两例突破，但本系列中未发生与S2AI螺钉置入相关的并发症。
四级，治疗性。
