Zhao Y, Jiang C Q, Sun T, Xin D J, Wang Z H, Wang D, Zhang S D
Department of Orthopedics, Yantai Shan Hospital, Yantai 264008, China.
Zhonghua Yi Xue Za Zhi. 2018 Nov 6;98(41):3309-3314. doi: 10.3760/cma.j.issn.0376-2491.2018.41.003.
To introduce a robot-assisted modified method of sacroiliac screw path planning in order to reduce the incidence of screw misplacement. The study involved 13 patients suffering from posterior pelvic injuries treated by percutaneous sacroiliac screw in Yantai Shan Hospital from August 2016 to May 2018. The patients included 9 males and 4 females, aged from 18 to 70 years (mean age 46.2 years). Causes of injury were traffic accidents (=7), crushing injury (=4) and fall from height (=2). According to AO classification, 8 cases were classified with type B fractures (3 with type B1 and 5 with type B2), and 5 cases with type C fractures (2 with type C1, 1 with type C2, 2 with type C3). All the patients were treated by robot-assisted percutaneous sacroiliac screws (AO cannulated screws with a diameter of 7.3 mm) with an improved method of screw path planning. The screw placement time, blood loss, postoperative neurological, vascular and visceral function etc were observed. X-ray and CT were checked in the follow-up after the operation. Visual analogue scale (VAS) score was used to assess the pain degree of patients one week after the surgery. All the sacroiliac screws were successfully implanted once with the robot-assisted improved method of screw path planning. The mean placement time of single screw was 15.9 min and the mean blood loss for single screw placement was less than 1 ml. No clinical manifestations of injuries of blood vessels, internal organs and lumbosacral nerve was found after the operation. The postoperative X-ray films and CT showed that none of the sacroiliac screws wore out the sacral body or the sacral wing's frontal cortex. Also, it was found that none of the sacroiliac screws strayed into the sacral canal and the intervertebral space. The mean VAS score decreased from preoperative 6.9 (4-10) to postoperative 1.8(0-3). The robot-assisted improved method of screw path planning contributes to safe and accurate sacroiliac screw placement.
介绍一种机器人辅助改良的骶髂螺钉路径规划方法，以降低螺钉误置的发生率。本研究纳入了2016年8月至2018年5月在烟台山医院接受经皮骶髂螺钉治疗的13例骨盆后部损伤患者。患者包括9例男性和4例女性，年龄18至70岁（平均年龄46.2岁）。受伤原因包括交通事故（7例）、挤压伤（4例）和高处坠落（2例）。根据AO分类，8例为B型骨折（B1型3例，B2型5例），5例为C型骨折（C1型2例，C2型1例，C3型2例）。所有患者均采用机器人辅助经皮骶髂螺钉（直径7.3 mm的AO空心螺钉）及改良的螺钉路径规划方法进行治疗。观察螺钉置入时间、出血量、术后神经、血管及内脏功能等情况。术后随访行X线和CT检查。采用视觉模拟评分（VAS）评估患者术后1周的疼痛程度。采用机器人辅助改良的螺钉路径规划方法，所有骶髂螺钉均一次成功置入。单枚螺钉平均置入时间为15.9分钟，单枚螺钉置入平均出血量少于1 ml。术后未发现血管、内脏及腰骶神经损伤的临床表现。术后X线片和CT显示，无一例骶髂螺钉穿出骶骨体或骶骨翼前皮质。此外，发现无一例骶髂螺钉误入骶管和椎间隙。VAS评分均值从术前的6.9（4 - 10）降至术后的1.8（0 - 3）。机器人辅助改良的螺钉路径规划方法有助于安全、准确地置入骶髂螺钉。
