Zhao Y, Jiang C Q, Sun T, Xin D J, Qu W Q, Wang Z H, Wang D, Zhang S D
Department of Orthopedics, Yantai Shan Hospital, Yantai 264008, China.
Zhonghua Yi Xue Za Zhi. 2020 Sep 22;100(35):2763-2767. doi: 10.3760/cma.j.cn112137-20200227-00488.
To evaluate the precision of the robot-assisted sacroiliac screw placement for posterior pelvis injury and the impacting factors. The clinical data of twenty-four cases of posterior pelvic fractures treated by percutaneous sacroiliac screw placement in Yantai shan Hospital from August 2016 to May 2018 were studied retrospectively. There were 17 males and 7 females with a mean age of 44.1 years (ranged from 17 to 71 years). According to AO classification, 17 cases were type B fractures (9 cases of type B1 and 8 type B2), and 7 cases were type C factures (3 cases of type C1, 2 type C2 and 2 type C3). All cases were treated by robot-assisted percutaneous sacroiliac screw placement (AO cannulated screws with a diameter of 7.3 mm). In the posterior pelvic surgeries for the 24 cases, 26 S(1) sacroiliac screws fixations and 18 S(2) sacroiliac screw fixations were placed in total, with single S(1) segmental fixation in 8 cases, single S(2) segmental fixation in 3 cases, S(1) and S(2) combined fixation in 13 cases, S(1) unidirectional one-sided fixation in 18 cases, S(1) bidirectional two-sided fixation in 3 cases, S(2) unidirectional one-sided fixation in 14 cases, S(2) bidirectional two-sided fixation in 2 cases and S(1) unidirectional double screws fixation in 2 cases. X-ray and CT examinations were taken for all 24 cases after operation. The visual analogue scale (VAS) of pain were performed before and after the operation. All the sacroiliac screws were successfully implanted at once as planned with the assistance of the robot. The postoperative X-ray films and CT showed that none of the sacroiliac screws broke through the sacral body and the contralateral sacral wing's frontal cortex nor did they stray into the sacral canal and the intervertebral space. In 3 cases, the sacroiliac screws went closely against and wore out the front edge of iliac cortical density line and sacral alar slope and finally re-entered the sacral body. In 3 cases, sacroiliac screws touched upon the sacral nerve canals but did not break through the nerve canals. The mean VAS of pain was improved from 7.1 points (4-10 points) before the operation to 1.9 points (0-3 points) after. The robot-assisted sacroiliac screw placement shows high precision, and hence is worthy of clinical promotion; however the primary role of the surgeon could not be replaced.
评估机器人辅助骶髂螺钉置入治疗骨盆后环损伤的精度及影响因素。回顾性分析2016年8月至2018年5月在烟台山医院采用经皮骶髂螺钉置入治疗的24例骨盆后环骨折患者的临床资料。其中男性17例，女性7例，平均年龄44.1岁（17～71岁）。按AO分型，B型骨折17例（B1型9例，B2型8例），C型骨折7例（C1型3例，C2型2例，C3型2例）。所有病例均采用机器人辅助经皮骶髂螺钉置入（直径7.3mm的AO空心螺钉）。24例骨盆后环手术共置入S(1)骶髂螺钉固定26枚、S(2)骶髂螺钉固定18枚，其中单纯S(1)节段固定8例，单纯S(2)节段固定3例，S(1)与S(2)联合固定13例，S(1)单向单侧固定18例，S(1)双向双侧固定3例，S(2)单向单侧固定14例，S(2)双向双侧固定2例，S(1)单向双螺钉固定2例。术后对24例患者均行X线及CT检查，并于术前、术后进行疼痛视觉模拟评分（VAS）。所有骶髂螺钉均在机器人辅助下一次成功按计划置入。术后X线片及CT显示，所有骶髂螺钉均未穿出骶骨体及对侧骶骨翼前缘皮质，未误入骶管及椎间隙。3例骶髂螺钉紧贴并磨损髂骨皮质密度线前缘及骶骨翼斜坡，最终再次进入骶骨体。3例骶髂螺钉触及骶神经根管，但未穿破神经根管。疼痛VAS评分均值由术前的7.1分（4～10分）降至术后的1.9分（0～3分）。机器人辅助骶髂螺钉置入精度高，值得临床推广；但手术医生的主导作用不可替代。
