Department of Orthopedics and Traumatology, Xi'an Honghui Hospital, Xi'an JiaoTong University Health Science Center, Xi'an, China.
Department of Hand and Foot Microsurgery, The First Hospital of Yulin, Yulin, China.
Biomed Res Int. 2022 Jul 23;2022:3383665. doi: 10.1155/2022/3383665. eCollection 2022.
This study aimed to evaluate the safety and efficacy of the fixation of transforaminal sacral fractures using TiRobot-assisted transiliac-transsacral (TITS) screws under multimodal neuroelectrophysiological monitoring (MNM).
From January 2019 to May 2021, 22 patients (17 male and 5 female patients) with transforaminal sacral fractures who were treated with closed reduction and placement of TiRobot-assisted TITS screws under MNM were retrospectively evaluated. The average age of the patients was 43.32 ± 11.40 years (range: 19-63). The patients received MNM, including somatosensory-evoked potentials (SEPs), motor-evoked potentials (MEPs), and electromyographic monitoring (EMG), prior to surgery, during closed reduction and the placement of the guidewire and TITS screw, and at the end of surgery. The operation was adjusted according to the MNM results.
Overall, 22 TITS screws were inserted in 22 patients, including 5 TITS screws in the S1 body and 17 TITS screws in the S2 body. The average time needed for screw placement was 27.95 ± 6.84 mins, and the average frequency of X-ray fluoroscopy exposures was 31.00 ± 5.56 for each patient. Anterior ring fixation was performed in 4 patients using an external fixator, in 5 patients using cannulated screws, and in 13 patients using reconstruction plates. The mean follow-up time was 14.46 ± 2.46 months (12-20 months). Tornetta and Matta radiographic outcomes were excellent in 10 patients, good in 9 patients, fair in 2 patients, and poor in 1 patient. The proportion of excellent and good ratings was 86.36%. At the final follow-up, the average Majeed score was 82.18 ± 14.52, with clinical outcomes that were excellent in 9 patients, good in 9 patients, fair in 1 patient, and poor in 3 patients. The proportion of excellent and good ratings was 82.82%. Preoperatively, the amplitude of the SEP on the injured side was lower than that on the contralateral side before reduction in 9 patients (>50%). In this study, no screw was mistakenly inserted into the sacral canal, and no surgical site infection occurred.
MNM combined with TiRobot assistance can safely implant TITS screws and can effectively identify the neurological function of patients under anesthesia and reduce iatrogenic nerve injury.
本研究旨在评估在多模态神经电生理监测（MNM）下使用 TiRobot 辅助经髂骨-骶骨（TITS）螺钉固定经椎间孔骶骨骨折的安全性和有效性。
本研究回顾性分析了 2019 年 1 月至 2021 年 5 月期间，22 例经椎间孔骶骨骨折患者（17 例男性和 5 例女性），采用 MNM 下闭合复位和 TiRobot 辅助 TITS 螺钉固定治疗。患者平均年龄为 43.32±11.40 岁（19-63 岁）。在手术前、闭合复位和导丝及 TITS 螺钉置入过程中以及手术结束时，患者均接受了包括体感诱发电位（SEP）、运动诱发电位（MEP）和肌电图监测（EMG）在内的 MNM。根据 MNM 结果调整手术。
22 例患者共置入 22 枚 TITS 螺钉，其中 S1 体 5 枚，S2 体 17 枚。螺钉置入平均时间为 27.95±6.84 分钟，平均每位患者 X 线透视曝光次数为 31.00±5.56 次。4 例患者采用外固定器固定前环，5 例患者采用空心螺钉固定，13 例患者采用重建钢板固定。平均随访时间为 14.46±2.46 个月（12-20 个月）。Tornetta 和 Matta 影像学结果评定优 10 例，良 9 例，可 2 例，差 1 例。优良率为 86.36%。末次随访时，Majeed 评分平均为 82.18±14.52，优 9 例，良 9 例，可 1 例，差 3 例。优良率为 82.82%。术前，9 例患者（>50%）在复位前患侧 SEP 振幅低于对侧。本研究中无螺钉误置于骶管内，无手术部位感染发生。
MNM 联合 TiRobot 辅助可安全植入 TITS 螺钉，能有效识别麻醉下患者的神经功能，减少医源性神经损伤。
