Tian Wei, Jia Feng-Shuang, Zheng Jia-Ming, Liu Zhao-Jie, Jia Jian
Department of Orthopaedic Trauma, Tianjin Hospital, Tianjin University, Tianjin, China.
Department of Orthopaedic Trauma 2nd, Third People's Hospital of Jinan City, Jinan, China.
Orthop Surg. 2025 Mar;17(3):848-857. doi: 10.1111/os.14338. Epub 2024 Dec 26.
Type IV fragility fractures of pelvis (FFP IV) are serious and complicated and the treatment is challengeable. Robotic-assisted minimally invasive triangular fixation (RoboTFX) is a new and advanced technique to treat this injury. The objective of this report is to evaluate the clinical outcomes of FFP IV treated with RoboTFX.
From March 2017 to December 2022, 22 consecutive patients with FFP IV were included in the study. Patients were divided into two groups according to the surgical method employed (RoboTFX or robotic-assisted minimally invasive iliosacral screws, RoboISS). Between two groups, we compared clinical data on operation time, intraoperative bleeding, intraoperative fluoroscopy time, favorable fracture healing rate, implant loosening rate, and Majeed pelvic outcome score.
All operations were undertaken from 3 to 15 days (average 5.7 ± 1.7 days) following primary injuries. All patients were followed up continuously 15 months. The average surgical time was 125.3 ± 15.5 (55-190) min in group RoboTFX, 137.1 ± 17.2 min in group RoboISS (p > 0.05). The average amount of intraoperative bleeding was 320.4 ± 25.2 (50-550) mL in group RoboTFX, 302.4 ± 21.5 (50-500) mL in Group 2 (p > 0.05). The average intraoperative fluoroscopy time of the two groups was 23.3 ± 4.5 (15-35) s in group RoboTFX and 40.3 ± 3.8 (10-75) s in group RoboISS (p < 0.05). No patients experienced loss of reduction, 5 of 40 screws had implant loosening in group RoboTFX, meanwhile 13 of 48 screws had implant loosening in Group 2. Four of 20 vertical sacral fractures were healed undesirable including 2 nonunion and the favorable healing rate of 80% in group RoboTFX, meanwhile 8 of 24 fractures were undesirable including 4 nonunion and the favorable healing rate was 66.7% in group RoboISS. Implant loosening rate in the RoboTFX group were all significantly better than those of the RoboISS group (p < 0.05). There were no occurrences of wound infection in both groups, and Majeed scores for the last follow-up were 76.2 ± 3.4 in group RoboTFX and 74.2 ± 2.7 in group RoboISS (p > 0.05).
RoboTFX has the advantages of less intraoperative fluoroscopy and implant loosening rate compared to RoboISS which is better than other methods. We thus recommend RoboTFX as an effective option for treating FFP IV. However, the indications of its operation should be strictly evaluated.
骨盆IV型脆性骨折（FFP IV）病情严重且复杂，治疗具有挑战性。机器人辅助微创三角固定术（RoboTFX）是治疗该损伤的一种新型先进技术。本报告旨在评估采用RoboTFX治疗FFP IV的临床疗效。
2017年3月至2022年12月，连续纳入22例FFP IV患者。根据所采用的手术方法（RoboTFX或机器人辅助微创髂骶螺钉固定术，RoboISS）将患者分为两组。比较两组患者的手术时间、术中出血量、术中透视时间、骨折愈合良好率、植入物松动率和Majeed骨盆结局评分等临床数据。
所有手术均在初次受伤后3至15天（平均5.7±1.7天）进行。所有患者均连续随访15个月。RoboTFX组平均手术时间为125.3±15.5（55 - 190）分钟，RoboISS组为137.1±17.2分钟（p>0.05）。RoboTFX组平均术中出血量为320.4±25.2（50 - 550）毫升，第二组为302.4±21.5（50 - 500）毫升（p>0.05）。两组平均术中透视时间，RoboTFX组为23.3±4.5（15 - 35）秒，RoboISS组为40.3±3.8（10 - 75）秒（p<0.05）。无患者出现复位丢失，RoboTFX组40枚螺钉中有5枚植入物松动，第二组48枚螺钉中有13枚植入物松动。RoboTFX组20例垂直骶骨骨折中有4例愈合不佳，包括2例骨不连，愈合良好率为80%，RoboISS组24例骨折中有8例愈合不佳，包括4例骨不连，愈合良好率为66.7%。RoboTFX组植入物松动率均显著优于RoboISS组（p<0.0）。两组均未发生伤口感染，末次随访时RoboTFX组Majeed评分为76.2±3.4，RoboISS组为74.2±2.7（p>0.05）。
与RoboISS相比，RoboTFX具有术中透视少和植入物松动率低的优点，优于其他方法。因此，我们推荐RoboTFX作为治疗FFP IV的有效选择。然而，应严格评估其手术适应症。
