Objective To summarize the surgical learning curve and preliminary operative experience of dual-robotic navigated minimally invasive treatment on pelvic fractures by TiRobot and Artis Zeego. Methods Between July 2019 and February 2021, 90 patients with pelvic fractures were treated with dual-robotic navigated minimally invasive surgery by TiRobot and Artis Zeego. There were 64 males and 26 females, with an average age of 46.5 years (range, 13-78 years). Body mass index was 14.67-32.66 kg/m2 (mean, 23.61 kg/m2). Causes of injuries included traffic accident in 43 cases, falling from height in 37 cases, low-energy injuries such as flat falls in 10 cases. The interval between injury and surgery was 1-36 days (mean, 7.3 days). According to the location of the implanted screws, the patients were divided into sacroiliac screw group (n=33), acetabular screw group (acetabulum anterior/posterior column, n=24), composite screws group (sacroiliac and acetabulum anterior/posterior column, n=33). According to the screw implantation time and accuracy, the surgical learning curve was plotted, and the differences in the relevant indicators between learning stage and skilled stage were compared. Results All 90 patients successfully completed the operation, the intraoperative bleeding volume was 5-200 mL (median, 20 mL). There was no vascular or nerve injury. All incisions healed by first intention. The screw implantation time ranged from 7.5 to 33.0 minutes (mean, 18.92 minutes), and the screw implantation accuracy ranged from 1.1 to 1.8 mm (mean, 1.56 mm). According to the learning curve, the practice stage of 3 groups was reached after 7, 10, and 11 cases, respectively. With the accumulation of surgical experience, the screw implantation time had a significant downward trend. Compared with the learning stage, the screw implantation time on skilled stage in 3 groups significantly shortened (P<0.05), but the difference in the screw implantation accuracy was not significant (P>0.05). Conclusion TiRobot and Artis Zeego assisted pelvic fracture surgery is safe and efficient, which helps the surgeon to quickly master the pelvic channel screw surgery, and the operation time is significantly shortened on the premise of ensuring the implantation accuracy.
Objective?To investigate the effectiveness of minimally invasive plate fixation in treatment of unstable pelvic fractures.?Methods?Between May 2006 and December 2009, 21 patients with unstable pelvic fractures were treated. There were 13 males and 8 females with an average age of 39 years (range, 21-66 years). The causes of injury included traffic accident in 9 cases, falling from height in 6 cases, and heavy pound injury in 6 cases. The time from injury to hospitalization was 1 to 4 hours with an average of 2.8 hours. According to Tile’s classification, there were 12 cases of type B and 9 cases of type C. After admission, bone traction and exo fixation were performed, and minimally invasive plate fixation was given at 5-24 days after injury.?Results?All incisions healed by first intention, and no complications of nerve and vessel injuries occurred. According to the reduction criteria of Matta radiography, anatomic reduction was achieved in 16 cases, satisfactory reduction in 4 cases, and fair reduction in 1 case. All patients were followed up 12 months. The X-ray films showed all fractures healed at 2-4 months (mean, 2.6 months). According to Majeed clinical evaluation, the results were excellent in 12 cases, good in 7 cases, and fair in 2 cases.?Conclusion?Minimally invasive plate fixation can provide effective fixation, reconstruct pelvic ring, and reduce perioperative complications in the treatment of unstable pelvic fractures.
ObjectiveTo compare the effectiveness and changes of sagittal spino-pelvic parameters between minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion in treatment of the low-degree isthmic lumbar spondylolisthesis. MethodsBetween May 2012 and May 2013, 86 patients with single segmental isthmic lumbar spondylolisthesis (Meyerding degree Ⅰ or Ⅱ) were treated by minimally invasive transforaminal lumbar interbody fusion (minimally invasive group) in 39 cases, and by open posterior lumbar interbody fusion in 47 cases (open group). There was no significant difference in gender, age, disease duration, degree of lumbar spondylolisthesis, preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between 2 groups (P>0.05). The following sagittal spino-pelvic parameters were compared between 2 groups before and after operation: the percentage of slipping (PS), intervertebral height, angle of slip (AS), thoracolumbar junction (TLJ), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), spino-sacral angle (SSA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Pearson correlation analysis of the changes between pre- and post-operation was done. ResultsPrimary healing of incision was obtained in all patients of 2 groups. The postoperative hospital stay of minimally invasive group [(5.1±1.6) days] was significantly shorter than that of open group [(7.2±2.1) days] (t=2.593, P=0.017). The patients were followed up 11-20 months (mean, 15 months). The reduction rate was 68.53%±20.52% in minimally invasive group, and was 64.21%±30.21% in open group, showing no significant difference (t=0.725, P=0.093). The back and leg pain VAS scores, and ODI at 3 months after operation were significantly reduced when compared with preoperative ones (P<0.05), but no significant difference was found between 2 groups (P>0.05). The postoperative other sagittal spino-pelvic parameters were significantly improved (P<0.05) except PI (P>0.05), but there was no significant difference between 2 groups (P>0.05). The correlation analysis showed that ODI value was related to the SVA, SSA, PT, and LL (P<0.05). ConclusionBoth minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion can significantly improve the sagittal spino-pelvic parameters in the treatment of low-degree isthmic lumbar spondylolisthesis. The reconstruction of SVA, SSA, PT, and LL are related to the quality of life.
ObjectiveTo investigate the effectiveness of anterior subcutaneous internal fixator combined with posterior plate in the treatment of unstable pelvic fractures.MethodsBetween January 2015 and January 2019, 26 cases of unstable pelvic fractures were treated with anterior subcutaneous internal fixator combined with posterior plate. There were 16 males and 10 females, with an average age of 42.8 years (range, 25-66 years). According to the Tile classification, 9 of them belonged to type B2, 6 to type B3, 7 to type C1, 3 to type C2, 1 to type C3. The injury severity score (ISS) was 6-43 (mean, 18.3). Four cases combined with brain injury, 7 with limb fractures, 3 with hemopneumothorax, 1 with sciatic nerve injury. The time from injury to operation was 4-12 days (mean, 6.4 days). The intraoperative blood loss, operation time, and the complications were recorded. The fracture reduction and the postoperative function of patients were evaluated.ResultsAll patients were followed up 12-26 months (mean, 16.8 months). The operation time was 65-142 minutes (mean, 72.5 minutes) and the intraoperative blood loss was 42-124 mL (mean, 64.2 mL). There were 2 cases of unilateral lateral femoral cutaneous nerve stimulation, 1 case of femoral nerve paralysis, and 1 case of superficial infection of incision, which were cured after corresponding treatment. X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, according to Matta criteria for fracture reduction, the results were excellent in 8 cases, good in 15 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 88.5%. According to Majeed scoring system for pelvic function, the results were excellent in 10 cases, good in 12 cases, and fair in 4 cases, with an excellent and good rate of 84.6%.ConclusionFor unstable pelvic fractures, the anterior subcutaneous internal fixator combined with posterior plate has fewer operative complications, high security, and achieve good effectiveness.
【Abstract】 Objective To evaluate the effectiveness of percutaneous fixation of pelvic fracture by Acutrak full thread headless hollow compression screw. Methods Between March 2008 and April 2010, 31 patients with pelvic fracture underwent percutaneous fixation surgery with Acutrak full thread headless hollow compression screw (surgical group). The effectivenss was compared with those of 14 patients with pelvic fracture treated conservatively (control group). There was no significant difference in age and sex between 2 groups (P gt; 0.05). The injury was more severe in surgical group than in control group. The standard of short-term recovery was active turning over and walking for 5 steps with walking aids. The standard of long-term recovery was pain, gait, fracture healing, and function recovery. Results In surgical group, the other patients reached the standard of short-term recovery at 1-4 days after injury except 1 patient who had sacral plexus injury; in control group, the patients could turn over at 9-13 days (Tile type A2) and 17-25 days (Tile type B2) respectively, and could walk at 17-21 days (Tile type A2) and at 45-57 days (Tile type B2) respectively. The patients of 2 groups were followed up 6-19 months. The time of fracture healing was 2-6 months. The long-term results were excellent in 29 cases and good in 2 cases in surgical group, and were excellent in 8 cases and good in 6 cases in control group, showing significant difference between 2 groups (χ2=6.636, P=0.017).Conclusion Percutaneous internal fixation combined with Acutrak full thread headless hollow compression screw can provide more effective treatment. It can alleviate patients, pain quickly, improve life quality, and has better long-term effectiveness.
ObjectiveTo explore the value of the long time lower abdominal aorta balloon block technology in the pelvis or sacrum tumor surgery. MethodsFrom January 2005 to June 2013, the sacrum or pelvic tumor patients underwent the long time lower abdominal aorta balloon block technology in the Orthopedics Department of West China Hospital of Sichuan University were enrolled. According to the balloon blocking time, patients were divided into A (<90 mins), B (90 to 180 mins), and C (>180 mins) groups. The intraoperative blood loss, blood transfusion amount, average lengths of hospital stay, postoperative volume of drainage, and postoperative complications were compared among the three groups. ResultsA total of 78 patients were included, of which 21 were in group A, 38 were in group B and 19 were in group C. All patients received en bloc resection, and did not experience intraoperative balloon shift and abdominal aorta flow leakage. Comparing the three groups, there were significant differences in intraoperative blood loss (P=0.026) and average lengths of hospital stay (P=0.021). Further pairwise comparison showed the intraoperative blood loss and average lengths of hospital stay in group C were significantly higher than those in group A and group B. In addition, there were no statistical differences among the three groups in blood transfusion amount, postoperative volume of drainage and postoperative complications. ConclusionIn the pelvis and sacrum tumor surgery, extending the time of abdominal aorta balloon block can reduce bleeding, save blood, increase the safety of surgery without increasing in postoperative complications.
Objective To evaluated the application effect of reverse digital modeling combined with three-dimensional (3D)-printed disease models in the standardized training of orthopedic residents focusing on pelvic tumors. Methods From August 2022 to August 2023, 60 orthopedic residents from West China Hospital, Sichuan University were randomly assigned to a trial group (n=30) and a control group (n=30). The trial group received instruction using reverse digital modeling and 3D-printed pelvic tumor models, while the control group underwent traditional teaching methods. Teaching outcomes were evaluated and compared between groups through knowledge tests, practical skill assessments, and satisfaction surveys. Results Before training, there was no statistically significant difference in knowledge tests or practical skill assessments between the two groups (P>0.05). After training, the trial group showed significantly better performance than the control group in knowledge tests (90.5±5.2 vs. 78.4±6.8, P<0.05), skill assessments (92.7±4.9 vs. 81.3±6.2, P<0.05), and satisfaction surveys (9.40±1.10 vs. 7.60±1.20, P<0.05). One month after training, the trial group still showed significantly better performance than the control group in knowledge tests (88.1±6.4 vs. 72.3±7.1, P<0.05) and skill assessments (90.3±5.8 vs. 75.6±6.9, P<0.05). Conclusions Reverse digital modeling combined with 3D printing offers an intuitive and effective teaching approach that improves comprehension of pelvic tumor anatomy and strengthens clinical and technical competencies. This method significantly enhances learning outcomes in standardized residency training and holds promise for broader integration into medical education.
ObjectiveTo investigate the impact of the Salter innominate osteotomy on the acetabular morphology and direction and the relationship between them in children with developmental dislocation of the hip (DDH) by three-dimensional CT. MethodsBetween January 2013 and January 2015, 51 patients with unilateral DDH were treated. All patients were females with an average age of 2 years and 5 months (range, one year and 6 months to 5 years). All the patients underwent open reduction of the hip, Salter innominate osteotomy, proximal femoral osteotomy, and hip cast immobilization for treatment. The data of three-dimensional CT before surgery and at 1 week after surgery were measured and collected as follows:the anterior acetabular index (AAI), posterior acetabular index (PAI), axial acetabular index (AxAI), acetabular anteversion angle (AAA) of the acetabulum, and the distances of the forward, outward, and lateral rotation of the distal osteotomy fragments. The differences of AAI, PAI, AxAI, AAA between before and after surgeries were compared and the difference values of the data with significant difference results were calculated. The relationship between the difference values and the distances of three different rotation directions before and after surgeries were tested by Spearman correlation analysis. ResultsThere were significant differences in the AAI, PAI, and AAA between before and after surgery (P<0.05), but no significant difference was found in the AxAI between before and after surgery (t=0.878, P=0.384). The difference values of AAI, PAI, and AAA were (4.518±4.601), (4.219±6.660), and (3.919±4.389)° respectively. The distances of the outward, lateral, and forward rotation of the distal osteotomy fragments after surgery were (0.420±0.339), (2.440±0.230), and (0.421±0.311) cm. There was a significant correlation between the three different rotation directions and AAI difference (P<0.05), especialy the outward rotation (r=0.981). There was a correlation between the outward, forward rotation and PAI, AAI differences (P<0.05), and no significant correlation between the lateral rotation and PAI, AAA was found (P>0.05). There was a significant correlation between the forward rotation and AAA difference (r=0.841). ConclusionSalter innominate osteotomy can increase the curvature of the anterior wall of the acetabulum in DDH, but reduce the curvature of the rear wall. At the same time, it can also change the direction of the acetabulum, significantly decrease the acetabular anteversion, but it can not change the depth of the acetabulum. The main factors of the curvature change after Salter innominate osteotomy of DDH is attributable to outward rotation, followed by forward rotation, and the main factor of the acetabular direction change is attributable to forward rotation.
Objective To investigate the effectiveness of three-dimensional (3D)-printed hemi-pelvic prosthesis for revision of aseptic loosening or screw fracture of modular hemi-pelvic prosthesis. MethodsBetween February 2017 and January 2020, 11 patients with aseptic loosening or screw fracture of modular hemi-pelvic prosthesis were revised using 3D-printed hemi-pelvic prostheses. There were 7 males and 4 females with an average age of 44 years (range, 25-60 years). In the first operation, all patients underwent total tumor resection, modular hemi-pelvic prosthesis reconstruction, and autologous femoral head transplantation. According to the Enneking pelvic partition system, 8 cases were resected in zones Ⅰ+Ⅱ and 3 cases in zones Ⅰ+Ⅱ+Ⅲ. The interval from the initial operation to this revision ranged from 14.3-66.2 months, with an average of 35.8 months. The operation time, the amount of intraoperative bleeding, and the occurrence of complications were recorded. At 6 months after the first operation, before revision, and at last follow-up, the American Musculoskeletal Tumor Society (MSTS) score and Harris score were used to evaluate the recovery of lower limb function. The pain-free walking distance of patients without brace assistance was recorded at last follow-up. X-ray films were taken at 1 month after the first operation, before revision, and at 1 month after revision, the acetabulum position was assessed by the differences in weight arm and cup height between bilateral hip joints. At last follow-up, the digital X-ray tomography was taken to evaluate the prosthesis-bone integration and the occurrence of aseptic loosening. Results The operation time was 182.6-238.0 minutes (mean, 197.4 minutes). The amount of intraoperative bleeding was 400-860 mL (mean, 550.0 mL). All incisions healed by first intention with no infection, hip dislocation, nerve damage, or vascular-related adverse events. The MSTS score and Harris score at last follow-up were significantly higher than those at 6 months after the first operation and before revision (P<0.05), while the score before revision was significantly lower than that at 6 months after the first operation (P<0.05). At last follow-up, the patients were able to walk more than 1 000 meters painlessly without brace assistance. Imaging review showed that the difference of cup height at 1 month after revision was significantly lower than that at 1 month after the first operation and before revision, and at 1 month after the first operation than before revision operation, and the differences were significant (P<0.05). There was no significant difference in the difference of weight arm among three time points (P>0.05). All prostheses were well integrated, and no aseptic loosening of the prosthesis or screw fracture occurred. Conclusion Revision with 3D-printed hemi-pelvic prostheses benefited in reconstructing stable pelvic ring and natural bodyweight transmission for patients encountering the aseptic loosening or screw fracture of modular hemi-pelvic prosthesis. Early postoperative rehabilitation training can maximize the recovery of patient limb function, reduce pain during walking, and reduce the incidence of complications.