Robot‐assisted percutaneous screw placement combined with pelvic internal fixator for minimally invasive treatment of unstable pelvic ring fractures

Liu, Hua-shui; Duan, Sheng‐jun; Liu, Shidong; Jia, Feng-shuang; Zhu, Liu; Liu, Min-cen

doi:10.1002/rcs.1927

Cited by 39 publications

(52 citation statements)

References 23 publications

(48 reference statements)

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“…This study was designed to determine the narrowing of safe ranges in screw insertion lengths in the supra‐acetabular area. Proper selection of angulation and screw insertion depths are essential to avoid breaching the pelvic wall and maintain full intraosseous containment . Safe transverse ranges increased caudally with values ranging from 6.0° ± 3.9° to 27.5° ± 4.1° for a 60 mm ISD.…”

Section: Discussionmentioning

confidence: 99%

“…Lastly, we focused on only one screw diameter. Because our algorithm was not fully automated, we had to limit the screw dimension to the most commonly adopted diameter of 6.5 mm . The safe ranges found should be considered narrower for larger screw diameters.…”

Section: Discussionmentioning

confidence: 99%

“…The ISD of 120 mm was selected to characterize the extreme combination of the longest documented screw length used for extremely obese patients, and largest bone to rod distance documented in literature of 25 mm . The screw core diameter of the template was set to 4 mm as representative to a screw size of 6.5 mm …”

Section: Methodsmentioning

confidence: 99%

“…A wide range of screw lengths has also been reported by many authors but no specific criteria for its determination and safety has been proposed. Liu et al and Jain et al used 60 mm screws. Merriman et al suggested 60–80 mm, while Gardner et al disclosed 70–100 mm.…”

mentioning

confidence: 99%

“…Also, it is important to achieve total screw containment and avoid posterior cortex breaching which is determined from screw length and angles of insertion . With the exemption of Vaidya et al that suggested drilling of the screw in the direction of the posterior superior iliac spine just above the sciatic notch, in existing literature, screw angulation is often not disclosed . When it is disclosed, it is not supported by a criteria for its determination at time of surgery .…”

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confidence: 99%

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Safe Supra‐Acetabular Pin Insertion in Relation to Intraosseous Depth

Morandi

Daily

Kee

et al. 2019

Journal Orthopaedic Research

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In pelvic fractures, dysfunction of the pelvic ring is often stabilized with supra-acetabular pin insertion. In existing literature, there are heterogeneous indications on proper pins selection and inclinations. Therefore, this study aimed to quantify the narrowing of safe pin corridors in the transverse and sagittal planes with increments of intraosseous screw depths. A computer algorithm created cross-sections over three-dimensional pelvic reconstructions at sagittal inclinations from 45°cranial to 45°caudal in 5°i ncrements. Templates of screw depths spanning 60-120 mm in 15 mm increments were disposed in the transverse plane from 45°medial to 45°lateral. Each intraosseous screw depth and transverse angle were evaluated for intraosseous containment to evaluate ranges narrowing with increasing screw depths. The 60-mm depth resulted in the largest sagittal range (60.9°± 6.9°) and transverse range (27.5°± 4.1°) at 30°caudal. Increasing depths by 15 mm resulted in ranges being significantly different from one another (p < 0.01). The sagittal plane of 20°cranial had the highest frequency of insertion for all depths, while transverse ranges were narrowed (p < 0.01). Bisecting angles were similar for sagittal planes 20°cranial to 30°caudal with an average of 27.9°± 1.2°(p ≥ 0.115). In conclusion, while 60 mm depths can be inserted with the highest discretion, 15 mm increments in depth significantly reduce safe ranges. Screws depths above 90 mm have low frequencies of insertion, should be inserted more cranially and must be considered prone to breaching.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Safe Supra‐Acetabular Pin Insertion in Relation to Intraosseous Depth

Morandi

Daily

Kee

et al. 2019

Journal Orthopaedic Research

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The impact of robot‐assisted spine surgeries on clinical outcomes: A systemic review and meta‐analysis

Fang

Jin

et al. 2020

Robotics Computer Surgery

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Background: Medical robotics has enabled a significant advancement in the field of modern spine surgery, especially in pedicle screw fixation. A plethora of studies focused on the accuracy of pedicle fixation in robotic-assisted (RA) technology. However, it is not clear whether RA techniques can improve patients' clinical outcomes. Methods: We retrieved relevant studies that compare the differences between RA and freehand (FH) techniques in spine surgeries from the following databases: PubMed, Embase, Cochrane Library and Web of Science. The perioperative outcomes of this technology were measured with parameters including radiation exposure, operative time, the length of hospital stay, complication rates and revision rates. Two reviewers independently reviewed the studies in our sample, assessed their validity and extracted relevant data. Results: Our search resulted in a sample of 23 eligible studies, which involved 1247 patients (5042 pedicle screws) in the RA group and 1273 patients (4830 pedicle screws) in the FH group. With regard to the radiation exposure, the fluoroscopy time was less in surgeries assisted by Mazor robots (standard mean difference [SMD] ¼ À 0.96, 95% CI ¼ À 1.60 to À 0.31) but more in Tianji robots (SMD ¼ 0.91, 95% CI ¼ 0.17 to 1.66) and ROSA robots (SMD ¼ 2.57, 95% CI ¼ 2.01 to 3.13). For radiation dose, a decrease was observed in Tianji robots (SMD ¼ À 1.59, 95% CI ¼ À 2.13 to À 1.05). In the lumbar subgroup, the use of robots increased the operative time (SMD ¼ 0.53, 95% CI ¼ 0.19 to 0.86). In the degenerative diseases (DG) group, there was a significant decrease in the length of hospital stay when robots were introduced (SMD ¼ À 0.30, 95% CI ¼ À 0.48 to À 0.12). While in the DF (deformity) and DG group, a significant increase was found (SMD ¼ 0.17, 95% CI ¼ 0.02 to 0.32). The complication (OR ¼ 0.41, 95% CI ¼ 0.26 to 0.66) and the revision rates (OR ¼ 0.38, 95% CI ¼ 0.24 to 0.60) showed a significant decrease in the RA group compared to the conventional FH group. Conclusions: This study suggests that RA spine surgeries would result in fewer complications, a lower revision rate and shorter length of hospital stay. As the technology continues to evolve, we may expect more applications of robotic systems in spine surgeries. Junyu Li and Yanming Fang contributed equally to this work.

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