The Kocher-Langenbeck approach combined with robot-aided percutaneous anterior column screw fixation for transverse-oriented acetabular fractures: a retrospective study

Abstract

Objective Transverse-oriented acetabular fractures (TOAFs), including transverse, transverse with posterior wall and T-shaped fractures, are always challenging for double-column reduction and fixation with minimally invasive method. The purpose of this study is to compare the therapeutic effects of robot-aided percutaneous anterior column screw fixation versus minimally invasive anterior plate fixation for TOAFs based on the Kocher-Langenbeck (K-L) approach. Methods Patients suffering TOAFs that were fixed by robot-aided percutaneous anterior column screw fixation or minimally invasive anterior plate fixation associated with posterior fixation via the K-L approach were divided into two groups: group A (screw fixation) and group B (plate fixation). Surgical time, blood loss, incision length for anterior fixation and complications were recorded. Fracture reduction quality was evaluated using criteria described by Matta. Fracture healing was assessed on the series of pelvic radiographs at each follow-up. Functional outcomes were investigated using the modified Postel Merle D’Aubigne score at the final follow-up. Results Twenty-nine patients with TOAFs, including 12 patients in group A and 17 patients in group B, were evaluated for study eligibility. The mean surgical time of anterior fracture fixation was 18.7 ± 4.6 min in group A and 33.4 ± 5.0 min in group B (P < 0.001). The amount of intraoperative blood loss was 615.6 ± 178.7 ml in group A and 719.3 ± 199.0 ml in group B (P < 0.001). Incision length for anterior fixation was 9.0 ± 1.8 mm in group A and 81.2 ± 7.3 mm in group B (P < 0.001). The complications related to the surgery of anterior column only occurred in group B (lateral femoral cutaneous nerve palsy in 1 patient and groin discomfort in 1 patient). No significant differences in reduction quality, hospital stay, fracture healing time and functional results were noted between the two groups. Conclusion The K-L approach combined with robot-aided anterior column screw fixation is a safe and effective option for TOAFs. Compared with minimally invasive anterior plate fixation, robot-aided screw fixation has obvious advantages on surgical time, blood loss, and invasiveness. The K-L approach combined with minimally invasive anterior plate fixation can also be a reliable alternative for TOAFs, with the similar reduction quality and functional results.

TiRobot-assisted channel screw fixation for elderly patients with fragility fractures of the pelvis: A retrospective study

“…According to the Gras criteria of the affected pelvic fractures, the 51 screws implanted in the RA group were classi ed as follows: class I (41), class II (10), and class III (0); the accuracy rate of the implants was 100% (Accuracy of screw placement = [number of screws of class I + number of screws of class II]/total number of implanted screws × 100%). Thirty-nine screws implanted in the FH group, 22 screws were de ned class I, class II (12), and class III (5).…”

“…Over the years, for the treatment of this disease, the surgical mode has changed from the traditional open surgery with high risk and many complications to minimally invasive surgery, and manual screw implantation and internal xation has been widely used in clinical practice. In recent years, robot-assisted surgery has been applied to a variety of orthopedic procedures, including joint replacement, spine surgery, bone tumor surgery, arthroscopic surgery, and fracture xation [7][8][9][10] , and has achieved accelerated postoperative recovery. Wu et al 11 took the lead in using Tianji Orthopedic robot system to carry out robot-assisted percutaneous minimally invasive pelvic xation.…”

TiRobot‐Assisted Percutaneous Cannulated Screw Fixation for Elderly Patients with Fragility Fractures of the Pelvis: A Retrospective Study

“… 11 Over the years, in treatment this disease, the surgical mode has changed from the traditional open surgery with high risk and many complications to minimally invasive surgery, and manual screw implantation and internal fixation has been widely used in clinical practice. In recent years, robot‐assisted surgery has been applied to a variety of orthopedic procedures, including joint replacement, spine surgery, bone tumor surgery, arthroscopic surgery, and fracture fixation, 12 , 13 , 14 , 15 , 16 , 17 and has achieved accelerated postoperative recovery.…”