Using the Starr Frame and Da Vinci surgery system for pelvic fracture and sacral nerve injury

Ye, Peng; Zhang, Wei; Zhang, Gongzi; Wang, Xiang; Zhang, Shuwei; Ma, Xin; Tang, Peifu; Zhang, Lihai

doi:10.1186/s13018-018-1040-6

Cited by 17 publications

(11 citation statements)

References 13 publications

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“…Various robot-assisted orthopedic surgery (RAOS) is currently available on the market, each addressing specific surgeries and characterized by a series of special features that may involve different requirements or modus operandi. RAOS has been utilized in a variety of orthopedic operations, including fracture fixation for traumatic surgery, total hip and total knee arthroplasty [ 18 , 19 ], spine surgery [ 20 , 21 ], bone tumor surgery [ 22 ], arthroscopy [ 23 ], and fracture fixation for traumatic surgery [ 24 ]. However, robotic in fracture reduction remains at an infant stage.…”

Section: Discussionmentioning

confidence: 99%

Design and evaluation of an intelligent reduction robot system for the minimally invasive reduction in pelvic fractures

Zhao

Wang

et al. 2022

J Orthop Surg Res

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Introduction Pelvic fracture is a severe high-energy injury with the highest disability and mortality of all fractures. Traditional open surgery is associated with extensive soft tissue damages and many complications. Minimally invasive surgery potentially mitigates the risks of open surgical procedures and is becoming a new standard for pelvic fracture treatment. The accurate reduction has been recognized as the cornerstone of minimally invasive surgery for pelvic fracture. At present, the closed reduction in pelvic fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces of soft tissue involved in the fragment manipulation, which might result in fracture malreduction. To overcome these shortcomings and facilitate pelvic fracture reduction, we developed an intelligent robot-assisted fracture reduction (RAFR) system for pelvic fracture. Methods The presented method is divided into three parts. The first part is the preparation of 20 pelvic fracture models. In the second part, we offer an automatic reduction algorithm of our robotic reduction system, including Intraoperative real-time 3D navigation, reduction path planning, control and fixation, and robotic-assisted fracture reduction. In the third part, image registration accuracy and fracture reduction accuracy were calculated and analyzed. Results All 20 pelvic fracture bone models were reduced by the RAFR system; the mean registration error E1 of the 20 models was 1.29 ± 0.57 mm. The mean reduction error E2 of the 20 models was 2.72 ± 0.82 mm. The global error analysis of registration and reduction results showed that higher errors are mainly located at the edge of the pelvis, such as the iliac wing. Conclusion The accuracy of image registration error and fracture reduction error in our study was excellent, which could reach the requirements of the clinical environment. Our study demonstrated the precision and effectiveness of our RAFR system and its applicability and usability in clinical practice, thus paving the way toward robot minimally invasive pelvic fracture surgeries.

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Section: Discussionmentioning

confidence: 99%

Design and evaluation of an intelligent reduction robot system for the minimally invasive reduction in pelvic fractures

Zhao

Wang

et al. 2022

J Orthop Surg Res

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“…In recent years, due to the clinical application of the pelvic reduction frame, some pelvic fractures can be treated with closed reduction and minimally invasive fixation in the early stage, with better results and a lower incidence of pelvic malunion or nonunion [ 12 , 13 ]. However, the application of this new technique has not been popularized, and some complex pelvic fractures are difficult to correct with reduction frames.…”

Section: Discussionmentioning

confidence: 99%

Sacral osteotomy combined with triangular osteosynthesis in the treatment of malunion and nonunion of vertically displaced pelvic fractures

Luo

et al. 2022

J Orthop Surg Res

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Background Malunion and nonunion of vertically displaced pelvic fractures result in lower limb length discrepancies, claudication, and pain. There have been few previous reports of this type of corrective surgery for these old pelvic fractures. We present a surgical technique of sacral osteotomy combined with triangular osteosynthesis in the treatment of malunion and nonunion of vertically displaced pelvic fractures and report on its short-term clinical results. Methods We retrospectively reviewed nine patients (five males and four females) with malunion or nonunion of vertically displaced pelvic fractures treated with sacral osteotomy and triangular osteosynthesis from April 2015 to January 2020. The age ranged from 14 to 45 years (average, 30.7 years). The time from injury to deformity correction surgery ranged from 3 months to 5 years (average, 12.8 months). The vertical displacement of a unilateral hemipelvis was 3.0–4.5 cm (average, 3.80 cm). According to AO/OTA classification at the initial fracture, there are eight cases in type C1.3 and one case in type C3.3. Sacral osteotomy and triangular osteosynthesis were used in all nine patients. The degree of unilateral hemipelvic reduction was assessed postoperatively based on measurements from the anteroposterior (AP) X-ray. Majeed score and pain visual analog scale (VAS) were used to assess the therapeutic effect of the patients during follow-up. Results In all nine patients, postoperative AP X-ray showed correction displacement of 1.7–3.9 cm (average, 3.20 cm). All the patients were followed up for 6–36 months (average, 12.7 months). At the last follow-up, the Majeed score of pelvic fracture increased from an average of 53.9 points (30–84 points) preoperatively to 87.0 points (72–94 points), and the VAS score for pain decreased from an average of 6.0 points (4–8 points) preoperatively to 1.2 points (0–3 points). None had complications like infection, implant broken, screw loosening, iatrogenic nerve, and blood vessel injury. Conclusion Sacral osteotomy combined with triangular osteosynthesis for the treatment of pelvic malunion and nonunion caused by sacral fractures can correct significantly vertical displacement of a unilateral pelvis, prolong limb length, and reconstruct the stability of a pelvic ring, achieving good clinical results.

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“…In recent years, due to clinical application of the pelvic reduction frame, some pelvic fractures can be treated with closed reduction and minimally invasive xation in the early stage, with better results and a lower incidence of pelvic malunion or nonunion [12,13].…”

Section: Discussionmentioning

confidence: 99%

Sacral Osteotomy Combined With Lumbopelvic Distraction Osteosynthesis in the Treatment of Malunion or Nonunion of Vertically Displaced Pelvic Fractures

Luo

et al. 2021

Preprint

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Background Malunion or nonunion of vertically displaced pelvic fractures resulting in lower limb length discrepancies, claudication, and pain. There have been few previous reports of this type of corrective surgery of the old pelvis. We present a new surgical technique of sacral osteotomy combined with lumbopelvic distraction osteosynthesis (LPDO) in the treatment of malunion and nonunion of vertically displaced pelvic fractures and report on its short-term clinical results.Methods We retrospectively reviewed nine patients (five males and four females) with malunion or nonunion of vertically displaced pelvic fractures treated with sacral osteotomy and LPDO from April 2015 to January 2020. The age ranged from 14 to 45 years (average, 30.7 years). The time from injury to deformity correction surgery ranged from 3 months to 5 years (average, 12.8 months). The vertical displacement of a unilateral pelvis was 3.0-4.5 cm (average, 3.80 cm). According to the AO/OTA classification at initial pelvic fracture, eight cases were type C1.3 and one case were type C3.3. Sacral osteotomy and LPDO were used in all nine patients. The degree of unilateral pelvic reduction was assessed postoperatively based on measurements from the anteroposterior (AP) X-ray. The Majeed score and pain visual analog scale (VAS) score were used to assess the therapeutic effect of the patients during follow-up.Results In all nine patients, postoperative AP X-ray showed correction displacement of 1.7-3.9 cm (average, 3.20 cm). All the patients were followed up for 6 to 36 months (average, 12.7 months). At the last follow-up, the Majeed score of pelvic fracture increased from an average of 53.9 points (30-84 points) preoperatively to 87.0 points (72-94 points), and the VAS score for pain decreased from an average of 6.0 points (4-8 points) preoperatively to 1.2 points (0-3 points). None of the patients had complications, such as infection, implant broken, screw loosening, iatrogenic nerve, or blood vessel injury. Conclusion Sacral osteotomy combined with LPDO for the treatment of pelvic malunion or nonunion caused by sacral fracture can correct significantly vertical displacement of a unilateral pelvis, prolong limb length, and reconstruct the stability of a pelvic ring, leading to good clinical results.

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Using the Starr Frame and Da Vinci surgery system for pelvic fracture and sacral nerve injury

Cited by 17 publications

References 13 publications

Design and evaluation of an intelligent reduction robot system for the minimally invasive reduction in pelvic fractures

Design and evaluation of an intelligent reduction robot system for the minimally invasive reduction in pelvic fractures

Sacral osteotomy combined with triangular osteosynthesis in the treatment of malunion and nonunion of vertically displaced pelvic fractures

Sacral Osteotomy Combined With Lumbopelvic Distraction Osteosynthesis in the Treatment of Malunion or Nonunion of Vertically Displaced Pelvic Fractures

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