[Clinical research on robot-assisted percutaneous pelvic and acetabular screws surgery].

OBJECTIVE: To evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures.

METHODS: In the study, 12 patients with pelvic and acetabular fractures who were treated in Beijing Jishuitan Hospital from January to April in 2016 were involved in this research. The research subjects were randomly divided into two groups: the experimental group and the control group. Robotic-assisted percutaneous sacroiliac screw internal fixations were performed under the guidance of fluoroscopy navigation in the experimental group; in the control group, doctors operated manually guided by fluoroscopy. Statistical analysis was performed on the total operation time, the intraoperative fluoroscopy time, the adjustment numbers of intraoperative guide wires, the excellent rate of screw placement and the incidence of adverse events in order to evaluate the security and efficiency of a surgical robotic assisted percutaneous screw fixation for the treatment of pelvic and acetabular fractures.

RESULTS: Eleven screws were placed in 7 patients from the experimental group, while 7 screws were placed in 5 patients from the control group in total. All the screw placement positions were satisfactory according to postoperative CT images. The excellent rates of screw placement position were 100% in both groups. However, the P value was 0.016 based on the comparison between the screws' distribution in the two groups which meant that the screw distribution of the experimental group was better than that of the control group. The average fluoroscopy time needed for screw insertion was (7.36±2.63) s in the experimental group while (41.80±13.99) s in the control group (P<0.001). This suggested that the difference between the two groups had statistical significances. Intra-operative fluoroscopy time of the experimental group was significantly smaller than that of the control group. The number of the average screw adjustment was (0.36±0.48) times in the experimental group while (9.00±3.06) times in the control group (P=0.003). This suggested that the difference of the number of the guide needle adjustment between the two groups had statistical significances, and the number of the experimental group was smaller than that of the control group. The average operation time was (43.86±49.06) min in the experimental group while only (29.00±12.14) min were needed in the control group (P=0.528). This suggested that the difference between the two groups had no statistical significance. That is, the total operation time of the two groups was equal. All the screws were in satisfactory positions according to validation results of CT scans. No complications such as screw breaking out the bone cortex and entering into the knee joint cavity, wound infection occurred.

CONCLUSION: Surgical robots are suitable for robot-assisted percutaneous screw fixation in pelvic and acetabular fractures. Robot-assisted treatment of pelvic and acetabular fractures has significant advantages over manual operations including high accuracy, small perspective radiation, safety and efficiency.