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percutaneous Sacroiliac screw placement： A Prospective Randomized Comparison of Robot？assisted Navigation Procedures with a Conventional Technique

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Chinese Medical Journal 2017年第21期130卷 2527-2534页

作者： Jun-Qiang Wang Yu Wang Yun Feng Wei Han Yong-Gang Su Wen-Yong Liu Wei-Jun Zhang Xin-Bao Wu Man-Yi Wang Yu-Bo Fan School of Biological Science and Medical Engineering Beihang University Beijing 100191 China Department of Orthopaedic Trauma Beijing Jishuitan Hospital Beijing 100035 China TINAVI Medical Technologies Company Limited Beijing 100192 China Medical Robot Engineering Laboratory of Beijing Beijing 100192 China

Background： Sacroiliac （SI） screw fixation is a demanding technique, with a high rate of screw malposition due to the complex pelvic anatomy. TiRobot- is an orthopedic surgery robot which can be used for SI screw fixation. This study aimed to evaluate the accuracy of robot-assisted placement of SI screws compared with a freehand technique. Methods：Thirty patients requiring posterior pelvic ring stabilization were randomized to receive freehand or robot-assisted SI screw fixation, between January 2016 and June 2016 at Beijing Jishuitan Hospital. Forty-five screws were placed at levels S1 and S2. In both methods, the primary end point screw position was assessed and classified using postoperative computed tomography. Fisher＇s exact probability test was used to analyze the screws＇positions. Secondary end points, such as duration of trajectory planning, surgical time after reduction of the pelvis, insertion time for guide wire, number of guide wire attempts, and radiation exposure without pelvic reduction, were also assessed. Results： Twenty-three screws were placed in the robot-assisted group and 22 screws in the freehand group; no postoperative complications or revisions were reported. The excellent and good rate of screw placement was 100% in the robot-assisted group and 95% in the freehand group. The P value （0.009） showed the same superiority in screw distribution. The fluoroscopy time after pelvic reduction in the robot-assisted group was significantly shorter than that in the freehand group （median [Q1, Q3]： 6.0 [6.0, 9.0] s vs. median [Q1, Q3]： 36.0 [21.5, 48.0] s; χ2 = 13.590, respectively, P 〈 0.001）; no difference in operation time after reduction of the pelvis was noted （χ2 = 1.990, P = 0.158）. Time for guide wire insertion was significantly shorter for the robot-assisted group than that for the freehand group （median [Q1, Q3]： 2.0 [2.0, 2.7] min vs. median [Q1, Q3]： 19.0 [15.5, 45.0] min; χ2 = 20.952, respectively, P 〈 0.001）. The number of guide wire attem

关键词： Computer-Assisted Pelvic Injuries percutaneous screw placement Robotics Sacroiliac screw Surgery

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