Robotic-assisted ilio-sacral screws in vertically-unstable sacral fractures

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-05-19 DOI:10.1016/j.jcot.2025.103063

Madhava Pai , S. Vidyadhara , T. Balamurugan

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引用次数: 0

Abstract

Posterior pelvic stabilization with the iliosacral screw has long been a challenge due to the complex anatomy, proximity to vessels and nerves and narrow safe bony corridor for screw placement. Conventionally these screws were placed under fluoroscopic guidance, however the safe bony corridors are poorly represented on 2D imaging. The current generation of spine robots allow accurate drilling of trajectories while visualizing the 3D bony anatomy using intraoperatively acquired computed tomographic scans. The TiRobot (TINAVI Medical Technologies, Beijing, China) has been used to place percutaneous iliosacral screws in pelvic fractures, but no such workflow exists for the MazorX stealth edition (MXSE) (Medtronic, Dublin, Ireland).

Two patients who underwent iliosacral screw fixation for vertically unstable sacral fractures using robotic assistance were included. The challenges faced and lessons learned were described in detail in this technical note.

In each patient, two 6.5mm cannulated cancellous ilio-sacral screws were placed percutaneously through the ilium-S1/S2 bony corridor, using robotic assistance. The patients were allowed to sit with the leg hanging down on the first post operative day.

Robotic assistance in surgery offers unique solutions to challenges, improves surgeon's understanding of the problem, and increases confidence in treating them unconventionally.

查看原文本刊更多论文

机器人辅助髂-骶骨螺钉治疗垂直不稳定骶骨骨折

由于髂骶椎复杂的解剖结构、靠近血管和神经以及放置螺钉的狭窄的安全骨通道，使用髂骶椎螺钉稳定后骨盆一直是一个挑战。传统上，这些螺钉是在透视引导下放置的，然而安全的骨通道在二维成像上表现不佳。当前一代的脊柱机器人可以在使用术中获得的计算机断层扫描可视化三维骨骼解剖的同时精确地钻孔轨迹。TiRobot （TINAVI医疗技术公司，北京，中国）已被用于在骨盆骨折中放置经皮髂骶螺钉，但MazorX隐形版（MXSE）（美敦力公司，都柏林，爱尔兰）没有这样的工作流程。本研究包括2例使用机器人辅助髂骶螺钉固定垂直不稳定骶骨骨折的患者。本技术说明详细描述了面临的挑战和吸取的教训。在每位患者中，在机器人辅助下，经皮通过髂骨s1 /S2骨通道放置两枚6.5mm空心松质髂骶螺钉。术后第一天，允许患者垂腿坐下。手术中的机器人辅助为挑战提供了独特的解决方案，提高了外科医生对问题的理解，并增加了非常规治疗的信心。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.