The Kocher-Langenbeck approach combined with TiRobot-assisted percutaneous anterior column screw fixation for transverse with or without posterior wall fractures of acetabulum: a retrospective study.

Abstract

Purposes: To compare radiological and clinical outcomes of TiRobot-assisted versus traditional freehand percutaneous anterior column screw fixation for transverse with or without posterior wall fractures of acetabulum based on the Kocher‑Langenbeck (K‑L) approach.

Methods: Patients suffering transverse with or without posterior wall fractures of acetabulum that were fixed by TiRobot-assisted or traditional freehand percutaneous anterior column screw fixation via the K-L approach were divided into two groups:group A (TiRobot-assisted fixation) and group B (traditional freehand fixation). Surgical time, blood loss, postoperative complications, follow-up length, hospital stay and fracture healing time were recorded. Fracture reduction quality was estimated via criteria described by Matta.Fracture healing was evaluated on the pelvic radiographs at each follow-up. Functional outcomes were examined using the Postel Merle D'Aubigné score system at the final follow-up.

Results: A total of 29 patients who met the inclusion and exclusion criteria were evaluated for eligibility in this study, with 16 patients assigned to group A and 13 to group B.The mean intraoperative blood loss was 581.3 ± 242.8 ml in group A and 761.5 ± 193.8 ml in group B(P < 0.05). The average intraoperative fluoroscopy in group A was 8.3 ± 1.5 times, while that in group B was 12.7 ± 2.0 times(P < 0.001). The mean number of needle adjustments was 0.6 ± 0.6 in group A and 2.0 ± 0.7 in group B(P < 0.001). No signifcant differences in surgical time of the anterior column screw fixation,hospital stay,reduction quality, fracture healing time, complications and functional outcomes were noted between the two groups. It is worth noting that, in TiRobotic-assistance early-stage group the mean surgical time of anterior fracture fixation was 29.3 ± 2.5 min, while it was 19.3 ± 2.2 and 26.7 ± 4.2 min in Tirobotic-assistance late-stage group and freehand group respectively, with a statistically significant inter-group difference (P < 0.001).

Conclusions: The K‑L approach combined with TiRobot‑aided anterior column screw fixation is a safe and effective option for transverse with or without posterior wall fractures of acetabulum. Compared with traditional freehand percutaneous anterior column screw fixation, TiRobot‑aided screw fixation has obvious advantages on blood loss, invasiveness, screw placement accuracy, patient and physician radiation exposure. Tirobot‑aided screw fixation involves a learning curve. During the initial phase, the surgical time is prolonged due to unfamiliarity with the technology; however, as proficiency improves, the surgical time is significantly reduced compared to traditional freehand technique. The K‑L approach combined with traditional freehand percutaneous anterior column screw fixation can also be a reliable alternative for transverse with or without posterior wall fractures of acetabulum, with the similar reduction quality, complications and functional outcomes.