| Objective:Acetabulum fractures are often caused by high-energy injuries,such as falls or car accidents.Acetabulum fractures account for about 0.95% of all adult skeletal fractures,and among all acetabulum fractures,acetabular anterior column fractures account for about 12.39%.Due to the complexity of its anatomy,acetabular anterior column fractures pose significant surgical difficulty and high risk.Cases have been reported of traditional manual percutaneous screw fixation surgery resulting in damage to pelvic vascular bundles and pelvic organs.The emergence of orthopedic robots has changed this traditional surgical approach and opened up a new approach for minimally invasive acetabular anterior column screw fixation surgery.Methods:The present experiment adopts a case-control study design,collecting 40 patients who were admitted to Shanxi Bethune Hospital between 2016 and 2022.These patients were divided into a navigation group and a non-navigation group based on different surgical methods.The navigation group collected and followed up on 21 patients who received percutaneous cannulated screw fixation treatment for anterior column fractures of the acetabulum using robot navigation.There were 15 males and 6 females,with an average age of 46.57±16.52 years,an average height of 166.62±7.76 cm,and an average weight of 69.48±10.13 kg.The manual group collected and followed up on 18 patients who received manual percutaneous cannulated screw internal fixation surgery for anterior column fractures of the acetabulum.There were 12 males and 6 females,with an average age of 51±12.01 years,an average height of 166.5±6.15 cm,and an average weight of 65.61±6.13 kg.Both groups of patients underwent X-ray fluoroscopy of the pelvis in the anteroposterior,inlet,outlet,obturator oblique,and iliac oblique positions during surgery to confirm satisfactory fracture reduction and appropriate positioning of the plates and screws.The number of times the patients’ guide wires were adjusted,the number of intraoperative fluoroscopies,the duration of surgery,and the amount of intraoperative bleeding were recorded.Postoperative X-rays and multi-slice spiral CT scans were performed,and the surgical incision was dressed and observed for postoperative complications,which were promptly treated.Postoperative multi-slice spiral CT scan data were collected and the hip socket model was reconstructed and measured using Mimics 21.0,Geomagic Design X,and CREO 8.0 software to assess the relationship between the screw placement position and the bone cortex.Patients were followed up at6 months postoperatively and Merle D’Aubigné and Postel scores were collected.Organize data and collect general patient information such as age and gender.Select surgery time,hospital stay,intraoperative bleeding volume,incidence of complications,and Merle D’Aubigne and Postel score at 6 months postoperatively as safety evaluation indicators.The number of guide wire adjustments,intraoperative fluoroscopy times,and screw placement quality will be used as accuracy evaluation indicators.Data processing and analysis will be conducted using SPSS 21.00 software.Results:A total of 39 patients who met the inclusion and exclusion criteria were enrolled in this study,including 21 patients in the navigation group and 18 patients in the manual group.There was no significant statistical difference in the length of the surgical incision between the navigation and manual groups(P>0.05).However,there were significant statistical differences in the number of needle adjustments and intraoperative fluoroscopy between the two groups(P<0.05),with the navigation group having fewer needle adjustments and intraoperative fluoroscopy times than the manual group.A total of 39 vertebral pedicle screws were inserted,including 21 screws in the navigation group and 18 screws in the manual group.There was a statistically significant difference(P<0.05)in the distance score(d)for evaluating screw placement quality between the navigation and manual groups,with better screw placement quality in the navigation group.There was no significant statistical difference(P>0.05)in the postoperative Merle D’Aubigné and Postel score or incidence of complications between the two groups.Conclusion:The study results showed that the accuracy and safety of using the Tirobot-assisted insertion technique were significantly higher than those of manual techniques.Compared with manual techniques,the Tirobot-assisted insertion technique has the advantages of less trauma,less bleeding,shorter operation time,and higher accuracy of screw placement.In addition,it also reduces minimizes radiation exposure for both patients and doctors.Therefore,in the surgery of acetabular anterior column screw placement,the use of the Tirobot-assisted technique is a better choice. |
