Abstract:

Objective

To discuss the early efficacy of the intelligent minimally invasive reduction robot system for pelvic fractures in the treatment of unstable pelvic fractures， and to analyze its clinical advantages， limitations and precautions.

Methods

A retrospective evaluation was conducted on 25 patients with unstable pelvic fractures treated by the robot system at the trauma orthopedics department of Foshan Traditional Chinese Medicine Hospital between June 2022 and November 2023. According to the Tile classification， there were 20 cases of type C and five cases of type B fractures. Minimally invasive closed reduction of pelvic fractures were performed with the assistance of the robot system. Pelvic CT scans and X-ray images at anteroposterior， outlet， and inlet positions were taken before and after surgery. The maximum displacement of the anterior and posterior pelvic rings before reduction and the maximum residual displacement of anterior and posterior pelvic rings after reduction were measured according to X-ray and CT images， and the quality of fracture reduction was evaluated by Matta criteria. The maximum displacement of the anterior and posterior pelvic rings before reduction， fluoroscopy frequency and time， reduction time， operation time，intraoperative blood loss， and maximum residual displacement of anterior and posterior pelvic rings after reduction were documented， and the distance required for the robotic arm to reduce the anterior and posterior pelvic rings was calculated. The fracture healing time and postoperative monitoring period were recorded， and the Majeed scoring system was used for functional evaluation.

Results

With the assistance of the robot system， 25 patients were all successfully treated with minimally invasive closed reduction for pelvic fractures. The average maximum displacement before reduction of the anterior pelvic ring was （16±7） mm. The average maximum displacement before reduction of the posterior pelvic ring was （9±6） mm. The intraoperative fluoroscopy frequency was 31 （19，58） times. The average fluoroscopy time was （31±16） s. The average reduction time was （59±4） min. The surgery time was 206 （200，213） min. The intraoperative blood loss was 100 （50，160） ml . The maximum residual displacement after reduction of the anterior and posterior pelvic rings were 2.1 （0， 7.6） mm， 3.8 （1.4，7.9）respectively. The distance required for the robotic arm to reduce the anterior and posterior pelvic rings were 14 （4，18） mm， 4.0 （1.8，6.6） mm respectively. According to Matta criteria， the reduction quality of both the anterior and posterior pelvic ring was excellent in 15 cases， good in seven cases， and fair in two cases， with a good-toexcellent rate of 91.7%. The fracture healing time was 3 （3， 4） months. Follow-up time for the 24 cases was 16 （14，19） months， with the Majeed functional score （85±8） on average. Nine cases scored excellent， and 16 cases were good， with a good-to-excellent rate of 100%.

Conclusion

In this study， the robot system can facilitate precise and minimally invasive closed reduction for the majority of patients with unstable pelvic fractures， achieving satisfactory fracture reduction quality and early efficacy.

Key words: Orthopedic Procedures, Surgical Navigation Systems, Hip Fractures, Traction, Closed Fracture Reduction