Analysis of the Therapeutic Effect of Robot-Assisted Sacroiliac Joint Screw Combined with INFIX in the Treatment of Unstable Pelvic Fractures

Luo Bin; Wu Yongjun; Wu Biao; Xu Shengkang

Abstract：Objective To explore the clinical efficacy of robot-assisted sacroiliac joint screw combined with anterior subcutaneous internal fixator(INFIX)in the treatment of unstable pelvic fractures.Methods A retrospective analysis was conducted on the data of 63 patients with unstable pelvic fractures who were treated at the Traumatic Orthopedics Department of Taihe Hospital in Shiyan City using the Tianji Orthopedic Robot-assisted posterior ring percutaneous sacroiliac joint screws combined with anterior ring INFIX from September 2021 to September 2024 including 29 males and 34 females,ageing from 18 to 60 years old[mnean(44.3±11.6)years old].According to Tile classification:There were 21 patients of B2 type,18 patients of B3 type,13 patients of C1 type,8 patients of C2 type,and 3 patients of C3 type.The following parameters were recorded:Surgical time,intraoperative blood loss,number of intraoperative fluoroscopies,the excellent rate of the initial screw placement position,the quality of fracture reduction(assessed by the Matta criteria),fracture healing time,and complications.The last follow-up was evaluated using the Majeed standard to assess the recovery of pelvic function.Results The follow-up period ranged from 12 to 32 months[mean(16.0±3.5)months].The surgical time was 65 to 90 minutes[mean(78.5±5.2)minutes].The intraoperative blood loss was 20 to 80 mL[mean(45.0±8.3)mL].A total of 95 posterior sacroiliac joint screws were implanted,including 57 screws at the S1 level and 38 screws at the S2 level.All the procedures of inserting the guide pin and inserting screws were completed at one time.All sacroiliac screws were in satisfactory positions during the operation,without entering the sacral canal,sacral foramen,or penetrating the bone.The number of intraoperative fluoroscopies ranged from 12 to 26 times[mean(15.5±1.8)times].8 patients experienced injury to the lateral femoral cutaneous nerve after the operation.All patients' sacroiliac joint screws were found to be without loosening.There were 3 cases of failure of INFIX after the operation.The fractures of the other 60 patients healed well,with the healing time ranging from 3 to 5 months[mean(3.5±0.6)months].The quality of fracture reduction was evaluated according to the Matta scoring criteria:31 cases were rated as excellent,28 cases as good,and 4 cases as fair.The overall excellent and good rate was 93.7％.At the last follow-up,the functional status was evaluated using the Majeed pelvic fracture quantification assessment system:43 cases were rated as excellent,15 cases as good,and 5 cases as fair.The excellent and good rate was 92.1％.Conclusion The treatment of unstable pelvic fractures using sacroiliac joint screws combined with INFIX under the assistance of robots has the advantages of minimally invasive,high precision,reduced radiation exposure and fewer complications.It is one of the minimally invasive methods that can be chosen by clinicians.