The Comparison Of Percutaneous Screw Placement Under Robot Navigation And Open Reduction Internal Fixation For Treating Pelvic And Acetabular Fractures

Objective:By comparing with the traditional surgical incision and internal fixation for the treatment of pelvic and acetabular fractures,we study the effect of robot navigation technology on the design of percutaneous screw insertion points and channels,and verify the advantages and clinical efficacy of this technology to the minimally invasive treatment of pelvic and acetabular fractures.The results provide strong evidence for its clinical promotion.Materials and Methods:The experiment used case-control study,set up observation group and control group.The observation group collected and followed up 21 cases of pelvic acetabular fracture treated by robotic guided navigation percutaneous hollow screw fixation from August 2018 to August 2019.Among them,10 cases were male and 11 cases were female,aged between 25 and 70 years,with an average age of 43 years.All patients in this group were treated with closed reduction or small incision pelvic reduction rack reduction,and robot-guided percutaneous hollow screw internal fixation.one patient was combined with Infix subcutaneous internal fixation.The control group collected and followed up 20 patients with pelvic acetabular fractures treated by traditional open reduction and internal fixation surgery in our hospital from August 2018 to August 2019,including 14 males and 6 females,aged 26 to 66 years,with an average age of 45 years.The patients in this group were fixed with modified Stoppa approach or combined iliac fossa approach and K-L approach with open reduction plate.Both groups performed intraoperative X-ray fluoroscopy of the positive position of the pelvis,the inlet position,the outlet position,the closed hole oblique position,and the iliac bone oblique position.The operative time and blood loss were recorded during the operation,and the X-ray and CT reconstruction were reviewed after operation.The fracture and articular surface reduction were evaluated according to clinical Matta criteriaScore,change the incision,observe and deal with the postoperative complications in time,hip function was evaluated 6 months after operation according to Majeed scoring criteria.collate the data,compare the operation time,blood loss,fracture reduction and hip Majeed score between the observation group and the control group,and use SPSS 21.00 software for data processing and analysis.Results:The operation time of the observation group was 1.0 to 2.5 hours,with an average of 1.61 hours,with a total of 48 screws placed,each of which was 20-35 minutes,with an average of 24.81 minutes;the operation time of the control group was 2.0 to 4.5 hours,with an average of 3.06 hours.Data of operation time of two groups did not accord with normal distribution,using ANOVA,the F=49.613,the P=0.00,P<0.05.There was a significant difference in statistics.The intraoperative bleeding volume of the observation group was 20-100 ml,with an average of 54.76 ml.intraoperative blood loss in the control group was 600-1500 ml with an average of 925.00 ml.Data of intraoperative bleeding of two groups were not in accordance with normal distribution,using ANOVA,the F=238.906,The P=0.00,P<0.05.There was a significant difference in statistics.The excellent and good rate of reduction effect in the observation group was 100%,and that in the control group was 95%.The excellent and good rate of hip function in the observation group was 85.7%(18/21),and that in the control group was 85.0%(17/20).The Majeed score was based on ANOVA,F=0.260,P=0.613,P>0.05,there was no statistical difference between the two groups.In the observation group,a total of 48 hollow screws were placed,22 screws were placed,25 screws were placed on the pubic branch and 1 screw was placed on the posterior column of the acetabulum.The safe implantation rate of the screw was 100%,and 26 screws of the pubic branch and the posterior column were placed in 0 grade.In the observation group,the incision of dressing change after operation was normal,no redness,purulent,wound healing was good,and the patient had no incision scar of more than 3 cm.two patients in the control group underwent postoperative change of medicine with fat liquefaction,one patient with delayed wound healing due to incision infection,and one patient with follow-up found failure of internal fixation and failure of fracture healing.Conclusion:Percutaneous hollow screw fixation under robot navigation for the treatment of pelvic acetabular fractures compared with the traditional open reduction plate internal fixation,has the characteristics of small trauma,less bleeding,short operation time,high accuracy of nail placement,and less postoperative complications,reducing the radiation exposure of patients and doctors.In terms of reduction effect and hip joint function recovery,the clinical effect is equally reliable and worthy of further promotion in clinic.