Objective To study the operative methods and therapeutic effects of acetabulum reinforcement ring in the reconstruction of acetabular defects in primary and revisional artificial hip replacement. Methods From November 2000 to July 2005, 14 cases (15 hips) of severe acetabular defects in artificial hip replacement were treated with acetabulum reinforcement ring combined autogenous or allogenic bone transplantation, including 7 males and 8 females aged 34-72 years with an average of 55 years. Among them, 9 cases (9 hips) underwent artificial hip joint revision, which was 3-22 years (average8.9 years) far away from their primary replacement, and 5 cases (6 hi ps) received primary replacement, including 1 case of rheumatoid arthritis of both hips, 1 osteoarthritis caused by acetabular dysplasia, 1 femoral head resection due to debridement of hi p infection, 1 nonunion of acetabulum old fracture with the center dislocation of femoral head and 1 old acetabulum fracture. The disease course was 2-25 years (average 11.6 years). According to the American Academy of Orthopaedic Surgeons (AAOS) classification, the acetabulum defects of 7 hips were categorized into Type II, 6 hips were Type III and 2 hips were Type IV. Harris score was (59.1 ± 15.4) points preoperatively. Results All wounds were healed by first intention. The symptom of sciatic nerve simulation was occurred in 1 case and was rel ieved after taking neuroprotective drug for 5 months. All the cases were followed up for 33-90 months (average 51.3 months). Harris score at the final follow-up was (81.9 ± 10.4) points, indicating there was a significant difference between before and after operation (P lt; 0.01). X-ray film demonstrated that the displacement of acetabulum reinforcement ring and acetabular cup was less than 5 mm, the rotation was less than 5°, and there was no progressive radiolucent zone around acetabulum and screw. Conclusion Acetabulum reinforcement ring is beneficial to reconstruct severe acetabular defects, improve hip joints’ function and provide primary stabil ity for putting acetabular cup into an ideal biomechanical position.
Objective To investigate the effectiveness of 5G remote robotic surgery in the treatment of pelvic fractures. Methods A retrospective analysis was conducted on the clinical data of 160 patients with pelvic fractures admitted between July 2023 and June 2024 who met the selection criteria. Among these patients, 80 underwent internal fixation surgery with the assistance of 5G remote robotic surgery (5G group), while 80 received local robotic surgical assistance (control group). Baseline characteristics, including gender, age, body mass index, disease duration, cause of injury, and fracture classification, were compared between the two groups, and no significant difference was found (P>0.05). The incision length, operation time, intraoperative blood loss, hospital stay, accuracy of screw placement, maximum residual displacement postoperatively, quality of fracture reduction, incidence of complications, Majeed pelvic function score and classification at last follow-up were recorded and compared between the two groups. Results In the 5G group, 180 screws were implanted during surgery, while 213 screws were implanted in the control group. The 5G group demonstrated significantly reduced intraoperative blood loss and shorter incision length compared to the control group (P<0.05). No significant difference was observed between the two groups in terms of operation time or hospital stay (P>0.05). Radiographic evaluation revealed excellent and good reduction rates of 98.8% (79/80) in the 5G group and 97.5% (78/80) in the control group, while excellent and good screw placement accuracy rates were 98.3% (177/180) in the 5G group and 95.8% (204/213) in the control group. No significant difference was found between the two groups in maximum residual displacement, reduction quality, or screw placement accuracy (P>0.05). All patients were followed up 7-16 months (mean, 11.3 months), with no significant difference in follow-up duration between the groups (P>0.05). No perioperative or follow-up complication, such as wound infection, iatrogenic fractures, iatrogenic neurovascular injury, screw loosening or breakage, or nonunion, were observed in either group. The control group exhibited a worse degree of gait alteration compared to the 5G group (P<0.05), while no significant difference was found in incidences of squatting limitation or persistent pain (P>0.05). At last follow-up, no significant difference was observed between the groups in Majeed pelvic function scores or grading (P>0.05). Conclusion Compared with the local surgery group, 5G remote robotic surgery supported by remote expert technical guidance demonstrated smaller incision lengths, less intraoperative blood loss, and fewer postoperative complications, and was shown to be a precise, minimally invasive, safe, and reliable surgical method.
Objective To investigate the accuracy and safety of percutaneous screw fixation for pelvic and acetabular fractures with remote navigation of orthopedic robot based on 5G technology. Methods Between January 2021 and December 2021, 15 patients with pelvic and/or acetabular fractures were treated with percutaneous screws fixation which were placed by remote navigation of orthopedic robot based on 5G technology. There were 8 males and 7 females. The age ranged from 20 to 98 years, with an average of 52.1 years. The causes of trauma included traffic accident injury in 6 cases, falling from height injury in 6 cases, fall injury in 2 cases, and heavy object smashing injury in 1 case. The time from injury to operation ranged from 3 to 32 days, with an average of 10.9 days. There were 8 cases of simple pelvic fractures, 2 simple acetabular fractures, and 5 both pelvic and acetabular fractures. There were 7 cases of pelvic fractures of Tile type B2, 2 type B3, 1 type C1, and 3 type C2; 4 cases of unilateral anterior column fracture of the acetabulum, 2 bilateral anterior column fractures, and 1 anterior wall fracture. CT images within 5 days after operation were collected for screw position assessment. The screw planning time and guidewire placement time were recorded, as well as the presence of intraoperative adverse events and complications within 5 days after operation. Results All patients achieved satisfactory surgical results. A total of 36 percutaneous screws were inserted (20 sacroiliac screws, 6 LC Ⅱ screws, 9 anterior column screws, and 1 acetabular apical screw). In terms of screw position evaluation, 32 screws (88.89%) were excellent and 4 screws (11.11%) were good; there was no screw penetrating cortical bone. The screw planning time ranged from 4 to 15 minutes, with an average of 8.7 minutes. The guidewire placement time ranged from 3 to 10 minutes, with an average of 6.8 minutes. The communication delayed in 2 cases, but the operation progress was not affected, and no serious intraoperative adverse events occurred. No delayed vascular or nerve injury, infection, or other complications occurred within 5 days after operation. No cases need surgical revision. ConclusionThe fixation of pelvic and acetabular fractures by percutaneous screw with remote navigation of orthopedic robot based on 5G technology is accurate, safe, and reliable.