Abstract
Objectives
Percutaneous iliosacral screw placement is a standard, stabilization technique for pelvic fractures. The purpose of this study was to assess the effectiveness of a novel biplanar robot navigation aiming system for percutaneous iliosacral screw placement in a human cadaver model.
Methods
A novel biplanar robot navigation aiming system was used in 16 intact human cadaveric pelvises for percutaneous iliosacral screw insertion. The number of successful screw placements and mean time for this insertion and intra-operative fluoroscopy per screw-pair were recorded respectively to evaluate the procedure. The accuracy of the aiming process was evaluated by computed tomography.
Results
Sixteen intact human cadaveric pelvises were treated with percutaneous bilateral iliosacral S1 screw placement (32 cannulated screws, diameter-7.3mm, Synthes, Switzerland). All screws were placed under fluoroscopy-guided control using the biplanar robot navigation aiming system (TINAV, GD2000, China). There was no failed targeting for screw-pair placements. Computed tomography revealed high accuracy of the insertion process. 32 iliosacral screws were inserted (mean operation time per screw-pair 56 ± 3 minutes, mean fluoroscopy time per screw-pair 11.7 ± 9 seconds). In post-operative CT-scans the screw position was assessed and graded as follows: I. secure positioning, completely inserted in the cancellous bone (86%); II. secure positioning, but contacting cortical bone structures (9%); III. malplaced positioning, penetrating the cortical bone (5%).
Conclusion
This cadaver study indicated that an aiming device–based biplanar robot navigation system is highly reliable and accurate. The promising results suggest that it has the advantages of high positioning accuracy, decreased radiation exposure, operational stability and safety. It can be used not only for the percutaneous iliosacral screw placement but also for other orthopedic surgeries that require precise positioning.
