Design and evaluation of an intelligent reduction robot system for the minimally invasive reduction in pelvic fractures

Abstract

Introduction Pelvic fracture is a severe high-energy injury with the highest disability and mortality of all fractures. Traditional open surgery is associated with extensive soft tissue damages and many complications. Minimally invasive surgery potentially mitigates the risks of open surgical procedures and is becoming a new standard for pelvic fracture treatment. The accurate reduction has been recognized as the cornerstone of minimally invasive surgery for pelvic fracture. At present, the closed reduction in pelvic fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces of soft tissue involved in the fragment manipulation, which might result in fracture malreduction. To overcome these shortcomings and facilitate pelvic fracture reduction, we developed an intelligent robot-assisted fracture reduction (RAFR) system for pelvic fracture. Methods The presented method is divided into three parts. The first part is the preparation of 20 pelvic fracture models. In the second part, we offer an automatic reduction algorithm of our robotic reduction system, including Intraoperative real-time 3D navigation, reduction path planning, control and fixation, and robotic-assisted fracture reduction. In the third part, image registration accuracy and fracture reduction accuracy were calculated and analyzed. Results All 20 pelvic fracture bone models were reduced by the RAFR system; the mean registration error E1 of the 20 models was 1.29 ± 0.57 mm. The mean reduction error E2 of the 20 models was 2.72 ± 0.82 mm. The global error analysis of registration and reduction results showed that higher errors are mainly located at the edge of the pelvis, such as the iliac wing. Conclusion The accuracy of image registration error and fracture reduction error in our study was excellent, which could reach the requirements of the clinical environment. Our study demonstrated the precision and effectiveness of our RAFR system and its applicability and usability in clinical practice, thus paving the way toward robot minimally invasive pelvic fracture surgeries.

TiRobot‑assisted versus conventional fluoroscopy-assisted percutaneous sacroiliac screw fixation for pelvic ring injuries: a meta‑analysis

“…Screw positioning, evaluated by Florian Gras classification, was notably improved in the TiRobot group in our meta-analysis. Reduction is a crucial step in the surgical treatment of bone fractures to achieve anatomical alignment and facilitate healing [ 37 , 38 ]. The Matta score evaluates the reduction quality of pelvic fractures [ 38 ].…”

Autonomous path planning for robot‐assisted pelvic fracture closed reduction with collision avoidance

“…Step Calculate the orientation difference. Based on the symmetry of the pelvis, 5,27 the target position (datum ilium) for the reduction was generated in the Solidworks from a mirror operation. As shown in Figure 4, a centre‐of‐mass coordinate system C1 aligned with the model coordinate system M is created using the centre‐of‐mass of the datum ilium as the origin.…”

“…As a modern technology with high precision, reliability, and intelligence, robotics is widely used in medical, industrial, and aerospace fields. Therefore, the reduction movements during pelvic fracture closed reduction surgery can be performed by controlling the robot 4–6 …”

“…Therefore, the reduction movements during pelvic fracture closed reduction surgery can be performed by controlling the robot. [4][5][6] With the rapid development and application of medical robotics, 7 the path planning for robot-assisted pelvic fracture closed reduction (RPFCR) has attracted broad researchers. The RPFCR path planning can be divided into two steps: collision detection and path search.The pelvic environment is complex, with many soft and hard tissues.…”

Comparison of Freehand Technique and a Novel Laser-Guiding Navigation System in Femoral Neck-Cannulated Screw Fixation: A Randomized Controlled Trial

“…Numerous novel technologies, such as orthopedic surgical robot navigation, computer-aided navigation, and orthopedic minimally invasive intelligent visualization system, have been invented to optimize the process of channel screw placement [3][4][5] . However, including the most widely used freehand method, these technologies cannot satisfy the needs of simplicity, accuracy, and low radiation exposure simultaneously [6] .…”