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Clinical Cases
  • -Case 1Robot-assisted femoral neck fracture operation
    Patient 60-year-old woman
    Condition Femoral neck fracture 
    Procedure Femoral neck screw internal fixation 
    Operation time 60 minutes 

     

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    In 2010, we performed the first femoral neck fracture operation with the assistances of orthopaedic robot,through five year's clinical follow-up,no complications such as non-union and ischemic necrosis of head of femur occurred. Operations became safer, more accurate and less radiation-depended, therefore, all cases obtained satisfactory results.

     

    Background
     

    Fracture of the neck of femur is a challenging injury to manage. It is often a fracture of fragility due to osteoporosis in the elderly, though in the younger age group, it usually results from high-energy trauma sustained in a road crash.

    The goals of treatment in patients with femoral neck fractures are to promote healing, to prevent complications and to return function. This is completed with either surgical or nonsurgical management. Several factors must be considered before a treatment plan is recommended. For example, tension fractures are potentially unstable and may require operative stabilization, while compression fractures are more stable than tension-type fractures, and they can be treated nonoperatively.

    In surgical intervention part, internal fixation remains the treatment of choice for these fractures in all age groups, more so in displaced fractures in the younger patients, where preservation of the femoral head is the priority. What's more, requirements for screws placement are very strict because accurate and stable screw placement is extremely important for postoperative recovery.

    Robot-assistant positioning system is indispensable for superior outcomes. The intrinsic value of robot-assistant internal fixation has been proven by a high union rate, low number of complications, and low invasiveness to the soft tissues around the femur.

     

  • -Case 2Pelvis fracture treatment
    Patient 28-year-old man
    Condition Anterior column combined wing of ilium fracture 
    Procedure Anterior column combined wing of ilium internal fixation 

     

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    Conventional 
    operation

    Robotic-assisted
    operation

    Compared with
    conventional method

    Operation time

    4 hours

    2 hours

    50% reduced

    Amount of bleeding

    2000 ml

    100 ml

    95% reduced

    Incisions

    30cm

    2cm

    minimal damage to soft tissue

    Implants

    6 plates

    6 screws

     

     

    With the assistances of orthopaedic robot, this complex operation was completed successfully by minimal invasive approach, operation time is shortened by half, blood loss was markedly reduced by 95%, incisions are about 2 centimeters, radiation amount is greatly reduced, therefore, patients need less time to recovery from the injuries and no complications will occur. Also, the hollow screws take place of plates as a substitute, the total surgical cost could be greatly reduced.
     
     
    Background
     
     
    The goals of treatment are the same for pelvic fractures as for fractures of other bones—a healed fracture with the prevention of nonunion, malunion, or other complications. 
     
    Internal fixation is preferred for definitive management and has been demonstrated to provide superior results for unstable pelvis fracture. Pelvis is surrounded by vital structures including major blood vessels and nerves and digestive and reproductive organs, high operative accuracy is necessary. Nowadays, fluoroscopic images are become useful technique, but exposure to radiation is harmful to both patients and doctors.
     
  • -Case 3Upper cervical deformity management
    Patient 43-year-old man
    Condition Atlantoaxial deformity and instability 
    Procedure Posterior C1-2 transarticular screw fixation 
    Operation time 5 hour 30 minutes 

     

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    Performing this complex operation is beyond the human capacity. In this case, we found out that it was impossible to insert the implant on the right side due to severe deformity, the left side was also malformed, there is only one trajectory that can be used to insert the screw. From the fluoroscopic images, the only channel is only approximately 5 millimeter, even a tiny error may cause catastrophic result. However, with the assistances of robot, we successfully insert a transarticular screw through the cannula on the robotic arm, the deviation between the planned and real trajectories is in sub-millimeter lever, which guaranteed the superior clinical outcome.

     

    Background
     

    The cervical deformity has great influence on patients’ daily life. However, the clinical treatment of it is still a challenge as the corrective surgery of the upper cervical spine has great risk because of the important structures and frequent anatomical variation around the atlantoaxial region using the traditional free-hand method.

    C1-C2 transarticular fixation is a reliable procedure. However, there are two types of limitations which severely affect the safety and precision. The first is the limitation of vision, surgeons cannot see the complex anatomical structure directly. The other is the limitation of manipulation. Insufficient steadiness and force control and a steep learning curve can cause severe problems during spine surgery, especially at the upper cervical region.  The accuracy always not sufficient for clinical use.