Objective: To summarize the surgical learning curve and preliminary operative experience of dual-robotic navigated minimally invasive treatment on pelvic fractures by TiRobot and Artis Zeego.
Methods: Between July 2019 and February 2021, 90 patients with pelvic fractures were treated with dual-robotic navigated minimally invasive surgery by TiRobot and Artis Zeego. There were 64 males and 26 females, with an average age of 46.5 years (range, 13-78 years). Body mass index was 14.67-32.66 kg/m 2 (mean, 23.61 kg/m 2). Causes of injuries included traffic accident in 43 cases, falling from height in 37 cases, low-energy injuries such as flat falls in 10 cases. The interval between injury and surgery was 1-36 days (mean, 7.3 days). According to the location of the implanted screws, the patients were divided into sacroiliac screw group ( n=33), acetabular screw group (acetabulum anterior/posterior column, n=24), composite screws group (sacroiliac and acetabulum anterior/posterior column, n=33). According to the screw implantation time and accuracy, the surgical learning curve was plotted, and the differences in the relevant indicators between learning stage and skilled stage were compared.
Results: All 90 patients successfully completed the operation, the intraoperative bleeding volume was 5-200 mL (median, 20 mL). There was no vascular or nerve injury. All incisions healed by first intention. The screw implantation time ranged from 7.5 to 33.0 minutes (mean, 18.92 minutes), and the screw implantation accuracy ranged from 1.1 to 1.8 mm (mean, 1.56 mm). According to the learning curve, the practice stage of 3 groups was reached after 7, 10, and 11 cases, respectively. With the accumulation of surgical experience, the screw implantation time had a significant downward trend. Compared with the learning stage, the screw implantation time on skilled stage in 3 groups significantly shortened ( P<0.05), but the difference in the screw implantation accuracy was not significant ( P>0.05).
Conclusion: TiRobot and Artis Zeego assisted pelvic fracture surgery is safe and efficient, which helps the surgeon to quickly master the pelvic channel screw surgery, and the operation time is significantly shortened on the premise of ensuring the implantation accuracy.
目的: 总结天玑骨科机器人（TiRobot）联合Artis Zeego系统的双机器人模式微创治疗骨盆骨折的初步应用经验，分析手术学习曲线。.
方法: 2019年7月—2021年2月，采用TiRobot联合 Artis Zeego 系统微创治疗90例骨盆骨折患者。男64例，女26例；年龄13～78岁，平均46.5岁。身体质量指数14.67～32.66 kg/m 2，平均23.61 kg/m 2。致伤原因：交通事故伤43例，高处坠落伤37例，跌倒等低能量损伤10例。受伤至手术时间1～36 d，平均7.3 d。根据植入螺钉部位，将患者分为骶髂螺钉组（ n=33）、髋臼螺钉组（髋臼前柱或后柱， n=24）、复合螺钉组（骶髂及髋臼前、后柱， n=33），记录螺钉植入时间及植入精度，并绘制手术学习曲线，比较初学期及熟练期相关指标差异。.
结果: 90例患者均顺利完成手术。术中出血量5～200 mL，中位数20 mL；无血管神经损伤发生。术后切口均Ⅰ期愈合。患者螺钉植入时间7.5～33.0 min，平均18.92 min；螺钉植入精度1.1～1.8 mm，平均1.56 mm。骶髂螺钉组、髋臼螺钉组、复合螺钉组分别于完成7、10、11例手术后进入适应期。随手术经验积累，螺钉植入时间有明显下降趋势。与初学期相比，3组熟练期螺钉植入时间缩短（ P<0.05），但螺钉植入精度差异无统计学意义（ P>0.05）。.
结论: TiRobot联合Artis Zeego系统的双机器人模式辅助骨盆骨折手术安全、高效，有助于术者迅速掌握导航下的骨盆通道螺钉微创植入技术，在确保植入精度的前提下，明显缩短操作时间。.
Keywords: Artis Zeego system; TiRobot; learning curve; pelvic fracture; three-dimensional navigation.