Minimal-invasive Stabilisation von Azetabulumfrakturen mit virtueller Navigation in Kombination mit robotergestützter 3-D-Bildgebung

摘要

OBJECTIVE: Minimally invasive stabilization of non- and minimally displaced acetabular fractures using intraoperative, robot-assisted three-dimensional (3D) imaging and a navigation system. INDICATIONS: Nondisplaced or only minimally displaced fractures of the acetabulum. CONTRAINDICATIONS: Comminuted and highly displaced fractures of the acetabulum, protrusion of the femoral head into the pelvis with the need for open reduction, lack of possibility of intraoperative navigation. SURGICAL TECHNIQUE: After supine positioning the patient, the patient-side navigation reference is attached to the anterior superior iliac spine using a Schanz screw. The 3D scan and registration of the dataset in the navigation system can then be performed. This allows the 7.3 mm screws to be planned using 3D imaging and then implanted through minimally invasive incisions. POSTOPERATIVE MANAGEMENT: After successfully implanting the screws using the minimally invasive surgical technique, the patient can be mobilized the following day with pain-adapted physiotherapy exercises. Full weight bearing is usually possible. RESULTS: Between 2015 and 2023, 101 patients were treated using minimally invasive and navigation-assisted screw osteosynthesis for acetabular fractures. In 2 patients, a secondary screw dislocation occurred in the hip joint after mobilization, which required revision surgery with repositioning of the screw osteosynthesis and a hip arthroplasty, respectively. Minimally invasive navigated screw osteosynthesis, thus, offers adequate treatment of nondisplaced and minimally displaced acetabular fractures. Attention must be paid to the correct indication and surgical technique.