{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:50:44Z","timestamp":1793505044636,"version":"4.5.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T00:00:00Z","timestamp":1672790400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T00:00:00Z","timestamp":1672790400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Surg Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>To evaluate the effectiveness and safety of robot-aided percutaneous triangular osteosynthesis combined with close reduction for vertically unstable sacrum fractures (VUSFs).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The data on 21 patients of the VUSF were retrospectively analyzed from November 2016 to January 2021. According to Denis classification, there were 3 cases in zone I, 11 cases in zone II, and 7 case in zone III. The main perioperative indicators were recorded. The maximal angulation and displacement deviations of the screws were analyzed by comparing the planned trajectory with the actual position. Postoperative X-ray radiographs and CT scans were obtained for evaluating the reduction quality. Functional outcome was scored with Majeed criterion.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Fourteen patients of the unilateral VUSF and 7 patients of the bilateral VUSF underwent unilateral and bilateral triangular osteosynthesis with robotic assistance, respectively. No intraoperative neurovascular injuries and postoperative infection occurred. All patients were followed up for at least 12\u00a0months. The average operation time of posterior pelvic ring was 111.4\u00a0min, with the mean intraoperative bleeding of 110.5\u00a0ml. A total of 58 pedicle and iliosacral screws were implanted with robotic assistance. Of those, 52 screws were in the cancellous bone except 4 pedicle and 2 iliosacral screws cutting the cortical bone. The angulation and displacement deviations of the screws were 4.2\u00b0\u2009\u00b1\u20092.5\u00b0 and 1.7\u2009\u00b1\u20090.9\u00a0mm, respectively. The average displacement of the sacral fracture was reduced from 19.7\u00a0mm preoperatively to 3.1\u00a0mm postoperatively. According to Matta\u2019s criterion, the reduction quality was graded as \u201cexcellent\u201d in 13 patients and \u201cgood\u201d in 8. All sacral fractures healed within 6\u00a0months except one fracture with nonunion. The mean Majeed score at the last follow-up was 89.6.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Robot-aided triangular osteosynthesis combined with close reduction provide a safe and reliable option for percutaneous treatment of the fresh VUSF, with a high accuracy of iliosacral and pedicle screw implantation except insertion of iliac screws. Meanwhile, the technique may help to reduce incision-related complications.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13018-022-03489-4","type":"journal-article","created":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T03:02:42Z","timestamp":1672801362000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Robotic guidance for percutaneous placement of triangular osteosynthesis in vertically unstable sacrum fractures: a single-center retrospective study"],"prefix":"10.1186","volume":"18","author":[{"given":"Zhao-Jie","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,1,4]]},"reference":[{"issue":"5","key":"3489_CR1","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1097\/00005131-199806000-00002","volume":"12","author":"TA Schildhauer","year":"1998","unstructured":"Schildhauer TA, Josten C, Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma. 1998;12(5):307\u201314. https:\/\/doi.org\/10.1097\/00005131-199806000-00002.","journal-title":"J Orthop Trauma"},{"issue":"1","key":"3489_CR2","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1097\/00005131-200301000-00004","volume":"17","author":"TA Schildhauer","year":"2003","unstructured":"Schildhauer TA, Ledoux WR, Chapman JR, Henley MB, Tencer AF, Routt ML Jr. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma. 2003;17(1):22\u201331. https:\/\/doi.org\/10.1097\/00005131-200301000-00004.","journal-title":"J Orthop Trauma"},{"issue":"2","key":"3489_CR3","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1302\/0301-620X.93B2.24567","volume":"93","author":"O Berber","year":"2011","unstructured":"Berber O, Amis AA, Day AC. Biomechanical testing of a concept of posterior pelvic reconstruction in rotationally and vertically unstable fractures. J Bone Joint Surg Br. 2011;93(2):237\u201344. https:\/\/doi.org\/10.1302\/0301-620X.93B2.24567.","journal-title":"J Bone Joint Surg Br"},{"issue":"5","key":"3489_CR4","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1097\/BOT.0b013e3181a32b91","volume":"23","author":"HC Sagi","year":"2009","unstructured":"Sagi HC, Militano U, Caron T, Lindvall EA. Comprehensive analysis with minimum 1\u2043year follow\u2043up of vertically unstable transforaminal sacral fractures treated with triangular osteosynthesis. J Orthop Trauma. 2009;23(5):313\u201321. https:\/\/doi.org\/10.1097\/BOT.0b013e3181a32b91.","journal-title":"J Orthop Trauma"},{"issue":"2","key":"3489_CR5","doi-asserted-by":"publisher","first-page":"262","DOI":"10.3390\/jpm12020262","volume":"12","author":"YT Tsai","year":"2022","unstructured":"Tsai YT, Chou YC, Wu CC, Yeh TT. Traditional versus minimally invasive spinopelvic fixation for sacral fracture treatment in vertically unstable pelvic fractures. J Pers Med. 2022;12(2):262\u201372. https:\/\/doi.org\/10.3390\/jpm12020262.","journal-title":"J Pers Med"},{"issue":"1","key":"3489_CR6","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1186\/s13018-021-02768-w","volume":"16","author":"KE Wenning","year":"2021","unstructured":"Wenning KE, Yilmaz E, Schildhauer TA, Hoffmann MF. Comparison of lumbopelvic fixation and iliosacral screw fixation for the treatment of bilateral sacral fractures. J Orthop Surg Res. 2021;16(1):604. https:\/\/doi.org\/10.1186\/s13018-021-02768-w.","journal-title":"J Orthop Surg Res"},{"issue":"1","key":"3489_CR7","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.injury.2020.10.006","volume":"52","author":"S Erkan","year":"2021","unstructured":"Erkan S, Cetinarslan O, Okcu G. Traumatic spinopelvic dissociation managed with bilateral triangular osteosynthesis: Functional and radiological outcomes, health related quality of life and complication rates. Injury. 2021;52(1):95\u2013101. https:\/\/doi.org\/10.1016\/j.injury.2020.10.006.","journal-title":"Injury"},{"issue":"6","key":"3489_CR8","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1007\/s00402-010-1230-0","volume":"131","author":"G Osterhoff","year":"2011","unstructured":"Osterhoff G, Ossendorf C, Wanner GA, Simmen HP, Werner CM. Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications. Arch Orthop Trauma Surg. 2011;131(6):809\u201313. https:\/\/doi.org\/10.1007\/s00402-010-1230-0.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"2","key":"3489_CR9","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1097\/00005131-199902000-00007","volume":"13","author":"JF Keating","year":"1999","unstructured":"Keating JF, Werier J, Blachut P, Broekhuyse H, Meek RN, O\u2019Brien PJ. Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion. J Orthop Trauma. 1999;13(2):107\u201313. https:\/\/doi.org\/10.1097\/00005131-199902000-00007.","journal-title":"J Orthop Trauma"},{"issue":"2","key":"3489_CR10","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1111\/os.12908","volume":"13","author":"ZJ Liu","year":"2021","unstructured":"Liu ZJ, Hu YC, Tian W, Jin X, Qi HT, Sun YX, Jia J. Robot-aided minimally invasive lumbopelvic fixation in treatment of traumatic spinopelvic dissociation. Orthop Surg. 2021;13(2):563\u201372. https:\/\/doi.org\/10.1111\/os.12908.","journal-title":"Orthop Surg"},{"key":"3489_CR11","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.932724","volume":"27","author":"ZJ Liu","year":"2021","unstructured":"Liu ZJ, Gu Y, Jin X, Tian W, Qi HT, Sun YX, Jia J. Comparison of outcomes following TiRobot-assisted sacroiliac screw fixation with bone grafting and traditional screw fixation without bone grafting for unstable osteoporotic sacral fracture: a single-center retrospective study of 33 patients. Med Sci Monit. 2021;27: e932724. https:\/\/doi.org\/10.12659\/MSM.932724.","journal-title":"Med Sci Monit"},{"issue":"1","key":"3489_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1302\/0301-620X.70B1.3276697","volume":"70","author":"M Tile","year":"1988","unstructured":"Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br. 1988;70(1):1\u201312. https:\/\/doi.org\/10.1302\/0301-620X.70B1.3276697.","journal-title":"J Bone Joint Surg Br"},{"key":"3489_CR13","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/0268-0033(88)90124-6","volume":"227","author":"F Denis","year":"1988","unstructured":"Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988;227:67\u201381. https:\/\/doi.org\/10.1016\/0268-0033(88)90124-6.","journal-title":"Clin Orthop Relat Res"},{"issue":"9","key":"3489_CR14","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1097\/00007632-198511000-00011","volume":"10","author":"R Roy-Camille","year":"1985","unstructured":"Roy-Camille R, Saillant G, Gagna G, Mazel C. Transverse fracture of the upper sacrum. Suicidal jumper\u2019s fracture. Spine (Phila Pa 1976). 1985;10(9):838\u201345. https:\/\/doi.org\/10.1097\/00007632-198511000-00011.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"3489_CR15","doi-asserted-by":"publisher","first-page":"889","DOI":"10.3171\/jns.1990.72.6.0889","volume":"72","author":"KJ Gibbons","year":"1990","unstructured":"Gibbons KJ, Soloniuk DS, Razack N. Neurological injury and patterns of sacral fractures. J Neurosurg. 1990;72(6):889\u201393. https:\/\/doi.org\/10.3171\/jns.1990.72.6.0889.","journal-title":"J Neurosurg"},{"key":"3489_CR16","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1097\/00003086-199608000-00016","volume":"329","author":"JM Matta","year":"1996","unstructured":"Matta JM, Tornetta P 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res. 1996;329:129\u201340. https:\/\/doi.org\/10.1097\/00003086-199608000-00016.","journal-title":"Clin Orthop Relat Res"},{"issue":"2","key":"3489_CR17","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1302\/0301-620X.71B2.2925751","volume":"71","author":"SA Majeed","year":"1989","unstructured":"Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg Br. 1989;71(2):304\u20136. https:\/\/doi.org\/10.1302\/0301-620X.71B2.2925751.","journal-title":"J Bone Joint Surg Br"},{"issue":"24","key":"3489_CR18","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000016004","volume":"98","author":"S Kanezaki","year":"2019","unstructured":"Kanezaki S, Miyazaki M, Notani N, Ishihara T, Sakamoto T, Sone T, Kataoka M, Tsumura H. Minimally invasive triangular osteosynthesis for highly unstable sacral fractures: technical notes and preliminary clinical outcomes. Medicine Baltimore. 2019;98(24): e16004. https:\/\/doi.org\/10.1097\/MD.0000000000016004.","journal-title":"Medicine Baltimore."},{"issue":"5","key":"3489_CR19","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1097\/BSD.0000000000000798","volume":"32","author":"H Tsuji","year":"2019","unstructured":"Tsuji H, Takigawa T, Misawa H, Shiozaki Y, Yamakawa Y, Noda T, Ozaki T. Minimally invasive percutaneous spinopelvic fixation for unstable pelvic ring fracture performed with the patient in a lateral position. Clin Spine Surg. 2019;32(5):191\u20137. https:\/\/doi.org\/10.1097\/BSD.0000000000000798.","journal-title":"Clin Spine Surg"},{"issue":"10","key":"3489_CR20","doi-asserted-by":"publisher","first-page":"2521","DOI":"10.1007\/s00586-019-06180-1","volume":"29","author":"P Korovessis","year":"2020","unstructured":"Korovessis P, Spastris P, Syrimpeis V, Tsekouras V, Petrou S. Contemporary less invasive spinal instrumentation for AO C-type posterior pelvic ring injuries. Eur Spine J. 2020;29(10):2521\u201333. https:\/\/doi.org\/10.1007\/s00586-019-06180-1.","journal-title":"Eur Spine J"},{"issue":"3","key":"3489_CR21","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1007\/s00586-012-2561-z","volume":"22","author":"X Hu","year":"2013","unstructured":"Hu X, Pei F, Wang G, He J, Kong Q, Tu C. Application triangular osteosynthesis for vertical unstable sacral fractures. Eur Spine J. 2013;22(3):503\u20139. https:\/\/doi.org\/10.1007\/s00586-012-2561-z.","journal-title":"Eur Spine J"},{"issue":"9","key":"3489_CR22","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1016\/j.spinee.2017.04.032","volume":"17","author":"E Jazini","year":"2017","unstructured":"Jazini E, Weir T, Nwodim E, Tannous O, Saifi C, Caffes N, Costales T, Koh E, Banagan K, Gelb D, Ludwig SC. Outcomes of lumbopelvic fixation in the treatment of complex sacral fractures using minimally invasive surgical techniques. Spine J. 2017;17(9):1238\u201346. https:\/\/doi.org\/10.1016\/j.spinee.2017.04.032.","journal-title":"Spine J"},{"issue":"21","key":"3489_CR23","doi-asserted-by":"publisher","first-page":"E1297","DOI":"10.1097\/BRS.0000000000002694","volume":"43","author":"JN Shillingford","year":"2018","unstructured":"Shillingford JN, Laratta JL, Park PJ, Lombardi JM, Tuchman A, Saifi C, Lehman RA Jr, Lenke LG. Human versus robot: a propensity- matched analysis of the accuracy of free hand versus robotic guidance for placement of S2 alar-iliac (S2AI) screws. Spine (Phila Pa 1976). 2018;43(21):E1297\u2013304. https:\/\/doi.org\/10.1097\/BRS.0000000000002694.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"3489_CR24","doi-asserted-by":"publisher","first-page":"253","DOI":"10.3171\/2018.7.SPINE18710","volume":"30","author":"RR De la Garza","year":"2018","unstructured":"De la Garza RR, Nakhla J, Sciubba DM, Yassari R. Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis. J Neurosurg Spine. 2018;30(2):253\u20138. https:\/\/doi.org\/10.3171\/2018.7.SPINE18710.","journal-title":"J Neurosurg Spine"}],"container-title":["Journal of Orthopaedic Surgery and Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-022-03489-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13018-022-03489-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-022-03489-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,8]],"date-time":"2023-01-08T01:07:20Z","timestamp":1673140040000},"score":1,"resource":{"primary":{"URL":"https:\/\/josr-online.biomedcentral.com\/articles\/10.1186\/s13018-022-03489-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,4]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["3489"],"URL":"https:\/\/doi.org\/10.1186\/s13018-022-03489-4","relation":{},"ISSN":["1749-799X"],"issn-type":[{"value":"1749-799X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,4]]},"assertion":[{"value":"15 August 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 December 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 January 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures involving human participants in this study met the ethical standards of the institution and\/or the National Research Committee (the Ethics Committee of Tianjin hospital, China), as well as the 1964 Declaration of Helsinki and its subsequent amendments or similar ethical standards. Informed consent was obtained from all individual participants in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"The authors declare that the work described is a previously unpublished original study and is not considered for publication in whole or in part elsewhere. All authors listed have approved the manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"8"}}