Objective To explore the efficacy of internal fixation of TightRope buckle steel plate with robot assistance for acute acromioclavicular joint dislocation.Methods From October 2022 to December 2023,17 patients with acute acromioclavicular dislocation admitted to our hospital were treated with robot assisted TightRope buckle steel plate fixation.According to the Rockwood classification,there were 2 patients with type Ⅱ and 15 patients with type Ⅲ.Preoperative planning was carried out by the robot's"super brain".During the surgery,under the guidance of the robotic arm,a hole was drilled from the clavicle to the coracoid process,and one end of the loop steel plate was pushed into the coracoid process to tighten the tail line,achieving the goal of resetting the acromioclavicular joint.Results The operations were successfully completed in all the 17 patients,with an operation time of 15-42 min(mean,27.9 min)and intraoperative blood loss of 5-25 ml(mean,10.4 ml).Postoperative DR showed that the acromioclavicular joint had been reduced.All incisions healed in one stage without any vascular or nerve related complications.On the second day after surgery,CT evaluation showed that the accuracy of clavicle drilling position was excellent in 12 cases and good in 5 cases and accuracy of coracoid process drilling was excellent in 9 cases,good in 7 cases,and poor in 1 case.All the 17 patients were followed up for 6-12 months,with an average of 10.4 months.On the second day and six months after surgery,there were no significant differences in the distance between the surface cortex below the acromion and the surface cortex below the distal clavicle on the affected and healthy side[0.15(0.00,0.50)mm vs.-0.40(0.70,0.70)mm,Z=-1.553,P=0.120;0.15(0.00,0.50)mm vs.0.20(-0.25,0.85)mm,Z=-0.466,P=0.641].At six months after surgery,the distance between the surface cortex below the acromion and the surface cortex below the distal clavicle on the affected side was significantly higher than on the second day[0.20(-0.25,0.85)mm vs.-0.40(0.70,0.70)mm,Z=-3.426,P=0.001].On the second day after surgery,the Visual Analogue Scale(VAS)score was 3.0(3.0,4.0)points,significantly lower than the preoperative score of 4.0(3.5,5.5)points(Z=-2.716,P=0.007).On the sixth month,the VAS score was1.0(0.0,1.5)points,significantly lower than the preoperative score(Z=-3.649,P=0.000)and on the second day after surgery(Z=-3.672,P=0.000).At the last follow-up,the Constant Murley score for shoulder joint function ranged 91-100 points,with an average of 94.3 points,all of which were excellent.The American Shoulder and Elbow Surgeons(ASES)score ranged 87-100 points,with an average of 96.7 points,the excellent and good rate being 100%(15 cases were excellent and 2 cases were good).Conclusion The use of robot assisted TightRope buckle loop steel plate internal fixation technology for the treatment of acute Rockwood type Ⅱ and Ⅲ acromioclavicular dislocation has good therapeutic effects.

Objective Pelvic fracture urethral distraction defect(PFUDD)is relatively rare among boys and difficult to manage.This study aims to explore the efficacy of progressive urethral anastomosis in the treatment of this disease.Methods A total of 34 male children with PFUDD who were admitted to our hospitals during Jan.2008 and Dec.2022 were collected.The therapeutic effects and the occurrence of postoperative complications were observed and analyzed.Results All cases were traumatic pelvic fractures,including fall injuries in 3 cases,traffic-related impact injuries in 21 cases,and pelvic crush injuries in 10 cases.Urethroplasty was performed at least 3 months after the initial trauma or after the failure of the last intervention.The mean length of the urethral defect was 3.0 cm,with a range of 1.5 to 5.5 cm.Three cases complicated with urethrorectal fistula underwent urethroplasty concomitant with fistula repair.All children were followed up for an average of 65.5 months,with a range of 5.0 to 155.0 months,with 32 cases(94.1％)achieving successful treatment.Two cases with stricture recurrence were cured by a second operation.Three cases with mild urinary incontinence were improved after half a year of pelvic floor muscle rehabilitation training.Conclusion The progressive urethral anastomosis strategy can yield a relatively high success rate.The trans-inferior-pubic resection or simpler approaches can be adopted for the treatment of PFUDD in over 90％of male children.

Objective Pelvic fracture urethral distraction defect(PFUDD)is relatively rare among boys and difficult to manage.This study aims to explore the efficacy of progressive urethral anastomosis in the treatment of this disease.Methods A total of 34 male children with PFUDD who were admitted to our hospitals during Jan.2008 and Dec.2022 were collected.The therapeutic effects and the occurrence of postoperative complications were observed and analyzed.Results All cases were traumatic pelvic fractures,including fall injuries in 3 cases,traffic-related impact injuries in 21 cases,and pelvic crush injuries in 10 cases.Urethroplasty was performed at least 3 months after the initial trauma or after the failure of the last intervention.The mean length of the urethral defect was 3.0 cm,with a range of 1.5 to 5.5 cm.Three cases complicated with urethrorectal fistula underwent urethroplasty concomitant with fistula repair.All children were followed up for an average of 65.5 months,with a range of 5.0 to 155.0 months,with 32 cases(94.1％)achieving successful treatment.Two cases with stricture recurrence were cured by a second operation.Three cases with mild urinary incontinence were improved after half a year of pelvic floor muscle rehabilitation training.Conclusion The progressive urethral anastomosis strategy can yield a relatively high success rate.The trans-inferior-pubic resection or simpler approaches can be adopted for the treatment of PFUDD in over 90％of male children.

Objective To explore the efficacy of internal fixation of TightRope buckle steel plate with robot assistance for acute acromioclavicular joint dislocation.Methods From October 2022 to December 2023,17 patients with acute acromioclavicular dislocation admitted to our hospital were treated with robot assisted TightRope buckle steel plate fixation.According to the Rockwood classification,there were 2 patients with type Ⅱ and 15 patients with type Ⅲ.Preoperative planning was carried out by the robot's"super brain".During the surgery,under the guidance of the robotic arm,a hole was drilled from the clavicle to the coracoid process,and one end of the loop steel plate was pushed into the coracoid process to tighten the tail line,achieving the goal of resetting the acromioclavicular joint.Results The operations were successfully completed in all the 17 patients,with an operation time of 15-42 min(mean,27.9 min)and intraoperative blood loss of 5-25 ml(mean,10.4 ml).Postoperative DR showed that the acromioclavicular joint had been reduced.All incisions healed in one stage without any vascular or nerve related complications.On the second day after surgery,CT evaluation showed that the accuracy of clavicle drilling position was excellent in 12 cases and good in 5 cases and accuracy of coracoid process drilling was excellent in 9 cases,good in 7 cases,and poor in 1 case.All the 17 patients were followed up for 6-12 months,with an average of 10.4 months.On the second day and six months after surgery,there were no significant differences in the distance between the surface cortex below the acromion and the surface cortex below the distal clavicle on the affected and healthy side[0.15(0.00,0.50)mm vs.-0.40(0.70,0.70)mm,Z=-1.553,P=0.120;0.15(0.00,0.50)mm vs.0.20(-0.25,0.85)mm,Z=-0.466,P=0.641].At six months after surgery,the distance between the surface cortex below the acromion and the surface cortex below the distal clavicle on the affected side was significantly higher than on the second day[0.20(-0.25,0.85)mm vs.-0.40(0.70,0.70)mm,Z=-3.426,P=0.001].On the second day after surgery,the Visual Analogue Scale(VAS)score was 3.0(3.0,4.0)points,significantly lower than the preoperative score of 4.0(3.5,5.5)points(Z=-2.716,P=0.007).On the sixth month,the VAS score was1.0(0.0,1.5)points,significantly lower than the preoperative score(Z=-3.649,P=0.000)and on the second day after surgery(Z=-3.672,P=0.000).At the last follow-up,the Constant Murley score for shoulder joint function ranged 91-100 points,with an average of 94.3 points,all of which were excellent.The American Shoulder and Elbow Surgeons(ASES)score ranged 87-100 points,with an average of 96.7 points,the excellent and good rate being 100%(15 cases were excellent and 2 cases were good).Conclusion The use of robot assisted TightRope buckle loop steel plate internal fixation technology for the treatment of acute Rockwood type Ⅱ and Ⅲ acromioclavicular dislocation has good therapeutic effects.