文献类型：期刊文献

中文题名：骨科天玑机器人在手术治疗胸腰椎骨折的临床应用

英文题名：Clinical application of Orthopedic Tianji Robot in surgical treatment of thoracolumbar fractures

作者：张同同[1,2];王增平[2];王中华[1,2];文杰[1,2];迟飞[1,2];薛文[2];宋玉鑫[2];刘林[2]

第一作者：张同同

机构：[1]甘肃中医药大学临床医学院,甘肃兰州730000;[2]甘肃省人民医院骨二科,甘肃兰州730000

第一机构：甘肃中医药大学临床医学院

年份：2021

卷号：34

期号：11

起止页码：1034

中文期刊名：中国骨伤

外文期刊名：China Journal of Orthopaedics and Traumatology

收录：CSTPCD;;Scopus;CSCD:【CSCD_E2021_2022】；PubMed;

基金：甘肃省人民医院院内科研基金项目(编号:20GSSY4-31);兰州市指导性科研项目(编号:2019-ZD-105)。

语种：中文

中文关键词：骨科天玑机器人;胸腰椎骨折;椎弓根螺钉

外文关键词：Orthopedic Tianji Robot;Thoracolumbar fractures;Pedicle screw

摘要：目的:探讨骨科天玑机器人在微创经皮椎弓根螺钉内固定术治疗胸腰椎骨折的临床应用。方法:回顾性分析2018年6月至2020年1月甘肃省人民医院收治的46例胸腰椎骨折患者的临床资料。根据手术所应用的辅助设备不同,将其分为C形臂X线加机器人辅助置钉组(观察组)和单纯C形臂X辅助下置钉组(对照组)。其中观察组22例,男12例,女10例;年龄24~61(40.23±12.19)岁;T113例,T128例,L19例,L22例。对照组24例,男15例,女9例;年龄26~58(42.88±10.31)岁;T113例,T1210例,L17例,L24例。分别记录并比较两组的手术时间、术中透视次数、术中出血量、住院天数及术后并发症,比较术前及术后3 d,1周及3个月的视觉模拟评分(visual analogue scale,VAS)评分,手术前后的伤椎矢状面Cobb角及椎体前缘高度百分比,并收集术后CT影像,依据Gertzbein-Robbins分类标准对置钉的准确性进行评估。结果:所有患者获得随访,时间5~12(7.07±0.83)个月。两组患者术中出血量、手术时间、住院天数比较差异无统计学意义(P>0.05)。术中透视次数观察组为(5.62±0.51)次,对照组为(12.54±0.52)次,两组差异有统计学意义(P<0.05)。两组术后各时间点VAS、伤椎前缘高度百分比及伤椎矢状面Cobb角较术前改善(P<0.05),但两组比较差异无统计学意义(P>0.05)。术后对照组出现1例切口感染,经积极换药后痊愈。两组患者均未出现螺钉松动、断裂等严重并发症,两组之间并发症的发生率比较差异无统计学意义(P>0.05)。观察组和对照组术后置钉准确率分别为98.4%(126/128)和90.3%(121/134),两组比较差异有统计学意义(P<0.05)。结论:在胸腰椎骨折的手术治疗中骨科天玑机器人辅助下椎弓根螺钉置入与单纯C形臂X线透视相比,前者克服了术者生理性震颤、疲劳及术中多次透视等缺点,提高了置钉准确率,是一种更加准确、安全的胸腰椎骨折椎弓根螺钉置入方式。
Objective:To explore the clinical application of Orthopedic Tianji Robot in the treatment of thoracolumbar fractures with minimally invasive percutaneous pedicle screw internal fixation.Methods:The clinical data of 46 patients with thoracolumbar fractures treated by minimally invasive percutaneous pedicle screw internal fixation from June 2018 to January 2020 in Gansu Provincial People's Hospital was retrospectively analyzed.According to the different aided equipments,the patients were divided into a C-arm X-ray plus robot-assisted nail placement group(observation group)and simple C-arm X-ray assisted nail placement group(control group).Twenty-two patients in observation group,including 12 males and 10 females,aged from 24 to 61 years old,with a mean of(40.23±12.19)years,3 cases were T11 vertebrae fracture,8 cases were T12,9 cases were L1,and 2 cases were L2.And there were 24 cases in control group,including 15 males and 9 females,aged from 26 to 58 years old,with a mean of(42.88±10.31)years,3 cases were T11 vertebrae fracture,10 cases were T12,7 cases were L1,and 4 cases were L2.The operation time,the number of intraoperative fluoroscopy,intraoperative blood loss,the days of hospitalization,and postoperative complications were recorded.Preoperative and postoperative VAS at 3 days,1 week and 3 months were compared between two groups.The sagittal Cobb angle of the injured vertebral body and the percentage of the anterior edge height of the vertebral body were observed before and after operation,and evaluate the accuracy of nail placement according to the Gertzbein-Robbins classification criteria with collected postoperative CT images.Results:All patients were followed up for 5 to 12 months with an average of(7.07±0.83)months.There was no significant differences in intraoperative blood loss,operation time and hospitalization days between two groups(P>0.05).The number of intraoperative fluoroscopy was(5.62±0.51)times in observation group and(12.54±0.52)in control group,the difference between two groups was statistically significant(P<0.05).The VAS,the percentage of the height of the injured vertebra anterior edge and the Cobb angle of the injured vertebral plane at each time point after operation were improved(P<0.05),but the difference between two groups was not statistically significant(P>0.05).One case of postoperative incision infection occurred in the control group,which was cured after active dressing changes.There were no serious complications such as screw loosening and breakage in all patients,and there was no statistically significant difference in the incidence of complications between two groups(P>0.05).The postoperative nail placement accuracy rates of the observation group and the control group were 98.4%(126/128)and 90.3%(121/134),respectively,and the difference was statistically significant(P<0.05).Conclusion:In the surgical treatment of thoracolumbar fractures,compared with simple C-arm fluoroscopy,the pedicle screw placement assisted by Orthopedic Tianji Robot overcomes the shortcomings of surgeon's physiological tremor,fatigue and multiple intraoperative fluoroscopy,improves the accuracy of screw placement,and is a more accurate and safer way of pedicle screw placement for thoracolumbar fractures.