文献类型：期刊文献

中文题名：骨科机器人辅助下脊柱椎弓根螺钉置入准确性与安全性的临床研究

英文题名：Accuracy and safety of robot assisted pedicle screw placement

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

第一作者：张同同

机构：[1]甘肃中医药大学第一临床医学院,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：2022

卷号：35

期号：2

起止页码：108

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)。

语种：中文

中文关键词：外科手术,计算机辅助;机器人手术;椎弓根钉;准确性;安全性

外文关键词：Surgery,computer-assisted;Robotic surgical procedures;Pedicle screws;Accuracy;Safety

摘要：目的:探讨骨科机器人与C形臂X线透视辅助下脊柱椎弓根螺钉置入的准确性与安全性。方法:对2019年1月至2020年8月采用外科治疗的36例脊柱疾患病例进行回顾性分析。36例患者中18例采用骨科机器人辅助下的椎弓根螺钉置入(观察组),男12例,女6例;年龄16~61(38.44±3.60)岁;青少年脊柱侧弯1例,脊柱结核1例,腰椎滑脱7例,胸椎骨折4例,腰椎骨折5例。另外18例采用C形臂X线辅助下的椎弓根螺钉置入(对照组),男10例,女8例;年龄18~58(43.22±2.53)岁;青少年脊柱侧弯1例,腰椎滑脱6例,胸椎骨折6例,腰椎骨折5例。记录两组患者的术中透视次数、置钉时间及术后并发症;术后行CT扫描,采用Gertzbein-Robbins标准评价椎弓根螺钉置入的准确性,并计算椎弓根螺钉置入准确率。结果:观察组术中透视次数为(6.89±0.20)次,与对照组的(14.00±0.18)次比较,差异有统计学意义(P<0.05);观察组每枚螺钉置入时间为(2.56±0.12)min,与对照组的(4.22±0.17)min比较差异有统计学意义(P<0.05)。术后对照组出现1例切口感染,经积极换药后痊愈,随访期间两组患者均未出现螺钉松动、断裂等严重并发症,两组间并发症比较差异无统计学意义(P>0.05)。观察组共置入螺钉107枚,其中A类101枚,B类4枚,C类2枚,D类0枚,E类0枚,椎弓根螺钉置入的准确率=[(A类+B类螺钉数目)/组内所有置入螺钉数目]×100%=98.1%(105/107);对照组共置入螺钉104枚,其中A类90枚,B类4枚,C类5枚,D类5枚,E类0枚,椎弓根螺钉置入的准确率=[(A类+B类螺钉数目)/组内所有置入螺钉数目]×100%=90.3%(94/104),两组比较差异有统计学意义(P<0.05)。结论:骨科机器人辅助下置入椎弓根螺钉术中透视次数少,置钉时间短,准确率更高,可使手术安全性进一步提高,在骨科领域具有广阔的应用前景。
Objective:To investigate the accuracy and safety of pedicle screw placement assisted by orthopedic robot and C-arm fluoroscopy.Methods:The clinical data of 36 patients with spinal diseases underwent surgical treatment from January 2019 to August 2020 was retrospectively analyzed.Among them,18 cases were implanted pedicle screws assisted by orthopaedic robot(observation group),including 12 males and 6 females,aged from 16 to 61 years with an average of(38.44±3.60)years;there were 1 case of adolescent scoliosis,1 case of spinal tuberculosis,7 cases of lumbar spondylolisthesis,4 cases of thoracic fracture and 5 cases of lumbar fracture.Another 18 cases were implanted pedicle screws assisted by C-arm fluoroscopy(control group),including 10 males and 8 females,aged from 18 to 58 years with an average of(43.22±2.53)years;there were 1 case of adolescent scoliosis,6 cases of lumbar spondylolisthesis,6 cases of thoracic fracture and 5 cases of lumbar fracture.The intraoperative fluoroscopy times,nail placement time and postoperative complications were recorded in two groups.CT scan was performed after operation.The Gertzbein-Robbins standard was used to evaluate the accuracy of pedicle screw placement which was calculated.Results:The number of intraoperative fluoroscopy in observation group was(6.89±0.20)times,which was significantly higher than that in control group(14.00±0.18)times(P<0.05).The placement time of each screw in observation group was(2.56±0.12)min,which was significantly different from that in control group(4.22±0.17)min(P<0.05).One case of incision infection occurred in control group after operation,and recovered after active dressing change.During the follow-up period,no serious complications such as screw loosening and fracture occurred in two groups,and there was no significant difference in complications between two groups(P>0.05).A total of 107 screws were placed in observation group,including 101 screws in class A,4 in class B,2 in class C,0 in class D and 0 in class E,the accuracy rate of pedicle screw placement=[(number of screws in class A+B)/the number of all screws placed in the group]×100%=98.1%(105/107);and a total of 104 screws were placed in control group,including 90 screws in class A,4 in class B,5 in class C,5 in class D and 0 in class E,the accuracy rate of pedicle screw implantation=[(number of screws in class A+B/the number of all screws placed in the group]×100%=90.3%(94/104);there was significant difference between two groups(P<0.05).Conclusion:Orthopaedic robot assisted pedicle screw placement has the advantages of less fluoroscopy times,shorter screw placement time and higher accuracy,which can further improve the surgical safety and has a broad application prospect in the orthopaedic.