脊柱机器人辅助与传统后路椎弓根螺钉内固定矫形术治疗脊柱侧凸的效果比较  

Robot-assisted versus traditional posterior pedicle screw internal fixation in the treatment of scoliosis

作　　者：翟功伟 高延征 高坤 张敬乙 余正红 盛伟超 杨光 ZHAI Gongwei;GAO Yanzheng;GAO Kun;ZHANG Jingyi;YU Zhenghong;SHENG Weichao;YANG Guang(Henan Provincial People's Hospital of Henan University ,Zhengzhou 450003 , China;Department of Spinal and Spinal Cord Surgery ,Henan Provincial People's Hospital of Henan University,People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou 450003,China)

机构地区：[1]河南大学河南省人民医院,郑州450003 [2]河南大学河南省人民医院郑州大学人民医院河南省人民医院脊柱脊髓外科,郑州450003

出　　处：《中华实用诊断与治疗杂志》2019年第7期636-640,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省科技攻关项目(162102310018);河南省医学科技攻关计划省部共建项目(SBGJ2018076);河南省卫生计生科技创新型人才“51282”工程项目

摘　　要：目的比较脊柱侧凸患者行Renaissance脊柱机器人辅助与传统后路椎弓根螺钉内固定矫形术治疗的临床效果及安全性.方法 31例脊柱侧凸患者,随机分为观察组16例和对照组15例.观察组行脊柱机器人辅助后路椎弓根螺钉内固定矫形术,对照组行传统后路椎弓根螺钉内固定矫形术.记录2组手术时间,术中透视次数、置钉时间、出血量及术后住院时间;分别于术前、拔除引流管后复查脊柱全长X线片,测定冠状位Cobb角、矢状位Cobb角、顶椎偏移距离;比较术前及拔除引流管后视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分;拔除引流管后行手术部位椎体CT检查,根据Rampersaud分类法判断椎弓根螺钉置入位置的准确性.结果观察组手术时间[(378.4±71.7)min]、术中置钉时间[(2.5±0.6)min/枚]、术后住院时间[(8.6±1.1)d]较对照组[(538.1±99.2)min、(4.2±1.0) min/枚、(12.0±0.9)d]短,术中透视次数[(10.2±2.3)次]、术中出血量[(654.3±296.4)mL]较对照组[(15.6±3.2)、(1 053.3±379.5)mL]少(P<0.05);观察组、对照组拔除引流管后冠状位Cobb角[(11.3±7.8)°、(8.6±2.9)°]、矢状位Cobb角[(30.9±7.4)°、(31.6±6.3)°]、顶椎偏移距离[(1.6±0.4)、(1.6±0.4)cm]较术前[冠状位Cobb角:(48.2±22.7)°、(46.5±15.7)°;矢状位Cobb角:(40.2±6.8)°、(41.2±5.9)°;顶椎偏移距离(4.9±0.6)、(5.6±0.9)cm]小(P<0.05),观察组拔除引流管后冠状位Cobb角、矢状位Cobb角、顶椎偏移距离与对照组比较差异无统计学意义(P>0.05);观察组、对照组拔出引流管后VAS评分[(4.3±2.1)、(4.6±1.9)分]、JOA评分[(20.6±5.8)、(21.4±4.3)分]与术前[VAS评分:(3.6±0.8)、(3.4±0.7)分;JOA评分:(22.1±2.9)、(23.2±3.7)分]比较差异无统计学意义(P>0.05),2组拔除引流管后VAS评分、JOA评分比较差异无统计学意义(P>0.05);观察组置钉准确率(95.3%)高于对照组(85.1%)(P<0.05),术后并发症发生率(18.8%)与Objective To compare the clinical surgical outcome and safety of Renaissance spinal robot-assisted versus traditional posterior pedicle screw internal fixation for scoliosis. Methods Thirty-one patients with scoliosis were randomly divided into 16 patients undergoing posterior pedicle screw fixation and orthopaedic surgery assisted by robots(observation group) and 15 patients undergoing traditional posterior pedicle screw fixation and orthopaedic surgery(control group). The operative time, intraoperative fluoroscopy frequency, screw placement time, blood loss volume and postoperative hospital stay were recorded in two groups. The whole spine radiography image was evaluated before operation and after removal of the drainage tube. The coronal Cobb angle, sagittal Cobb angle and apical displacement distance were measured. The visual analogue scale(VAS) score and Japanese Orthopaedic Association(JOA) score were compared before operation and after removal of the drainage tube. The vertebral CT was reviewed to determine the accuracy of pedicle screw placement according to Rampersaud classification method after removal of the drainage tube.Results The operative time((378.4±71.7)min),screw placement time((2.5±0.6)min/piece)and postoperative hospital stay((8.6±1.1)d)in observation group were significantly shorter than those in control group((538.1±99.2)min,(4.2±1.0)min/piece,(12.0±0.9)d)(P<0.05).The intraoperative fluoroscopy frequency((10.2±2.3)times)and blood loss volume((654.3±296.4)mL)were significantly less than those in control group((15.6±3.2)times,(1 053.3±379.5)mL)(P<0.05).The coronal Cobb angles((11.3±7.8)°,(8.6±2.9)°)and sagittal Cobb angles((30.9±7.4)°,(31.6±6.3)°)after removal of the drainage tube were significantly smaller than those before operation(coronal Cobb angles:(48.2±22.7)°,(46.5±15.7)°;sagittal Cobb angles:(40.2±6.8)°,(41.2±5.9)°)in observation group and control group(P<0.05),parietal vertebral deviation distances((1.6±0.4),(1.6±0.4)cm)were significantly shorter than tho

关 键 词：脊柱侧凸 椎弓根螺钉内固定矫形术 Renaissance脊柱机器人辅助 安全性 

分 类 号：R687.3[医药卫生—骨科学]