机器人辅助椎弓根螺钉置入术中示踪器微创固定与常规固定效果比较  

Efficacy comparison between minimally invasive fixation and routine fixation of tracer in robot-assisted pedicle screw placement

作　　者：李勇奇 张德华 吴宏梓 张柯 杨睿 方洲 汪少波 廖燚 Li Yongqi;Zhang Dehua;Wu Hongzi;Zhang Ke;Yang Rui;Fang Zhou;Wang Shaobo;Liao Yi(Department of Orthopedics,Karamay Central Hospital,Karamay 834000,China)

机构地区：[1]新疆维吾尔自治区克拉玛依市中心医院骨科中心,834000

出　　处：《中华创伤杂志》2019年第9期839-847,共9页Chinese Journal of Trauma

基　　金：国家重点研发计划(2016YFC0105800,2016YFC0105801).

摘　　要：目的探讨改良示踪器微创固定方法与常规示踪器固定方法在机器人辅助椎弓根螺钉置入中的临床应用效果。方法采用前瞻性随机对照研究分析2017年7月— 2017年12月克拉玛依市中心医院骨科收治的41例胸腰椎新鲜骨折患者临床资料,其中男20例,女21例;年龄25~55岁,平均40.6岁。骨折AO分型:A型28例,B型13例。患者均采用机器人辅助椎弓根螺钉置入治疗。按随机数字表法分为两组:常规组20例(常规示踪器固定辅助置钉),改良组21例(改良示踪器微创固定辅助置钉)。常规组共置入椎弓根螺钉92枚,改良组共置入椎弓根螺钉96枚。记录两组固定示踪器时手术创口大小、创口出血量、固定示踪器时间、并发症发生情况(固定示踪器时脊髓损伤及神经根损伤)、示踪器固定装置显影及产生伪影情况。术后通过320排CT扫描及Gertzbein-Robbins分类标准评价两组患者的置钉准确率。结果两组患者的一般资料如性别、年龄、诊断、椎弓根横径、e角(椎弓根纵轴椎体矢状轴的夹角)等的差异均无统计学意义(P>0.05)。改良组创口大小、创口出血量、固定示踪器时间分别为(6.00±1.26)mm、(1.38±0.22)ml、(1.42±0.17)min,而常规组分别为(40.16±5.71)mm、(11.61±1.15)ml、(5.12±0.64)min(P<0.05)。两组固定示踪器时均无脊髓或神经根损伤发生。三维图像采集和自动配准过程中,改良示踪器固定装置的克氏针显影,未产生伪影,改良组透视效果良好。改良组Gertzbein-Robbins分类为A类94枚,B类2枚;常规组Gertzbein-Robbins分类为A类89枚,B类3枚。两组置钉准确性差异无统计学意义(P>0.05)。结论在机器人辅助椎弓根螺钉置入时,与常规示踪器固定比较,改良示踪器微创固定方法创伤小、安全性高,且不影响机器人辅助置钉时椎弓根螺钉的置钉精度。Objective To investigate the clinical efficacy of modified tracer minimally invasive fixation in robot-assisted pedicle screw placement. Methods A prospective randomized controlled study was conducted to analyze the clinical data of 41 patients with thoracolumbar fresh fracture at the orthopaedics department of Karamay Central Hospital from July 2017 to December 2017. There were 20 males and 21 females, aged 25-55 years, with an average of 40.6 years. According to AO fracture typing, there were 28 patients with type A and 13 patients with type B. The patients underwent robot-assisted pedicle screw placement. Random number table method was used to divide the patients into the conventional group (20 patients) and modified group (21 patients). The conventional group was treated with conventional tracer fixation, and the modified group modified tracer minimally invasive fixation. A total of 92 pedicle screws were implanted in the conventional group and 96 pedicle screws were implanted in the modified group. The size of wound, wound bleeding, time of fixing the tracer, complications (spinal cord injury and nerve root injury when fixing the tracer), development of the tracer fixator and artifacts were recorded. The accuracy of nail placement was evaluated by 320-slice CT scan and Gertzbein-Robbins criteria. Results There was no significant difference in age, sex, diagnosis, transverse diameter of pedicle and e angle between the two groups (P>0.05). The wound size, wound bleeding, and time of fixing the tracer in the modified group were (6.00±1.26)mm,(1.38±0.22)ml and (1.42±0.17)minutes, respectively, while those of the conventional group were (40.16±5.71)mm,(11.61±1.15)ml, and (5.12±0.64)minutes respectively (P<0.05). No spinal cord or nerve root injury occurred in either group when the tracer was fixed. In the process of three-dimensional image acquisition and automatic registration, the tracer fixator in the modified group developed with Kirschner needle without artifacts, and the tracer in minimally invasive f

关 键 词：机器人 脊柱骨折 外科手术 微创性 示踪器固定 

分 类 号：TP242[自动化与计算机技术—检测技术与自动化装置] R687.3[自动化与计算机技术—控制科学与工程]