天玑骨科机器人辅助椎弓根螺钉置入的临床应用及体会  

Clinical Application and Experience of Pedicle Screw Insertion Assisted by Tianjiorthopaedic Robot

作　　者：杨睿 李勇奇 张柯 方洲[1] 夏海军 汪少波[1] 廖燚[1] Yang Rui;Li Yongqi;Zhang Ke(Department of Orthopaedics,The Karamay Central Hospital of Xinjiang,Karamay834000,China)

机构地区：[1]新疆克拉玛依市中心医院骨科

出　　处：《实用骨科杂志》2019年第10期892-897,共6页Journal of Practical Orthopaedics

摘　　要：目的通过对比机器人辅助胸腰椎椎弓根螺钉置入与传统徒手置钉的临床效果,对机器人辅助置钉的精准性、安全性和术中辐射剂量做一客观评价。方法收集2017年4月至2018年2月接受胸腰椎椎弓根螺钉内固定患者88例,采用随机数字表法随机分为机器人辅助置钉(治疗组45例)、传统徒手置钉(对照组43例),分别记录两组患者手术时间、术中出血量、术中放射剂量,并采集术后CT影像。根据Gertzbein-Robbins分类标准对置钉的精确度进行评估,所得数据经统计分析评定结果。结果两组患者在性别、年龄及病种方面差异无统计学意义,具有可比性(P>0.05)。治疗组手术平均时间为(48.87±8.82)min,对照组手术平均时间为(46.57±7.05)min,两组比较差异无统计学意义(P>0.05)。治疗组术中出血量(21.27±13.13)mL,对照组术中出血量(20.95±17.37)mL,两组比较差异无统计学意义(P>0.05)。治疗组共打入椎弓根螺钉208枚,其中A级203枚,B级5枚;对照组打入椎弓根螺钉202枚,其中A级164枚,B级22枚,C级15枚,D级1枚,两组在置钉的精准性上差异有统计学意义(P<0.05)。此外,两组在术中接受的放射剂量上差异也有统计学意义(P<0.05)。结论 机器人辅助置钉与传统徒手置钉相比,没有明显延长手术时间及增加出血量,且明显降低了术中透视放射剂量的前提下,具备更高的置钉准确性及安全性。Objective This research aimto observe the difference of clinical efficacy of robot-assisted versus conventional freehand pedicle screw insertion in thoracolumbar surgery,and toevaluate the accuracy,safety and radiation doseof the robot-assisted system.Methods 88 patientswere randomly assigned toreceive pedicle screw insertion by using random digits table from April 2017 to February 2018.45 patients were treated by robot-assisted spinal instrumentation and 43 patients were treated by freehand surgery.Then the operation time and blood loss of 2 groups were compared,and intraoperative X-ray exposure was also done.The computer tomographic scans were used to assess the accuracy and safety of the inserted pedicle screws between thetwo groups using the Gertzbein-Robbins grade scores.Results There were no significant differences in terms of the baseline,such as gender,age and diseaseetc.between the two groups(P>0.05).The average operation time was(48.87±8.82)min in therobot-assisted group and(46.57±7.05)min in the freehand group(P>0.05).The blood loss was(21.27±13.13)mL in robot-assisted group and(20.95±17.37)mL in the freehand group(P>0.05).208 pedicle screws were inserted in the robot-assisted group,and the Gertzbein-Robbins scores was categorized as A of 203 screws and B in 5 screws;202 pedicle screws were placed in the freehand group.The Gertzbein-Robbins scores were A in 164,Bin 22,C in 15 and D in 1 screw,respectively;and the significant differences were shown in accuracy of pedicle screws placement(P<0.05).Robot-assisted system also significantly decreases intraoperative radiation exposure(P<0.05).Conclusion The accuracy and safety of robot-assistedpedicle screw placement compared with the traditional freehandprocedurewere significantly improved without increasing the amount of bleeding,operation time,and also significantly reducing the radiation dose of intraoperative fluoroscopy.

关 键 词：骨科机器人 椎弓根螺钉置入 精准度 安全性 辐射剂量 

分 类 号：R683.2[医药卫生—骨科学]