骨科机器人辅助椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的学习曲线  

Learning curve of Tianji orthopaedic robot in assisting percutaneous kyphoplasty for osteoporotic vertebral compression fractures

作　　者：袁伟[1] 孟小童 刘欣春[1] 朱海涛[1] 崔璀[1] 陶琳[1] 曹文海 朱悦[1] Yuan Wei;Meng Xiaotong;Liu Xinchun;Zhu Haitao;Cui Cui;Tao Lin;Cao Wenhai;Zhu Yue(Department of Orthopedics,The First Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院骨科,沈阳110001

出　　处：《中华创伤骨科杂志》2019年第8期670-675,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家重点研发计划课题(2017YFC1104903);辽宁省自然科学基金指导计划(20180550926)

摘　　要：目的探讨"天玑"骨科机器人辅助椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折(OVCF)的学习曲线。方法回顾性分析2018年5月至2019年3月中国医科大学附属第一医院骨科应用"天玑"骨科手术机器人辅助PKP连续治疗的44例(共71个骨折椎体)OVCF患者资料。男2例,女42例;年龄55~89岁,平均68.6岁。手术均由同一组医生完成。患者按接受手术日期先后平均分成4组(n=11):组1、组2、组3、组4。统计比较4组患者的机器人辅助穿刺准确率、总手术时间、机器人手术时间、PKP手术时间及并发症的发生情况。并对总手术时间、机器人手术时间、PKP手术时间采用对数曲线回归分析方法反应手术时间随手术例数变化的趋势[y=aln(x)+b,x为手术例数,y为手术时间]。结果4组患者年龄、性别、手术节段数等差异均无统计学意义(P>0.05),具有可比性。组1、组2和组3各有1次穿刺失败,穿刺总准确率95.8%(68/71),4组间穿刺准确率差异无统计学意义(P>0.05)。组1、组2与组3、组4总手术时间分别为(56.6±6.6)、(46.4±8.5)、(40.2±4.7)、(40.4±5.7)min,机器人手术时间分别为(32.1±4.9)、(23.8±5.1)、(18.9±2.7)、(19.6±5.3)min,4组间比较差异有统计学意义(P<0.05);组1、组2分别与组3、组4相比差异均有统计意义(P<0.05);但组3与组4比较差异无统计学差异(P>0.05)。ln对数曲线回归分析结果显示,随着手术病例数的增加,总手术时间(y=-7.286ln(x)+66.616,R2=0.4889,P<0.001)、机器人手术时间(y=-5.662ln(x)+39.763,R2=0.5196,P<0.001)显著减少,在组3和组4相对稳定。组1、组2、组3、组4 PKP手术时间4组间比较差异无统计学意义(P>0.05)。术中并发症主要为骨水泥的椎前及椎间隙渗漏,总发生率为8.5%(6/71),4组间并发症发生率比较差异无统计学意义(P>0.05)。结论"天玑"骨科机器人辅助PKP治疗OVCF穿刺精准率不随着手术例数增加而变化。总手术时间、机器人手术时间Objective To explore the learning curve of the Tianji orthopedic robot in assisting percutaneous kyphoplasty(PKP)for osteoporotic vertebral compression fractures(OVCF).Methods A retrospective study was conducted of the consecutive 44 OVCF patients(71 fractured vertebrae)who had been treated with PKP assisted by the Tianji orthopedic robot from May 2018 to March 2019 at Department of Orthopedics,The First Hospital of China Medical University.They were 2 men and 42 women,aged from 55 to 89 years(average,68.6 years).Their operations were performed by the same surgical team.The patients were divided into 4 even groups(n=11)according to the date of operation.The accuracy of robot-assisted puncture,total operation time,robot operation time,PKP operation time and complications were statistically analyzed and compared between the 4 groups.Natural logarithm regression analysis of total operation time,robot operation time and PKP operation time was conducted to determine the association between operation time and operation number[y=aln(x)+b,x indicating operation number and y operation time].Results The 4 groups were comparable due to insignificant differences in age,gender or operative segment between them(P>0.05).The total rate of accurate puncture was 95.8%(68/71).The rates of accurate puncture were 92.9%(13/14),94.4%(17/18),94.7%(18/19)and 100%(20/20)for groups 1,2,3,and 4,respectively,with no significant differences between groups(P>0.05).The total operation time for the 4 groups was respectively 56.6±6.6 min,46.4±8.5 min,40.2±4.7 min and 40.4±5.7 min and the robot operation time for the 4 groups was respectively 32.1±4.9 min,23.8±5.1 min,18.9±2.7 min and 19.6±5.3 min,showing significant differences between the 4 groups(P>0.05)and a significant difference between groups 1 and 2 versus groups 3 and 4(P>0.05)but no significant difference between group 3 and 4(P>0.05).The natural logarithm regression analysis showed that the total operation time[y=-7.286ln(x)+66.616,R2=0.4889,P<0.001]and robot operation time[y=-5

关 键 词：机器人 椎体成形术 骨质疏松性 骨折 压缩性 学习曲线 

分 类 号：R68[医药卫生—骨科学]