机器人辅助与传统徒手植钉在上胸椎椎弓根螺钉内固定中的比较研究  

A comparative study of robot-assisted and freehand pedicle screw placement in upper thoracic surgery

作　　者：王飞[1] 胡豇[1] 唐六一[1] 万仑[1] 俞阳[1] 唐智 张伟[1] WANG Fei;HU Jiang;TANG Liuyi;WAN Lun;YU Yang;TANG Zhi;ZHANG Wei(Department of Orthopaedics,Sichuan Academy of Medical Sciences ScSichuan Provincial People's Hospital,Chengdu Sichuan,610072,P.R.China)

机构地区：[1]四川省医学科学院·四川省人民医院骨科,成都610072

出　　处：《中国修复重建外科杂志》2020年第12期1521-1525,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省科技厅科技计划项目(2019YFS0268)

摘　　要：目的通过与传统徒手椎弓根螺钉植入技术比较,分析在上胸椎手术中应用骨科机器人系统辅助椎弓根螺钉植入的安全性与准确性。方法回顾性分析2017年12月—2019年12月符合选择标准的39例上胸椎椎弓根螺钉内固定手术患者,根据植钉方式不同分为机器人组(A组,19例,使用天玑骨科手术机器人辅助植钉)和徒手组(B组,20例,采用徒手椎弓根螺钉植入技术)。A组共植入104枚螺钉,B组108枚。两组患者年龄、性别构成、体质量指数、疾病类型、植入螺钉数量及节段分布等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中出血量及术后引流量。术后2 d行CT检查,采用Gertzbein-Robbins分级标准对螺钉是否穿破骨皮质情况进行评估,以评价植钉准确度(A级和B级为植钉准确)。结果A组手术时间显著高于B组(t=2.759,P=0.009);两组术中出血量及术后引流量比较差异均无统计学意义(t=-0.796,P=0.431;t=-0.814,P=0.421)。术后2 d采用Gertzbein-Robbins分级标准评价植钉准确度,A组A级94枚、B级9枚、C级1枚,B组A级72枚、B级26枚、C级9枚、D级1枚,两组比较差异有统计学意义(Z=4.257,P=0.000);A组植钉准确率为99.04%,B组为90.74%,A组显著优于B组,差异有统计学意义(χ^2=7.415,P=0.006)。结论与传统徒手植钉相比,机器人辅助下椎弓根螺钉植入在未增加手术出血和术后引流量的情况下,明显提高了螺钉植入的精确性与安全性。Objective To compare the safety and accuracy of pedicle screw placement assisted by robot system with freehand pedicle screw placement in upper thoracic surgery.Methods Between December 2017 and December 2019,39 cases with upper thoracic pedicle screw internal fixation were included in the study,including 19 cases in robot group(group A,robot assisted pedicle screw placement)and 20 cases in freehand group(group B,freehand pedicle screw placement).There were 104 screws implanted in group A and 108 screws in group B.There was no significant difference in age,gender composition,body mass index,disease type,number of screws implanted,and segmental distribution between the two groups(P>0.05).The operation time,intraoperative blood loss,and postoperative drainage were recorded and compared between the two groups.CT scan was performed in all patients at 2 days after operation to evaluate the screw accuracy based on the Gertzbein-Robbins grading standard.Results The operation time of group A was significantly longer than that in group B(t=2.759,P=0.009).There was no significant difference in intraoperative blood loss and postoperative drainage between the two groups(t=-0.796,P=0.431;t=-0.814,P=0.421).At 2 days after operation,according to Gertzbein-Robbins grading standard,the accuracy of pedicle screw implantation in group A were grade A in94 screws,grade B in 9 screws,and grade C in 1 screw;and in group B were grade A in 72 screws,grade B in 26 screws,grade C in 9 screws,and grade D in 1 screw;the difference between the two groups was significant(Z=4.257,P=0.000).The accuracy rate of group A was 99.04%,and that of group B was 90.74%,showing significant difference(χ^2=7.415,P=0.006).Conclusion Compared with traditional freehand pedicle screw placement,robot-assisted pedicle screw placement significantly improves the accuracy and safety of screw placement without increasing the bleeding and postoperative drainage.

关 键 词：骨科机器人系统 上胸椎 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]