“天玑”骨科机器人辅助下经皮椎弓根螺钉植钉安全性评价  

The safety of TiRobot-guided percutaneous transpedicular screw implantation

作　　者：林书[1] 胡豇[1] 万仑[1] 唐六一[1] 王跃[1] 俞阳[1] 张伟[1] LIN Shu;HU Jiang;WAN Lun;TANG Liuyi;WANG Yue;YU Yang;ZHANG Wei(Department of Orthopedics,Sichuan Academy of Medical Science,People’s Hospital of Sichuan Province,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》2021年第7期813-817,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省科技厅科技支撑项目(2019YFS0268)。

摘　　要：目的评价"天玑"骨科机器人辅助下经皮椎弓根螺钉植钉的安全性。方法回顾分析2018年1月—2020年12月收治且符合标准的158例胸腰椎骨折和腰椎退行性病变患者临床资料,均行经皮椎弓根螺钉植钉手术,根据手术方式不同分为试验组(机器人辅助植钉,86例)和对照组(透视下植钉,72例)。两组患者性别、年龄、病因、病变节段、平均每例植钉数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、透视剂量、透视时间、透视次数;术后1 d,根据Gertzbein-Robbins分类标准评估椎弓根螺钉是否存在穿透骨皮质的情况,并测量植钉内倾角。结果试验组手术时间、透视剂量、透视时间和透视次数均显著少于对照组(P<0.05)。术后1 d,试验组植钉内倾角为(21.10±4.08)°,明显大于对照组的(19.17±3.48)°(t=6.810,P=0.000)。根据Gertzbein-Robbins分类标准,试验组植入的446枚螺钉中,A类377枚、B类46枚、C类23枚,植钉准确率94.8%;对照组植入的380枚螺钉中,A类283枚、B类45枚、C类44枚、D类6枚、E类2枚,植钉准确率86.3%;两组植钉准确率比较差异有统计学意义(χ2=25.950,P=0.000)。结论相比传统经皮植钉,"天玑"骨科机器人辅助经皮椎弓根螺钉植钉准确率高,可降低辐射损害,提高手术安全性,具有良好应用前景。Objective To evaluate the safety of TiRobot-guided percutaneous transpedicular screw implantation.Methods The medical records of 158 patients with thoracolumbar fractures and lumbar degenerative diseases who underwent percutaneous transpedicular screw implantation were retrospectively analyzed between January 2018 and December 2020.The patients were divided into trial group(TiRobot-guided screw implantation,86 cases)and control group(fluoroscopy-guided screw implantation,72 cases).There was no significant difference in gender,age,pathology,lesion segment,and the average number of screw implantation per case(P>0.05).The operation time,fluoroscopic dose,fluoroscopic time,and fluoroscopic frequency were compared between the two groups.One day postoperatively,the convergence angle was measured and the penetration of the pedicle cortex was evaluated according to Gertzbein-Robbins classification standard.Results The operation time,fluoroscopic dose,fluoroscopic time,and fluoroscopic frequency of the trial group were significantly lesser than those of control group(P<0.05).One day postoperatively,the convergence angle of trial group was(21.10±4.08)°,which was significantly larger than control group(19.17±3.48)°(t=6.810,P=0.000).According to the Gertzbein-Robbins classification standard,446 pedicle screws were implanted in trial group,trajectories were grade A in 377 screws,grade B in 46 screws,grade C in 23 screws,and the accuracy of screw implantation was 94.8%;380 pedicle screws were implanted in control group,trajectories were grade A in 283 screws,grade B in 45 screws,grade C in 44 screws,grade D in 6 screws,grade E in 2 screws,and the accuracy of screw implantation was 86.3%.There was significant difference in the accuracy of screw implantation between the two groups(χ2=25.950,P=0.000).Conclusion Compared with traditional percutaneous transpedicular screw implantation,TiRobot-guided percutaneous transpedicular screw implantation can improve the accuracy of screw implantation,reduce radiation exposure,and impro

关 键 词：机器人 经皮植钉 胸腰椎骨折 腰椎退行性病变 安全性 

分 类 号：R687.3[医药卫生—骨科学]