机器人辅助经皮椎体后凸成形术治疗单/双节段骨质疏松性椎体压缩骨折临床疗效  

Effectiveness of robot assisted percutaneous kyphoplasty for treatment of single/doublesegment osteoporotic vertebral compression fractures

作　　者：袁伟[1] 孟小童 刘欣春[1] 朱海涛[1] 丛琳[1] 朱悦[1] YUAN Wei;MENG Xiaotong;LIU Xinchun;ZHU Haitao;CONG Lin;ZHU Yue(Department of Orthopedics,the First Hospital of China Medical University,Shenyang Liaoning,110001,P.R.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：《中国修复重建外科杂志》2021年第8期1000-1006,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家重点研发计划项目(2017YFC1104903);辽宁省教育厅科学研究经费项目(QN2019001)。

摘　　要：目的比较机器人与C臂X线机辅助经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗单/双节段骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效。方法回顾性分析2018年5月—2019年10月收治且符合选择标准的108例单/双节段OVCF患者临床资料。单节段骨折65例,其中38例接受"天玑"骨科机器人辅助PKP手术(机器人组)、27例接受C臂X线机透视辅助PKP手术(C臂组);双节段骨折43例,其中机器人组21例、C臂组22例。单/双节段骨折患者机器人组及C臂组间性别、年龄、骨密度T值、骨折节段分布、受伤至手术时间以及术前疼痛视觉模拟评分(VAS)、椎体后凸角(vertebral kyphosis angle,VKA)、伤椎椎体高度(height of fractured vertebra,HFV)等一般资料比较差异均无统计学意义(P>0.05)。记录并比较单/双节段两组患者手术时间、医患术中透视次数、医患透视暴露时间、C臂X线机辐射剂量,术前、术后1 d及6个月的VAS评分、VKA、HFV及并发症发生情况。结果所有患者手术均顺利完成。单节段机器人组手术时间明显长于C臂组(t=5.514,P=0.000),双节段机器人组手术时间与C臂组比较差异无统计学意义(t=1.892,P=0.205)。单/双节段机器人组需进行三维扫描,患者接受的透视次数、透视暴露时间及C臂辐射剂量均显著高于C臂组(P<0.05);医生接受的透视次数、透视暴露时间显著少于C臂组(P<0.05)。均无感染、肺栓塞、脊髓或神经损伤、相邻节段骨折等严重并发症发生。单/双节段机器人组骨水泥渗漏率显著低于C臂组(P<0.05);术中发生的骨水泥渗漏均为椎管外渗漏。单/双节段机器人组和C臂组术后1 d及6个月的VAS评分、VKA和HFV均较术前明显改善(P<0.05),其中术后6个月VAS评分较术后1 d进一步改善(P<0.05)。术后1 d及6个月,单/双节段机器人组和C臂组间除VAS评分比较差异无统计学意义(P>0.05)外,机器人组VKA和HFV�Objective To compare the effectiveness of robot assisted and C-arm assisted percutaneous kyphoplasty(PKP)in the treatment of single/double-segment osteoporotic vertebral compression fracture(OVCF).Methods The clinical data of 108 cases of single/double-segment OVCF who met the selection criteria between May 2018 and October 2019 were retrospectively analyzed.There were 65 cases of single-segment fractures,of which 38 cases underwent"TiRobot"orthopedic robot-assisted PKP(robot group),27 cases underwent C-arm X-ray machine fluoroscopy-assisted PKP(C-arm group).There were 43 cases of double-segment fractures,including 21 cases in robot group and 22 cases in C-arm group.There was no significant difference in gender,age,T value of bone mineral density,fracture segment distribution,time from injury to operation,and preoperative visual analogue scale(VAS)score,vertebral kyphosis angle(VKA),and height of fractured vertebra(HFV)in the patients with single/double-segments fractures between robot group and C-arm group(P>0.05).The operation time,the fluoroscopy frequency of the surgeons and the patient,the fluoroscopy exposure time of the surgeons and the patient,the radiation dose of the C-arm;the VAS scores,VKA,HFV before operation,at 1 day and 6 months after operation;and the complications in the two groups were recorded and compared.Results All patients underwent surgery successfully.The operation time of the single-segment robot group was significantly longer than that of the C-arm group(t=5.514,P=0.000),while the operation time of the double-segment robot group was not significantly different from that of the C-arm group(t=1.892,P=0.205).The single/double-segment robot group required three-dimensional scanning,so the fluoroscopy frequency,fluoroscopy exposure time,and radiation dose of C-arm received by the patient were significantly higher than those of the C-arm group(P<0.05);the fluoroscopy frequency and the fluoroscopy exposure time received by the surgeons were significantly less than those of the C-arm group(P<0.

关 键 词：经皮椎体后凸成形术 机器人 骨质疏松性椎体压缩骨折 

分 类 号：R687.3[医药卫生—骨科学]