机器人辅助下微创经皮椎弓根螺钉固定治疗多节段胸腰椎骨折的疗效分析  

Robot-assisted percutaneous minimally invasive pedicle screwing for multi-segmental thoracolumbar fractures

作　　者：刘刚 刘斌 田乐[1] 刘亚欧[1] 徐伟明[1] 郭有为 张元智[1] Liu Gang;Liu Bin;Tian Le;Liu Yaou;Xu Weimin;Guo Youwei;Zhang Yuanzhi(Department of Orthopaedics,Hospital Affiliated to Inner Mongolia Medical University,Hohhot 010050,China)

机构地区：[1]内蒙古医科大学附属医院骨科,呼和浩特010050

出　　处：《中华创伤骨科杂志》2021年第10期877-883,共7页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(81760412);内蒙古自治区科技成果转化项目(CGZH2018148);内蒙古卫生健康领域应用技术研发项目(201802157);内蒙古自治区自然科学基金(2019MS08151,2020MS(LH)08027);内蒙古医科大学百万工程联合项目(YKD2018KJBW(LH)001)。

摘　　要：目的探讨骨科手术机器人辅助下微创经皮椎弓根螺钉固定治疗无神经功能障碍的多节段胸腰椎骨折的疗效。方法回顾性分析2019年1月至2020年12月内蒙古医科大学附属医院收治的24例多节段胸腰椎骨折患者的临床资料,根据术中有无机器人辅助分为机器人组(n=12,机器人辅助下完成经皮微创椎弓根螺钉固定)和徒手组(n=12,徒手完成经皮微创椎弓根螺钉固定)。机器人组男8例,女4例;年龄35~74岁;徒手组男7例,女5例;年龄36~69岁。通过比较两组患者手术时间、透视次数、透视时间、术中导针调整次数、术中出血量、置钉精准度,以及术前、术后3 d及末次随访时的疼痛视觉模拟评分(VAS)、椎体前缘高度百分比、矢状位cobb角来观察疗效。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。机器人组共置入螺钉128枚,徒手组共置入螺钉126枚,机器人组手术时间[(129.2±10.5)min]、透视次数[(8.5±2.1)次]、透视时间[(9.8±1.9)s]、导针调整次数[(2.3±1.4)次]、术中出血量[(65.3±9.8)mL]均显著少于徒手组[(153.8±18.1)min、(39.8±5.1)次、(43.9±4.8)s、(18.6±2.6)次、(96.8±10.9)mL],差异有统计学意义(P<0.05);置钉精准度机器人组为93.75%(120/128),徒手组为84.92%(107/126),差异有统计学意义(P<0.05)。术后3 d及末次随访时两组间VAS评分、伤椎椎体前缘高度百分比和矢状位cobb角比较差异均无统计学意义(P>0.05)。术后3 d及末次随访时两组间VAS评分、伤椎椎体前缘高度百分比和矢状位cobb角均较术前显著改善,差异有统计学意义(P<0.05)。两组患者术后均无附加手术、螺钉松动等并发症发生。结论机器人辅助下微创经皮椎弓根螺钉固定治疗多节段胸腰椎骨折可获得满意的临床效果;与传统开放手术相比,具有手术时间短、射线暴露量低、术中出血量少、置钉精度高等优点。Objective To investigate the clinical effects of robot-assisted minimally invasive percutaneous pedicle screwing in the treatment of multi-segmental thoracolumbar burst fractures without neurological dysfunction.Methods A retrospective analysis was conducted of the 24 patients who had been treated at Department of Orthopaedics,Hospital Affiliated to Inner Mongolia Medical University for multi-segmental thoracolumbar fractures from January 2019 to December 2020.They were randomly divided into a robot group(n=12)in which the minimally invasive percutaneous pedicle screwing was assisted by a surgical robot and a manual group(n=12)in which the minimally invasive percutaneous pedicle screwing was performed manually.There were 8 males and 4 females in the robot group,aged from 35 to 74 years;there were 7 males and 5 females in the manual group,aged from 36 to 69 years.The clinical effects were evaluated by comparing the 2 groups in terms of operation time,fluoroscopy frequency,fluoroscopy time,intra-operative needle adjustments,intra-operative blood loss,screwing accuracy,and visual analogue scale(VAS)scores,anterior vertebral height ratios and sagittal cobb angles at preoperation,postoperative 3 days and the last follow-up.Results There was no statistically significant difference in the preoperative general data between the 2 groups,showing comparability(P>0.05).A total of 128 screws were implanted in the robot group and 126 ones in the manual group.In the robotic group,operation time[(129.2±10.5)min],fluoroscopy frequency[(8.5±2.1)times],fluoroscopy time[(9.8±1.9)s],guide needle adjustments[(2.3±1.4)times],and intraoperative blood loss[(65.3±9.8)mL]were significantly less than those in the manual group[(153.8±18.1)min,(39.8±5.1)times,(43.9±4.8)s,(18.6±2.6)times and(96.8±10.9)mL](all P<0.05).Regarding the screwing accuracy evaluated using CT scanning,the robot group was significantly higher(93.75%,120/128)than the manual group(84.92%,107/126)(P<0.05).There was no significant difference between the 2 groups i

关 键 词：胸椎 腰椎 骨折 机器人 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]