脊柱机器人辅助下皮质骨轨迹螺钉技术在脊柱外科手术中的应用  

CLINICAL APPLICATION OF THE CORTICAL BONE TRAJECTORY SCREW TECHNIQUE ASSISTED BY SPINE ROBOT SYSTEM IN SPINAL SURGERY

作　　者：王岩[1] 郭建伟[1] 许德荣 张豪[1] 周传利[1] 马学晓[1] WANG Yan;GUO Jianwei;XU Derong;ZHANG Hao;ZHOU Chuanli;MA Xuexiao(Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266100, China)

机构地区：[1]青岛大学附属医院脊柱外科,山东青岛266100

出　　处：《精准医学杂志》2021年第5期386-390,共5页Journal of Precision Medicine

基　　金：国家重点研发计划项目(2019YFC0121400);国家自然科学基金资助项目(81871804,82100940)。

摘　　要：目的探讨脊柱机器人辅助下皮质骨轨迹(CBT)螺钉技术在脊柱外科手术中的临床应用效果。方法选取2017年7月—2021年2月行脊柱机器人辅助下CBT螺钉固定手术的患者25例,其中腰椎术后邻近节段退变性疾病患者5例,腰椎管狭窄症患者8例,胸腰椎压缩性骨折继发性椎管狭窄患者10例,腰椎椎间隙感染患者2例。记录术中透视次数、有无CBT螺钉相关的手术并发症,术后3~5 d行X线、CT、MRI检查评估CBT螺钉置入的准确性及手术减压的效果,术后3个月、6个月及末次随访行X线检查评估CBT螺钉位置,末次随访应用日本骨科学会(JOA)腰背痛手术评分标准和视觉模拟评分法(VAS)评估症状恢复情况。结果25例患者均获得随访,随访时间3~46个月,共置入CBT螺钉116枚,其中腰椎98枚,胸椎18枚,手术置钉过程中均未出现螺钉把持力不足、椎弓根或峡部劈裂以及神经、硬膜、血管损伤等情况,术中平均透视8.85次。按照Gertzbein-Robbins分类标准,术后CT检查结果显示A类螺钉114枚,B类螺钉2枚,CBT螺钉置入准确率为98.28%。术后3~5 d及术后随访影像学检查均未见螺钉松动、断裂、穿透椎弓根皮质、椎间融合器移位、椎间隙高度丢失等不良事件。末次随访25例患者JOA腰背痛手术评分、腰痛和腿痛VAS评分较术前有明显差异(t=8.94~12.84,P<0.05)。结论脊柱外科手术中应用脊柱机器人辅助下CBT螺钉技术安全有效,能替代和补充传统椎弓根螺钉固定技术。Objective To investigate the clinical application of the cortical bone trajectory(CBT)screw technique assisted by spine robot system in spinal surgery.Methods A total of 25 patients with spinal diseases who underwent treatment with the CBT screw technique assisted by spine robot system from July 2017 to February 2021 were enrolled,among whom there were 5 patients with adjacent segment degeneration after lumbar surgery,8 patients with lumbar spinal stenosis,10 patients with spinal stenosis secondary to thoracolumbar compression fracture,and 2 patients with lumbar intervertebral space infection.The number of times of intraoperative fluoroscopy and surgical complications associated with CBT screw were recorded,and X-ray examination,computed tomography(CT),and magnetic resonance imaging were performed at 3-5 days after surgery to evaluate the accuracy of CBT screw placement and the effect of surgical decompression.X-ray examination was performed at 3-5 days after surgery and postoperative follow-up to evaluate the position of CBT screw,and Japanese Orthopaedic Association(JOA)score for low back pain and Visual Analogue Scale(VAS)score were used to evaluate the recovery of symptoms at final follow-up.Results All 25 patients were followed up,with a follow-up time of 3-46 months.A total of 116 CBT screws were placed,with 98 lumbar CBT screws and 18 thoracic CBT screws.No insufficient holding of screws,isthmus or pedicle cortical bone fracture,or nerve/dura mater/blood vessel damage were observed during screw placement,and the mean number of times of intraoperative fluoroscopy was 8.85.According to the Gertzbein-Robbins classification criteria,postoperative CT examination showed 114 class A screws and 2 class B screws,and the accuracy rate of screw placement was 98.28%.At 3-5 days after surgery and at postoperative follow-up,imaging examination showed no adverse events such as screw loosening,screw breakage,penetration of the pedicle cortical bone,displacement of interbody fusion cage,and loss of intervertebral space hei

关 键 词：机器人手术 皮质骨轨迹螺钉 脊柱 外科手术 治疗结果 

分 类 号：R681.5[医药卫生—骨科学] R319.1[医药卫生—外科学]