骨科机器人辅助皮质骨轨迹螺钉内固定治疗腰椎退行性疾病  

Orthopedic robot-assisted cortical bone trajectory screw internal fixation for the treatment of lumbar degenerative diseases

作　　者：林书 胡豇[1] 万仑[1] 唐六一[1] 王跃[1] 俞阳 Lin Shu;Hu Jiang;Wan Lun;Tang Liuyi;Wang Yue;Yu Yang(Department of Orthopedics,Sichuan Academy of Medical Sciences-Sichuan Provincial People’s Hospital,Chengdu 610072,Sichuan Province,China)

机构地区：[1]四川省医学科学院·四川省人民医院骨科,四川省成都市610072

出　　处：《中国组织工程研究》2022年第15期2356-2360,共5页Chinese Journal of Tissue Engineering Research

基　　金：四川省医学科学院·四川省人民医院院基金(2021LY09),项目负责人:林书。

摘　　要：背景:传统椎弓根螺钉在骨质疏松的腰椎内固定中存在螺钉松动的风险,皮质骨轨迹螺钉内固定可增加螺钉把持力,在骨科机器人的辅助下可提高置钉准确性,减少辐射伤害。目的:比较骨科机器人辅助与徒手皮质骨轨迹螺钉固定治疗合并骨质疏松腰椎退行性疾病的置钉准确性及安全性。方法:回顾分析2018年1月至2020年4月收治的39例合并骨质疏松的腰椎退行性疾病患者的临床资料,分为机器人组(19例)和徒手组(20例)。收集两组数据,包括手术时间、透视次数、透视剂量、术中出血量、切口长度、住院费用、置钉精准率,同时对比术前、术后腰椎神经功能日本骨科学会评分。该研究方案经四川省人民医院医学伦理委员会批准[伦审(研)2019年第298号]。结果与结论:①机器人组手术时间少于徒手组,术中透视次数和透视剂量明显低于徒手组(P<0.05);机器人组切口长度明显大于徒手组,住院费用明显高于徒手组(均P<0.05);②两组患者术中出血量和术前、术后3个月及6个月的JOA评分相比差异无显著性意义(P>0.05);③机器人组和徒手组置钉准确率分别为93%(71/76)和80%(64/80),差异有显著性意义(P=0.014);④结果说明,相比徒手皮质骨轨迹螺钉内固定,机器人辅助可减少手术时间、透视次数和透视剂量,提高置钉准确性。BACKGROUND:Traditional pedicle screw has the risk of screw loosening in osteoporotic lumbar spine internal fixation,and cortical bone trajectory screw fixation can increase the holding power of screws,which can improve the accuracy of screw placement and reduce radiation injury with the assistance of orthopedic robots.OBJECTIVE:To compare the accuracy and safety of robot-assisted and manual cortical bone trajectory screw fixation in the treatment of lumbar degenerative diseases with osteoporosis.METHODS:The clinical data of 39 patients with lumbar spine diseases and osteoporosis admitted from January 2018 to April 2020 were retrospectively analyzed.According to the different operation methods,the patients were divided into a robot group(n=19)and a manual group(n=20).The data of operation time,fluoroscopy frequency,fluoroscopy dose,intraoperative blood loss,incision length,hospitalization costs,and accuracy of screw placement were collected.Japanese Orthopedic Association scores were also used to compare preoperative and postoperative lumbar nerve function.This study protocol was approved by the Medical Ethics Committee of Sichuan Provincial People’s Hospital(approval No.2019[298]).RESULTS AND CONCLUSION:Compared with the manual group,the operation time was shorter,and intraoperative fluoroscopy frequency and fluoroscopy dose were significantly lower in the robot group(P<0.05).The robot group had significantly longer incision length and higher hospitalization cost than the manual group(both P<0.05).There was no significant difference between the two groups of patients in intraoperative blood loss and Japanese Orthopedic Association scores before,3 months and 6 months after operation(P>0.05).Accuracy of screw placement was 93%(71/76)in the robot group and 80%(64/80)in the manual group,and there was a significant difference between the two groups(P=0.014).To conclude,robot-assisted screw placement can reduce operation time,fluoroscopy frequency,fluoroscopy dose and increase accuracy of placement,compared with manu

关 键 词：机器人 皮质骨轨迹螺钉 腰椎退行性疾病 精准度 透视剂量 

分 类 号：R459.9[医药卫生—治疗学] R496[医药卫生—临床医学]