Renaissance机器人在青少年特发性脊柱侧凸中置钉失效分析及对策  

Failure analysis and countermeasures of Renaissance robot assisted screw placement in adolescent idiopathic scoliosis

作　　者：盛伟超 张敬乙[1] 杨光[1] 吕东波 廖文胜 高延征[1] Sheng Weichao;Zhang Jingyi;Yang Guang;Lv Dongbo;Liao Wensheng;Gao Yanzheng(Department of Spinal and Spinal Surgery,Henan Provincial People's Hospital,Zhengzhou Henan,450003,China)

机构地区：[1]河南省人民医院脊柱外科,河南郑州450003

出　　处：《生物骨科材料与临床研究》2022年第2期1-4,共4页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的回顾性分析采用Renaissance机器人系统治疗青少年特发性脊柱侧凸置钉失效原因,总结相关使用对策,加快手术进度及避免置钉差错出现。方法选择2017年9月至2019年9月采用后路椎弓根螺钉系统治疗的青少年特发性脊柱侧凸(AIS)患者189例,其中男72例,女117例。利用机器人软件系统进行术前手术规划,而后在术中辅助椎弓根螺钉置入,术后行CT扫描评估螺钉位置,记录椎弓根螺钉置入准确率及螺钉失效率。结果189例患者全部应用Renaissance机器人完成手术,共计划置入螺钉2996枚,因设备技术性原因无法注册螺钉12枚,机器人共植钉2984枚,椎弓根螺钉置入的准确率97.6%,机器人置钉失效率为3.5%。失效因素:(1)椎体标注错误;(2)椎板暴露不良;(3)出现“套管滑移”的问题;(4)操作平台倾斜。结论脊柱机器人仍是人工智能工具,应用中需要经验丰富的手术医师操作,以获得良好的治疗效果,但手术医师要充分理解其工作原理,熟知置钉风险因素,充分运用自身手术技巧,而不是完全依赖机器人才能安全完成手术。Objective To retrospectively analyze the causes of adolescent idiopathic scoliosis(AIS)failure using Renaissance robotic system,summarize the relevant countermeasures,accelerate the progress of operation and avoid the occurrence of screw errors.Methods A total of 189 patients with AIS treated with posterior pedicle screw system from September 2017 to September 2019 were selected,including 72 males and 117 females.The robot software system was used for preoperative operation planning,and then the pedicle screw placement was assisted during the operation.After the operation,CT scanning was performed to evaluate the screw position,record the accuracy and failure rate of pedicle screw placement,and summarize the causes of failure.Results All 189 patients completed the operation with Renaissance robot.A total of 2996 screws were planned to be placed,but 12 screws could not be registered due to technical reasons of the equipment,finally 2984 screws were implanted by the robot.The accuracy rate of pedicle screw placement was 97.6%,and the failure rate of robot screw placement was 3.5%.Failure factors:(1)The vertebral body was marked incorrectly;(2)The vertebral plate was poorly exposed;(3)The problem of"casing slip"occurred;(4)The operating platform was tilted.Conclusion Spinal robot is still an artificial intelligence tool.It needs experienced surgeons to operate in application and can obtain good treatment results.However,surgeons should fully understand its working principle,be familiar with the risk factors of nail placement,and make full use of their own surgical skills,rather than relying entirely on robots,in order to complete the operation safely.

关 键 词：脊柱侧凸 脊柱机器人 椎弓根螺钉 计算机辅助骨科手术 危险因素 

分 类 号：R682.3[医药卫生—骨科学]