机器人引导技术与计算机辅助导航胸腰椎椎弓根螺钉置钉准确性的荟萃分析  

A Meta-analysis of accuracy of pedicle screw placement in thoracolumbar surgery with robot guidance and computer-aided navigation

作　　者：褚开伟 洪宾 石岩 彭正武 孙英飞 CHU Kai-wei;HONG Bin;SHI Yan;PENG Zheng-wu;SUN Ying-fei(Jinzhai County People’s Hospital,Anhui,237300,China)

机构地区：[1]金寨县人民医院骨科,安徽金寨237300 [2]北京中日友好医院脊柱外科,北京100029

出　　处：《颈腰痛杂志》2023年第3期349-352,356,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的系统分析胸腰椎手术中机器人引导技术(robot guidance,RG)与计算机辅助导航(computer aided navigation,CAN)椎弓根螺钉放置的准确性。方法检索数据库包括维普、万方、CNKI等中文数据库及Pubmed EMBASE、Cochrane等英文数据库,检索胸腰椎手术中RG和CAN导航的相关研究,进行文献质量评价后,采用Revman 5.3软件进行Meta分析。结果共纳入6篇文献,其中随机对照研究1篇,队列研究5篇。Meta分析显示,胸腰椎手术中的RG和CAN导航患者在手术时间(P=0.82)、术中出血量(P=0.18)、并发症发生率(OR=0.63,P=0.31)和术中翻修率(OR=0.55,P=0.25)相比,差异均无统计学意义。RG导航患者的椎弓根螺钉置入准确率(OR=1.84,P<0.001)、椎弓根螺钉置入可接受率(OR=1.78,P<0.001)均显著高于CAN导航,辐射剂量(WMD=-4.15,95%CI=-5.96~-2.34,P<0.001)显著低于CAN导航。结论RG技术可提高胸腰椎手术患者椎弓根螺钉的准确率和可接受率,二者术中失血量、手术时间、并发症发生率及术中翻修率等方面无显著差异。Objective To systematically analyze the accuracy of pedicle screw placement by robot guidance(RG)and computer aided navigation(CAN)in thoracolumbar surgery.Methods The search databases included Chinese databases such as VIP,Wanfang and CNKI and English databases such as PubMed EMBASE and Cochrane.The randomized control(RCT)and cohort study(CS)of RG and CAN navigation in thoracolumbar surgery were searched.After literature quality evaluation,Revman5.3 was conducted forMeta-analysis.Results Totally 6 articles were included,including 1 randomized controlled study and 5 cohort study.Meta-analysis showed that there was no significant difference in operation time(P=0.82),intraoperative bleeding(P=0.18),complication rate(OR=0.63,P=0.31)and intraoperative revision rate(OR=0.55,P=0.25).The accuracy of pedicle screw placement in RG navigation patients(OR=1.84,P<0.001)and the acceptability of pedicle screw placement(OR=1.78,P<0.001)were higher than those in CAN navigation,and the radiation dose(WMD=-4.15,95%CI=-5.96--2.34,P<0.001)was lower than that in CAN navigation.Conclusion RG technique can improve the accuracy and acceptability of pedicle screws in patients undergoing thoracolumbar surgery.There is no significant difference in intraoperative blood loss,operation time,complication rate and intraoperative revision rate between the two.

关 键 词：胸腰椎手术 机器人导航 计算机辅助导航 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]