机器人辅助与徒手长节段置钉联合楔形截骨治疗Ⅳ型陈旧性症状性骨质疏松性椎体压缩骨折的疗效比较  

Efficacy comparison of robot‑assisted and free‑hand long segment screw fixation combined with wedge osteotomy in the treatment of type Ⅳ chronic symptomatic osteoporotic thoracolumbar fractures

作　　者：尹新华[1] 郝定均[1] 刘仲凯[1] 惠华[1] 闫亮[1] 杨小彬[1] 孔令擘 昌震[1] 贺宝荣[1] Yin Xinhua;Hao Dingjun;Liu Zhongkai;Hui Hua;Yan Liang;Yang Xiaobin;Kong Lingbo;Chang Zhen;He Baorong(Department of Spine Surgery,Honghui Hospital of Xi′an Jiaotong University,Xi′an 710054,China)

机构地区：[1]西安交通大学附属红会医院脊柱外科,西安710054

出　　处：《中华创伤杂志》2023年第7期619-626,共8页Chinese Journal of Trauma

摘　　要：目的比较机器人辅助与徒手长节段置钉联合楔形截骨治疗Ⅳ型陈旧性症状性骨质疏松性椎体压缩骨折(CSOVCFs)的疗效。方法采用回顾性队列研究分析2019年5月至2021年12月西安交通大学附属红会医院收治的68例Ⅳ型CSOVCFs患者临床资料,其中男22例,女46例;年龄61~82岁[(71.2±12.3)岁]。骨折节段:T_(11)~T_(12)37例,L_(1)~L_(2)31例。32例行机器人辅助长节段置钉联合楔形截骨治疗(机器人组),36例行徒手长节段置钉联合楔形截骨治疗(徒手组)。比较两组手术时间、术中出血量、术中辐射暴露剂量、术中导针调整次数、单枚椎弓根螺钉置入时间、椎弓根螺钉置入准确率。比较两组术前、术后3 d及末次随访时后凸Cobb角、矢状面轴向距离(SVA)、胸椎后凸角(TK)、腰椎前凸角(LL)、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)。比较两组上关节突关节损伤、术中导针置入偏差和脑脊液漏及近端交界性后凸(PJK)的发生率。结果患者均获随访12~26个月[(18.2±5.1)个月]。两组手术时间、单枚椎弓根螺钉置入时间比较,差异无统计学意义(P均>0.05)。机器人组术中出血量为(502.5±58.3)ml,明显少于徒手组的(690.2±45.9)ml;术中辐射暴露剂量为(32.6±10.8)μSv,明显低于徒手组的(48.6±15.2)μSv;术中导针调整次数为(2.1±0.3)次,明显少于徒手组的(20.7±5.8)次;椎弓根螺钉置入准确率为99.7%,明显高于徒手组的91.8%(P均<0.01)。与术前比较,两组内术后3 d及末次随访时后凸Cobb角、SVA、TK、LL明显恢复(P均<0.05);与术后3 d比较,两组内末次随访时后凸Cobb角、SVA、TK均增大,但差异无统计学意义(P均>0.05);与术后3 d比较,两组内末次随访时LL有所降低,但差异无统计学意义(P均>0.05)。两组间术后3 d及末次随访时后凸Cobb角、SVA、TK、LL比较,差异无统计学意义(P均>0.05)。与术前比较,两组内术后3 d及末次随访时VAS和ODI明显降低(P均<0.05);与�Objective To compare the clinical efficacies of robot-assisted and free-hand long segment screw fixation combined with wedge osteotomy in the treatment of type Ⅳ chronic symptomatic osteoporotic thoracolumbar fractures(CSOVCFs).Methods A retrospective cohort study was conducted to analyze the clinical data of 72 patients with type Ⅳ CSOVCFs who were admitted to Honghui Hospital of Xi′an Jiaotong University from May 2019 to December 2021,including 22 males and 46 females;aged 61-82 years[(71.2±12.3)years].Fracture segments were located at T_(11)-T_(12) in 37 patients and at L_(1)-L_(2) in 31.A total of 32 patients were treated with robot-assisted long segment screw fixation combined with wedge osteotomy(robot group)and 36 with free-hand long segment screw fixation combined with wedge osteotomy(free-hand group).The operation time,intraoperative bleeding volume,dosage of radiation exposure,intraoperative needle adjustment,time of single pedicle screw placement and accuracy of pedicle screw placement were compared between the two groups.The kyphotic Cobb angle,sagittal vertical axis(SVA),thoracic kyphosis(TK),lumbar kyphosis(LL),visual analogue scale(VAS)and Oswestry disability index(ODI)were measured preoperatively,at 3 days postoperatively and at the last follow-up.The incidences of facet joint violation,deviation in guide needle placement,cerebrospinal leak and proximal junctional kyphosis(PJK)were observed.Results All patients were followed up for 12-26 months[(18.2±5.1)months].The operation time and time of single pedicle screw placement showed no significant differences between the two groups(all P>0.05).The intraoperative bleeding volume was(502.5±58.3)ml in the robot group,less than that in the free-hand group[(690.2±45.9)ml].The dosage of radiation exposure was(32.6±10.8)μSv in the robot group,lower than that in the free-hand group[(48.6±15.2)μSv].The intraoperative needle adjustment was(2.1±0.3)times in the robot group,higher than that in the free-hand group[(20.7±5.8)times],and the accuracy

关 键 词：脊柱后凸 骨质疏松性骨折 机器人手术 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]