骨科机器人示踪器安装优化方案在胸腰椎骨折手术中的应用  

Application of optimization scheme of orthopedic robot tracerinstallation in thoracolumbar fracture surgery

作　　者：刘畅[1] 李伟[1] 曹云[1] 章仁杰[1] 张银顺[1] 钱军[1] 董福龙[1] 杨庆国[1] LIU Chang;LI Wei;CAO Yun;ZHANG Ren-jie;ZHANG Yin-shun;QIAN Jun;DONG Fu-long;YANG Qing-guo(The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院骨科脊柱外科病区,安徽合肥230022

出　　处：《颈腰痛杂志》2023年第4期517-520,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的与常规的棘突夹固定示踪器进行对比,回顾性观察在贴膜固定示踪器的条件下,使用“天玑”骨科机器人辅助植入胸腰段椎弓根螺钉的精确性和安全性。方法分析2019年8月~2022年12月采用“天玑”骨科机器人进行椎弓根螺钉内固定手术的胸腰椎骨折患者67例。调取记录的手术出血量、手术持续时间、术前和术后VAS评分数据,并通过分析术后复查的术区三维CT资料,使用Gertzbein-Robbins分级标准评估螺钉精确度,并按照使用贴膜固定示踪器(贴膜组)和棘突夹固定示踪器(棘突夹组)两种方案进行分组对比。结果贴膜组植入螺钉184枚,其中“精准”174枚,“优良”7枚,“不良”3枚;棘突夹组植入螺钉140枚,其中“精准”135枚,“优良”4枚,“不良”1枚,两组精确度无统计学差异(P>0.05)。手术出血量、手术时间和VAS评分指标方面,贴膜组均优于棘突夹组,但仅手术出血量差异较明显(P<0.05),其他指标的组间差异均无统计学意义(P>0.05)。结论贴膜固定示踪器可以提供与传统棘突夹固定示踪器一致的胸腰段椎弓根螺钉精确度,同时可以减少创伤和出血,具备潜在的缩短手术时间和减少术后疼痛的作用。Objective To retrospectively observe the accuracy of thoracolumbar pedicle screw implantation assisted by the“Tianji”orthopedic robot under two different tracer fixation methods for patients,and to analyze the accuracy and safety of the new method.Methods From August 2019 to December 2022,67 patients with thoracolumbar fractures who were treated with pedicle screw internal fixation by the“Tianji”orthopedic robot who met the inclusion criteria were analyzed.The recorded surgical blood loss,duration of surgery,and preoperative and postoperative VAS scores were obtained.The Gertzbein-Robbins grading criteria were used to evaluate screw accuracy by analyzing the three-dimensional CT data of the operative area reviewed after surgery.The screw accuracy was compared according to the film fixation tracer and spinal clamp fixation methods.Results A total of 184 screws were used in the film fixation scheme,among which 174 were“accurate”,7 were“excellent”and 3 were“poor”,and 140 were used in the spinous splint fixation scheme,among which 135 were“accurate”,4 were“excellent”and 1 was“poor”.There was no statistical difference in accuracy between the two groups(P>0.05).Surgical blood loss,operation time,and VAS score index were compared according to the operation scale.The membrane fixation scheme was superior to the spinal splint scheme,but the surgical blood loss was significantly different(P<0.05),there were no significant differences among other groups(P>0.05).Conclusion The film fixation tracer can provide thoracolumbar pedicle screw accuracy comparable to the traditional spinous clamp fixation tracer,while reducing trauma and bleeding,potentially reducing operative time and postoperative pain.

关 键 词：骨科手术机器人 椎弓根螺钉 示踪器 精确性 胸腰椎骨折 

分 类 号：R687.3[医药卫生—骨科学]