机器人辅助经皮椎体成形术治疗上段胸椎骨质疏松性骨折  

Robot-assisted PVP for the treatment of osteoporotic fractures of the upper thoracic vertebra

作　　者：赖居易 谭黄圣 冯华龙 蓝志明[2] 孙志涛[2] 王业广[2] 王建[2] 付远飞 何升华[2] LAI Ju-yi;TAN Huang-sheng;FENG Hua-long;LAN Zhi-ming;SUN Zhi-tao;WANG Ye-guang;WANG Jian;FU Yuan-fei;HE Shen-ghua(The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine,Shenzhen518000,Guangdong,China;Shenzhen Traditonal Chinese Medicine Hospital,Shenzhen 518000,Guangdong,China)

机构地区：[1]广州中医药大学第四临床医学院,广东深圳518000 [2]深圳市中医院,广东深圳518000

出　　处：《中国骨伤》2023年第9期859-865,共7页China Journal of Orthopaedics and Traumatology

基　　金：国家自然科学基金面上项目(编号:82174397)。

摘　　要：目的:探讨骨科机器人辅助经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗上段胸椎骨质疏松性骨折的临床疗效。方法:对深圳市中医院2016年8月至2022年6月住院部行PVP手术治疗的上段胸椎骨质疏松性骨折患者32例进行回顾性分析,男8例,女24例,年龄58~90(67.75±12.27)岁。15例采用机器人辅助PVP手术治疗(机器人组),其中T_(1)骨折0例,T_(2)骨折1例,T_(3)骨折1例,T_(4)骨折3例,T_(5)骨折3例,T_(6)骨折7例;随访时间1.0~3.0(1.6±0.7)个月。17例行常规PVP手术治疗(常规组),其中T_(1)骨折1例,T_(2)骨折0例,T_(3)骨折0例,T_(4)骨折5例,T_(5)骨折2例,T_(6)骨折9例;随访时间0.5~4.0(1.5±0.6)个月。比较两组患者的穿刺次数、透视次数、手术时间、术中出血量、骨水泥分布、骨水泥渗漏、术中辐射剂量,观察两组患者术前及术后3 d的视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)。结果:机器人组穿刺次数、透视次数、手术时间、术中出血量、骨水泥分布、骨水泥渗漏、术中辐射剂量均优于常规组(P<0.05),机器人组术后3 d的VAS和ODI分别为(2.03±0.05)分和(22.16±4.03)%,优于术前的(8.67±0.25)分和(79.40±7.72)%(t=100.869,P<0.001;t=25.456,P<0.001)。常规组术后3 d的VAS和ODI分别为(2.17±0.13)分和(23.88±6.15)%,优于术前的(8.73±0.18)分和(80.01±7.59)%(t=121.816,P<0.001;t=23.691,P<0.001)。术后VAS和ODI组间比较差异无统计学意义(t=-3.917,P=0.476;t=-0.922,P=0.364)。结论:机器人辅助PVP治疗上段胸椎骨质疏松性骨折可进一步提升手术安全性,降低骨水泥渗漏,获得满意的临床疗效。Objective To investigate the clinical effect of"Tianji"orthopedic robot-assisted percutaneous vertebro plasty(PVP)surgery in the treatment of upper thoracic osteoporotic fracture.Methods A retrospective analysis was performed on 32 patients with upper thoracic osteoporotic fracture who underwent PVP surgery in Shenzhen Hospital of Traditional Chinese Medicine from August 2016 to June 2022.There were 8 males and 24 females,ranging in age from 58 to 90 years old,with a mean of(67.75±12.27)years old.Fifteen patients were treated with robot-assisted PVP surgery(robot group),including 3 males and 12 females,with an average age of(68.5±10.3)years.Fracture location:1 case of T_(2) fracture,1 case of T_(3) fracture,3 cases of T_(4) fracture,3 cases of T_(5) fracture,and 7 cases of T_(6) fracture.The follow-up period ranged from 1.0 to 3.0 months,with a mean of(1.6±0.7)months.Seventeen patients underwent routine PVP surgery(conventional group),including 5 males and 12 females,with an average age of(66.8±11.6)years old.Fracture location:1 case of T_(1) fracture,5 cases of T_(4) fracture,2 cases of T_(5) fracture and 9 cases of T_(6) fracture.The follow-up period ranged from 0.5 to 4.0 months,with a mean of(1.5±0.6)months.Preoperative and postoperative visual analogue scale(VAS)and Oswestry disability index(ODI)scores were compared between the two groups,and the number of punctures,perspective times,operation time,intraoperative blood loss,bone cement distribution,bone cement leakage,and intraoperative radiation dose were compared between the two groups.Results Number of punctures times,perspective times,operation time,intraoperative blood loss,bone cement distribution,bone cement leakage and intraoperative radiation dose in the robot group were all significantly better than those in the conventional group(P<0.05)VAS of 2.03±0.05 and ODI of(22.16±4.03)%in the robot group were significantly better than those of the robot group before surgery,which were(8.67±0.25)score and(79.40±7.72)%(t=100.869,P<0.001;t=25.456,P<0.

关 键 词：胸椎 椎体 机器人 椎体成形术 骨水泥 并发症 

分 类 号：R687[医药卫生—骨科学]